Safety Committee Inspection

• Area inspected

• Conducted by

  Date

• Prepared by

• Date:

  Date

Building & Structures

• Windows

  Good

  Fair

  Poor

  N/A

• Doors

  Good

  Fair

  Poor

  N/A

• Floors/ Aisle markings

  Safe

  At Risk

  N/A

• Metal Containers for oily debris

  Pass

  Fail

  N/A

• Absorbent available for spills

  Pass

  Fail

  N/A

• Exits marked clearly

  Yes

  No

  N/A

• Bathroom areas clean

  Yes

  No

  N/A

• Kitchen appliances clean

  Yes

  No

  N/A

• Table and chairs in good condition

  Yes

  No

  N/A

• Fire extinguisher near heat sources

  Yes

  No

  N/A

• Grounds

  Good

  Fair

  Poor

  N/A

• Other

  Good

  Fair

  Poor

  N/A

Security

• Perimeter Door secure at all times

  Yes

  No

  N/A

• Locks and "crash bar" working properly

  Good

  Fair

  Poor

  N/A

• Procedure for suspicious mail know

  Yes

  No

  N/A

• Procedures for workplace violence known

  Yes

  No

  N/A

• Parking lot lighting

  Good

  Fair

  Poor

  N/A

Emergency

• Emergency Lighting/Exit signs

  Good

  Fair

  Poor

  N/A

• No obstructions in path to exits

  Safe

  At Risk

  N/A

• "Crash Bar" operates properly

  Good

  Fair

  Poor

  N/A

• Fire alarm stations marked

  Good

  Fair

  Poor

  N/A

• Signs showing fire extinguishers

  Yes

  No

  N/A

• Fire extinguishers fully charged

  Compliant

  Non-Compliant

  N/A

• Fire extinguishers current inspection

  Yes

  No

  N/A

• First aid kits readily accessible and stocked

  Pass

  Fail

  N/A

• Emergency eyewash stations operational

  Pass

  Fail

  N/A

PPE

• Eye protection worn

  Compliant

  Non-Compliant

  N/A

• All grinders have face shields available

  Compliant

  Non-Compliant

  N/A

• Hearing protection

  Safe

  At Risk

  N/A

• Hard toe shoes

  Compliant

  Non-Compliant

  N/A

• Other

  Safe

  At Risk

  N/A

Slip, Trip and Fall

• Cords, Ripped/Bunched carpet, uneven

  Safe

  At Risk

  N/A

• Obstacles, drawers open, etc.

  Safe

  At Risk

  N/A

• Oil, grease, water, coffee, cleaning

  Good

  Fair

  Poor

  N/A

• Walkways and hallways adequately lit

  Good

  Fair

  Poor

  N/A

• Walkway and hallways intersections view

  Good

  Fair

  Poor

  N/A

Machinery

• All guards in place and fully operational

  Compliant

  Non-Compliant

  N/A

• Safety placards in place and legible

  Compliant

  Non-Compliant

  N/A

• Lock-Out/Tag-Out kits

  Pass

  Fail

  N/A

• Wiring insulation intact – no cuts or breaks

  Good

  Fair

  Poor

  N/A

• Operator’s area free from debris and scrap

  Good

  Fair

  Poor

  N/A

• Hearing protection provided if needed

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Work Environment

• Warning signs

  Yes

  No

  N/A

• Proper lighting in area for workers

  Good

  Fair

  Poor

  N/A

• Flickering lights

  Yes

  No

  N/A

• Adequate ventilation (general) for area

  Yes

  No

  N/A

• Ventilation ducts unobstructed

  Safe

  At Risk

  N/A

• Fumes in area (Copier, cleaning, etc.)

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Lifting

• Safe lifting procedures known to workers

  Safe

  At Risk

  N/A

• Avoid heavy loads (split loads, team lift, etc.)

  Safe

  At Risk

  N/A

• Proper lifting procedures

  Safe

  At Risk

  N/A

• Use of carts, hand trucks, pallet jacks

  Compliant

  Non-Compliant

  N/A

• Other

  Safe

  At Risk

  N/A

Employee Conduct:

• Housekeeping (machine areas)

  Good

  Fair

  Poor

  N/A

• Unsafe Acts

  Safe

  At Risk

  N/A

• Are repetitive motion tasks minimum

  Safe

  At Risk

  N/A

• Step ladders not used as straight ladders

  Compliant

  Non-Compliant

  N/A

• Climbing ladders “3 point contact”

  Compliant

  Non-Compliant

  N/A

• Other

  Compliant

  Non-Compliant

  N/A

HazMat

• Proper labels on containers (visual standard)

  Compliant

  Non-Compliant

  N/A

• Proper storage (as per visual standard)

  Compliant

  Non-Compliant

  N/A

• Procedures for proper use and disposal

  Yes

  No

  N/A

• SDS available and known to workers

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

Storage

• Materials secured: bins/shelves/chains

  Yes

  No

  N/A

• Heavy items between thigh & shoulder

  Yes

  No

  N/A

• Safe access for high shelves

  Yes

  No

  N/A

• Shelving overloaded

  Safe

  At Risk

  N/A

• Shelving secured to avoid tip over

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Electrical

• Yes

  No

  N/A

• Cords, plugs and surge protectors condition

  Good

  Fair

  Poor

  N/A

• Outlets not overloaded

  Safe

  At Risk

  N/A

• Battery chargers clear and well ventilated

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

Completion

• Committee Member

  Sign

• HSE Manager

  Sign