Safety Gemba walk

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Pre audit check

• Is the area being audited safe to enter?

  Safe

  At Risk

  N/A

• Do you have the required personal protective equipment for the area?

  Yes

  No

  N/A

• Are the aisle ways clear of obstructions?

  Yes

  No

  N/A

• Are exit signs posted clearly to identify exits?

  Yes

  No

  N/A

• Are all walking or working surfaces free of tipping/slipping hazards?

  Yes

  No

  N/A

• Are emergency phone numbers and procedures posted at or near telephones?

  Yes

  No

  N/A

Equipment being used

• Are pinch points and exposed moving parts properly marked and guarded?<br><br><br><br>

  Yes

  No

  N/A

• Are the safe guards firmly secured and not easily removable?

  Yes

  No

  N/A

• Are the safe guards working properly?

  Yes

  No

  N/A

• Are working areas, walk ways and similar locations free of cords creating a possible hazard to the employees?

  Yes

  No

  N/A

• Is the equipment in 100% working order?

  Yes

  No

  N/A

• Have none working pieces of equipment been marked as unusable or unsafe to use?

  Yes

  No

  N/A

Chemicals in the work area

• Is each chemical in the work area clearly labeled of its contents?

  Yes

  No

  N/A

• Does each chemical in the work area have the appropriate hazard warning label on it?

  Yes

  No

  N/A

Personal protection Equipment

• Is the required personal protective equipment worn for the area?

  Yes

  No

  N/A

• Is hearing protection in use in selected areas?

  Yes

  No

  N/A

• Is eye and face protective equipment used when machines or operations present potential eye or face injury?

  Yes

  No

  N/A

• Is personal protective equipment readily available for all personal including visitors to the area?

  Yes

  No

  N/A

• Is the requirement of use of protective equipment enforced?

  Yes

  No

  N/A

Emergency Equipment

• Are emergency eye washes provided in the required chemical areas?

  Yes

  No

  N/A

• Are first aid supplies easily accessible?

  Yes

  No

  N/A

• Are spill kits accessible and fully stocked?

  Yes

  No

  N/A

• Is clearance of at least 18 inches maintained around fire sprinkler heads?

  Yes

  No

  N/A

• Are there fire extinguishers near potential hazardous areas?

  Yes

  No

  N/A

• Is there a fire action notice indicating assembly point present?

  Yes

  No

  N/A

Electrical

• Are all plugs properly grounded in work area?

  Yes

  No

  N/A

• Add signature

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