Safety Contact

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Why do you choose to work safely?

• Are all the required PPE being worn correctly?

  Compliant

  Non-Compliant

  N/A

• Who do you report work related incidents to?

• Are you aware of GPI Wayne's evacuation procedures? (review muster points)

• Have you inspected all the equipment you will be using in your tasks?

  Yes

  No

  N/A

• Have you received adequate training to complete your task?

  Yes

  No

  N/A

Housekeeping

• Does the area comply with GPI housekeeping standards?

  Good

  Fair

  Poor

  N/A

• Are there any trip hazards present?

  Yes

  No

  N/A

• Are tools and equipment in the designated safe place?

  Yes

  No

  N/A

• Are pallets stacked safely?

  Yes

  No

  N/A

Electrical Safety

• Are electrical panels closed, and have proper clearance of 36''?

  Yes

  No

  N/A

• Are electrical cords, plugs, and outlets in good condition?

  Yes

  No

  N/A

• Are extension cords being utilized as permanent wiring?

  Select Compliant Non-Compliant N/A

  • Compliant
  • Non-Compliant
  • N/A

Lockout Tagout

• Are LOTO and APM procedures posted on equipment?

  Yes

  No

  N/A

• Who is the Authorized person to LOTO Equipment?

  Yes

  No

  N/A

• Quiz* Can anyone Lock out equipment? (No, must be an Authorized Employee)

  Pass

  Fail

  N/A

Fire Safety

• Are fire extinguisher's readily available and are in good condition?

  Yes

  No

  N/A

• Is the monthly inspection completed?

  Yes

  No

  N/A

• Fire exits and emergency exits are free from obstructions?

  Yes

  No

  N/A

• Are workers protected below from any fall hazards? (Tooling, toolboxes, materials, etc.)

  Yes

  No

  N/A

• Are ladders being used? (in safe condition= not modified or broken)

  Compliant

  Non-Compliant

  N/A

Machinery/Equipment

• Can you see any temporary repairs present, Are the employees aware of any temporary repairs? (Tape, makeshift repairs)

  Yes

  No

  N/A

• Do you see any machine guarding exposures? (Guards in good condition or missing)

  Yes

  No

  N/A

• Are all guards functional, and in the proper safe configuration with interlocks?

  Yes

  No

  N/A

• Are there sharp corners, edges, or objects that can cause a cut?

  Yes

  No

  N/A

• Are all steps and platforms secure?

  Yes

  No

  N/A

Powered Industrial Vehicles

• Yes

  No

  N/A

• Is the PIV checklist completed and accurate?

  Select Compliant Non-Compliant N/A

  • Compliant
  • Non-Compliant
  • N/A

• Are PIV's Parked in accordance with GPI requirements?

  Yes

  No

  N/A

• PIV operators observed interfacing with pedestrians in accordance with GPI Policy?

  Safe

  At Risk

  N/A

• Are all safety lights working correctly?

  Compliant

  Non-Compliant

  N/A

Hazard Communications (Chemical Safety)

• Are all containers, washbottles, pales/buckets, Labeled?

  Yes

  No

  N/A

• Are chemicals stored properly and in the correct storage cabinet/ Area?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is there containment set in place to catch any residual solutions?

  Yes

  No

  N/A

• Is the employee aware of how to address spills? (Review location of Spill Kits).

  Yes

  No

  N/A

Fall Protection

• Are employees working from heights greater than 4 ft?

  Yes

  No

  N/A

• Are fall protection measures in use? (Guarding, Harness, Laynard)

  Yes

  No

  N/A