Information

  • Location #

  • Conducted on

  • Prepared by

  • Manager

  • Personnel on duty

  • Address

General Safety

  • Parking lot has no exaggerated pot holes (potentially dangerous to customers)?

  • There is no visible damage to curbs?

  • No loose floor tiles can be detected?

  • No sharp edges are detected in the store?

  • In general the store is clean, free of trip/slip hazards, and is stocked with shelves fronted?

Housekeeping

  • All aisles are clear and storeroom is tidy (no trip hazards are present)?

  • Cleaner/chemical bottles are all clearly marked?

  • The women's and/or unisex restroom has a covered trashcan present?

  • Outside the dumpsters are free of debris and there is nothing laying on the ground in the dumpster area?

  • Appropriate cylinders are chained or not present at all (x-large cylinders do not need to be chained)?

  • Ladders are in good condition and have all safety stickers present?

  • There are no slip hazards present - or, if there are slip hazards present, signage is being used to warn customers as well as other employees?

  • Wet floor signage is in stock?

Electrical

  • Cords under the counter are clean (free of dust, no exposed wires, strapped and as neat as possible)?

  • No extension cords are being used as permanent wiring?

  • Electrical panels have no missing breakers, spaces, knock-outs and all panels open and close with ease?

  • All breaker boxes are clear by 36" and have yellow indicators painted clearly on floor the area that needs to be clear at all times?

  • All outlets within 5 feet of water inside (bathrooms & kitchens) are GFCI or have been covered with plate?

  • There are no broken outlets anywhere on the property (including reset buttons on GFCI outlets)?

  • There are no exposed electrical wiring (excluding low voltage cleared by Jeff Williams or Eli Pannell?

Emergency Supplies

  • The store has an Emergency Response book that is up to date and accessible to all employees?

  • Preform a random check of at least 1 SDS - choose one chemical located in the store - is that chemical's SDS on file in the Emergency Book?

  • The location's spill kit with oil absorbent is on site and fully stocked?

  • First aid kit is present, accessible to all employees, and is stocked per OSHA guidelines?

  • An eye wash adapter has been installed and is accessible to all employees at all times?

  • A BBP (Blood Borne Pathogens) Kit is on site and is accessible to all employees at all times?

  • All PPE (Personal Protective Equipment) is stocked and is accessible to all employees at all times (glasses, gloves, etc. where needed)?

  • All fire extinguishers have initials indicating a monthly inspection is being preformed since the last certified annual inspection was completed?

  • All fire extinguishers are mounted to the wall, have appropriate signage that is visible to employees and customers, and is accessible to all employees and customers?

  • All marked emergency exits are clear with no obstructions?

  • All storage rooms, hallways, etc. have glow in the dark emergency exit and not an exit signs placed where needed?

  • All areas that should not be accessed by customers have been marked with an Employees Only sign?

  • Height indicators are readable and in good condition?

  • All panic buttons/necklaces have been checked with SSD and are functional.

  • Security system is working properly and all cash control areas have a camera present?

Signature

  • I hereby certify that the above form is true and accurate to the best of my knowledge.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.