Housekeeping

  • Check the box if the following are present in working area:

  • Spills

  • Add media

  • Corrective Action

  • Cords or other trip hazards

  • Add media

  • Corrective Action

  • Trash/clutter

  • Add media

  • Corrective Action

  • Poor lighting

  • Add media

  • Corrective Action

  • Improper storage of flammables

  • Add media

  • Corrective Action

  • Aisles/walkways kept clear?

  • Add media

  • Corrective Action

  • Work area kept organized?

  • Add media

  • Corrective Action

Personal Protective Equipment

  • Check the box for missing required PPE

  • Head

  • Add media

  • Corrective Action

  • Eyes/Face

  • Add media

  • Corrective Action

  • Hands

  • Add media

  • Corrective Action

  • Respiratory

  • Add media

  • Corrective Action

  • Feet

  • Add media

  • Corrective Action

  • Body

  • Corrective Action

  • Fall Protection (If operations are over 4 ft. high)

  • Add media

  • Corrective Action

  • Fire Resistant clothing/gear

  • Add media

  • Corrective Action

  • All appropriate equipment or gear worn correctly?

  • Add media

  • Corrective Action

  • PPE kept in good condition? (clean no chips, dirt or ripped up)

  • Add media

  • Corrective Action

Working Position

  • Check the box if the following are observed:

  • Poor posture

  • Add media

  • Corrective Action

  • Over stretched

  • Add media

  • Corrective Action

  • Above shoulder

  • Add media

  • Corrective Action

  • Below Knees

  • Add media

  • Corrective Action

  • Twisting

  • Add media

  • Corrective Action

  • Caught in between

  • Add media

  • Corrective Action

  • Struck by

  • Add media

  • Corrective Action

  • Working at heights greater than 4'

  • Add media

  • Corrective Action

  • Floor or wall openinig

  • Add media

  • Corrective Action

  • Unprotected work

  • Add media

  • Corrective Action

  • Body position?

  • Add media

  • Corrective Action

  • Location in working environment?

  • Add media

  • Corrective Action

Tools, Equipment, and Machinery

  • Check the box if the following is identified to be IN POOR CONDITION OR UNSAFE:

  • Ladders

  • Add media

  • Corrective Action

  • Power or hand tools

  • Add media

  • Corrective Action

  • Machines

  • Add media

  • Corrective Action

  • Equipment

  • Add media

  • Corrective Action

  • Appropriate tools, or machinery and equipment being used?

  • Add media

  • Corrective Action

Safe Procedures and Safe Behaviors

  • Fork lift and crane safe procedures are followed

  • Add media

  • Corrective Action

  • Lockout/Tagout, arc flash, hot work permit, confined space, and/ or departmental specific safety procedures are followed

  • Add media

  • Corrective Action

  • Safe behaviors are observed

  • Encouragement Steps

  • Corrective Action

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.