Title Page

  • Document No.

  • Audit Title

  • Site

  • Conducted on

  • Prepared by

  • Personnel Present

Program Manuals

  • Is There a Minteq SMS Health & Safety Program - US Operations Manual on Hand?

Clarity Net Completion

  • Clarity Net Completion- 25 % Percent Completed Per Quarter <br>

STOP Card Implementation

  • Are STOP cards being used?

  • Are STOP completion being tracked monthly

Safe Job Procedures

  • Is the Review Date Less than 1 Year?

  • Are Employees Reviewing SJP's? One SJP reviewed each week by every employee and are SJP's reviewed by employees documented by Initials or signature?

  • Is There a Current Index Available?

  • Are All Tasks Covered by SJP?

Near Miss Reporting

  • 4 Near misses per employee per shop completed? Are the shops posting near misses reports and the safety board?

R3's Completed

  • Are shops completing one R3 per quarter?

Monthly Safety Meeting

  • Are monthly safety meetings documented and signed off by all attending?

Medical Monitoring

  • Are all employees Annual Exams up to date? If not how many are out of date.

Monthly Site Inspection/Gemba (at least 3/quarter)

  • Are Monthly Site Safety Inspection or Gemba Walk by Shop Supervisor or SM completed and documented?

OSHA 300 Log Work-Relate Injury/Illness Reporting

  • OSHA 300 Log form posted 2/1 to 4/30 each year and 5 Years of History

Quarterly Tests on Relief Valves

  • Are test completed quarterly on all tanks and are the results documented?

Standard Work

  • Are weekly review of Standard Work and results documented

  • Is Standard Work Posted at Work Site

Communication Board

  • 5S Audits (Weekly, Monthly, Quarterly) Posted or available.

  • Are Safety Alerts Posted and reviewed by all employees?

Suggestion Board

  • 2 Suggestions per employee per month being collected?

  • Are suggestions entered into KMI or reconciled on the master file?

Safety Items

  • Are your hazardous chemicals labeled, is their a list of hazardous chemicals for your work area, and are the MSDS's available? <br>

  • Do extension cords have grounding conductor, are all cords and cable connections intact, are all extension cords or cables free of splices, and are GFCI's available for use? <br> <br> <br> <br>

  • Are exits properly marked, are they free of obstructions, and are directions to exits posted when not apparent <br> <br> <br>

  • Are first aid kits and eye wash stations available, inspected, and replenished

  • Are emergency phone numbers posted and easy to find in case of an emergency

  • Are approved containers and/or tanks used for storage and handling flammable or combustible liquids, are the containers properly labeled or tagged for contents, and are the storage cabinets labeled "Flammable Keep Fire Away" <br> <br>

  • Are fork-lifts and Minteq equipment being inspected prior to each shift? Are forklifts or Minteq equipment removed from service when not in safe operating condition? Are forklifts inspected daily or before each shift? Do forklifts have flashing lights, horn, overhead guard and nameplate?

  • Are operators licensed? Every three years? Are operator licenses on hand? Performance Evaluation and Training Certificate available? Per SAF-EHS-15 <br>

  • If your operations generate hazardous waste or oil or grease, do you handle it in an approved manner? <br>

  • Are workers protected from sources of excessive noise? Are approved hearing protective equipment available? <br>

  • Are work areas clean and free of debris? Are all work areas adequately illuminated? <br>

  • Is the compressed air for cleaning regulated to less than 30 psi? <br>

  • Are machinery guards secure and so arranged that they do not offer a hazard in their use? Are power tools used with the correct shield, guard, or attachment recommend by the manufacturer?

  • Are all employees required to use personal protection equipment (PPE) as needed? Is PPE functional and in good repair? Are all employees required to use personal protective equipment (PPE) when handling chemicals (gloves, eye protection, respirators, etc.)?

  • Are appropriate fire extinguishers mounted located and identified so that they are readily accessible (not obstructed) to employees? Are all fire extinguishers inspected monthly and serviced annually, and noted on the inspection tag?

  • Are pits and floor openings covered or otherwise guarded?

  • Are rotating or moving parts of equipment guarded to prevent physical contact? Are all moving chains and gears properly guarded? Are machinery guards secure and so arranged that they do not offer a hazard in their use?

  • Is all machinery or equipment capable of movement, required to be de-energized or disengaged and locked out during cleaning, servicing, adjusting or setting up operations, whenever required? Are correct lockout/tagout procedures in use?

Comments or findings

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.