Information
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Location #
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Conducted on
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Prepared by
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Manager
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Personnel on duty
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Address
General Safety
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Parking lot has no exaggerated pot holes (potentially dangerous to customers)?
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There is no visible damage to curbs?
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No loose floor tiles can be detected?
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No sharp edges are detected in the store?
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In general the store is clean, free of trip/slip hazards, and is stocked with shelves fronted?
Housekeeping
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All aisles are clear and storeroom is tidy (no trip hazards are present)?
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Cleaner/chemical bottles are all clearly marked?
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The women's and/or unisex restroom has a covered trashcan present?
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Outside the dumpsters are free of debris and there is nothing laying on the ground in the dumpster area?
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Appropriate cylinders are chained or not present at all (x-large cylinders do not need to be chained)?
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Ladders are in good condition and have all safety stickers present?
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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?
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Wet floor signage is in stock?
Electrical
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Cords under the counter are clean (free of dust, no exposed wires, strapped and as neat as possible)?
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No extension cords are being used as permanent wiring?
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Electrical panels have no missing breakers, spaces, knock-outs and all panels open and close with ease?
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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?
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All outlets within 5 feet of water inside (bathrooms & kitchens) are GFCI or have been covered with plate?
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There are no broken outlets anywhere on the property (including reset buttons on GFCI outlets)?
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There are no exposed electrical wiring (excluding low voltage cleared by Jeff Williams or Eli Pannell?
Emergency Supplies
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The store has an Emergency Response book that is up to date and accessible to all employees?
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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?
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The location's spill kit with oil absorbent is on site and fully stocked?
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First aid kit is present, accessible to all employees, and is stocked per OSHA guidelines?
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An eye wash adapter has been installed and is accessible to all employees at all times?
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A BBP (Blood Borne Pathogens) Kit is on site and is accessible to all employees at all times?
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All PPE (Personal Protective Equipment) is stocked and is accessible to all employees at all times (glasses, gloves, etc. where needed)?
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All fire extinguishers have initials indicating a monthly inspection is being preformed since the last certified annual inspection was completed?
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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?
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All marked emergency exits are clear with no obstructions?
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All storage rooms, hallways, etc. have glow in the dark emergency exit and not an exit signs placed where needed?
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All areas that should not be accessed by customers have been marked with an Employees Only sign?
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Height indicators are readable and in good condition?
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All panic buttons/necklaces have been checked with SSD and are functional.
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Security system is working properly and all cash control areas have a camera present?
Signature
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I hereby certify that the above form is true and accurate to the best of my knowledge.