Safety in Motion - General Inspection

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Behavior Observations

• Proper lifting and use of body mechanics?

  Safe

  At Risk

  N/A

• Ladder Usage

  Safe

  At Risk

  N/A

• Moving at safe speed?

  Safe

  At Risk

  N/A

• PPE Usage?

  Yes

  No

  N/A

• Body Placement

  Safe

  At Risk

  N/A

• Eyes on task

  Yes

  No

  N/A

Building Safety

• Floor surfaces even and uncluttered?

  Yes

  No

  N/A

• Entry and walkways kept clear?

  Yes

  No

  N/A

• Walkways adequately and clearly marked?

  Yes

  No

  N/A

• Intersections kept clear of boxes etc?

  Yes

  No

  N/A

• Stair and risers kept clear?

  Yes

  No

  N/A

• Are liquid spills removed quickly?

  Yes

  No

  N/A

• Are railings in good condition?

  Yes

  No

  N/A

• Are fall preventive measures in place and used where gaps occur in railings?

  Yes

  No

  N/A

• Furniture in sound condition?

  Yes

  No

  N/A

• Loading area clean and tidy?

  Yes

  No

  N/A

Chemical Safety

• Safety Data Sheets available for all chemicals?

  Yes

  No

  N/A

• All containers labelled correctly?

  Yes

  No

  N/A

• Workers trained in the use of hazardous substances?

  Yes

  No

  N/A

• If required is PPE available?

  Yes

  No

  N/A

• Is adequate ventilation provided?

  Yes

  No

  N/A

• Are eye washes and showers easily accessed?

  Yes

  No

  N/A

• Chemicals stored properly (flammables stored in cabinets)?

  Yes

  No

  N/A

Electrical Safety

• Safety switches installed?

  Yes

  No

  N/A

• Safety switches tested every 6 months and tests recorded?

  Yes

  No

  N/A

• Broken plugs, sockets and switches in good condition?

  Yes

  No

  N/A

• Walkways clear of cords and hoses?

  Yes

  No

  N/A

Employee Training

• Is safety training conducted with employees at least monthly?

  Yes

  No

  N/A

• List training topics covered recently:

  Yes

  No

  N/A

First Aid Facilities

• Cabinets clearly labelled?

  Yes

  No

  N/A

• Is there easy access to cabinets?

  Yes

  No

  N/A

• Employees aware of location of first aid cabinet?

  Yes

  No

  N/A

• Are emergency numbers displayed?

  Yes

  No

  N/A

Fire Prevention

• Evacuation plan displayed and understood by all employees?

  Yes

  No

  N/A

• Evacuation procedures discussed regularly? (>2 times a year)

  Yes

  No

  N/A

• Extinguishers in place and clearly marked?

  Yes

  No

  N/A

• Extinguishers recently serviced? (Check 12 monthly punch mark on tabs.)

  Yes

  No

  N/A

• Are drills conducted annually?

  Yes

  No

  N/A

• Exit doors easily opened from inside?

  Yes

  No

  N/A

• Exits clear of obstructions?

  Yes

  No

  N/A

• Fire alarm system functioning correctly?

  Yes

  No

  N/A

• Sprinkler system inspected and riser accessible?

  Yes

  No

  N/A

General Lighting

• Good natural lighting?

  Yes

  No

  N/A

• Reflected light from walls & ceilings not causing glare to employees?

  Yes

  No

  N/A

• Light fittings clean and in good condition?

  Yes

  No

  N/A

• Emergency exit lighting operable?

  Yes

  No

  N/A

Ladders

• Are all ladders Industrial strength? (Non Household rated, check label.)

  Yes

  No

  N/A

• Are ladders in good condition?

  Yes

  No

  N/A

• If used for electrical work are they non conductive? (Wood or fibre glass.)

  Yes

  No

  N/A

• Used according to instructions?

  Yes

  No

  N/A

• For extension ladders are ropes, pulleys and treads in a good state of repair?

  Yes

  No

  N/A

Machines

• Are they kept clean?

  Yes

  No

  N/A

• Are the floors around the machines kept clean?

  Yes

  No

  N/A

• Guards operational and in good condition?

  Safe

  At Risk

  N/A

• Starting and stopping devices within easy reach of operator?

  Yes

  No

  N/A

• Adequate work space?

  Yes

  No

  N/A

• Is lighting adequate?

  Yes

  No

  N/A

• Noise levels controlled?

  Yes

  No

  N/A

• No bending or stooping required?

  Yes

  No

  N/A

• Operators trained/inducted into the operation of the machines?

  Yes

  No

  N/A

• Is the training recorded?

  Yes

  No

  N/A

• Do operators comply with the training?

  Yes

  No

  N/A

• Are lockout procedures implemented and followed?

  Yes

  No

  N/A

• Are gas bottles secured?

  Yes

  No

  N/A

Manager Training

• Manager training takes place at least quarterly?

  Yes

  No

  N/A

• Training includes something like motivation, incident prevention, listening skills, disciple and more.

  Yes

  No

  N/A

Office Hazards

• Condition of chairs? (Five star bases.)

  Yes

  No

  N/A

• Chair/stool height adjusted properly?

  Yes

  No

  N/A

• Desks in good condition? (No damage.)

  Yes

  No

  N/A

• Screen Based Equipment adjusted to slightly lower than eye level and position to reduce glare from windows etc?

  Yes

  No

  N/A

• Tasks designed to prevent Occupational Overuse Syndrome? (Breaks included.)

  Yes

  No

  N/A

• Stable non-slip floor coverings in good condition?

  Yes

  No

  N/A

Rubbish Removal

• Bins located at suitable points around site?

  Yes

  No

  N/A

• Bins emptied regularly?

  Yes

  No

  N/A

• Oily rags and combustible refuse in covered metal containers?

  Yes

  No

  N/A

Storage Design and Use

• Materials stored in racks and bins wherever possible?

  Yes

  No

  N/A

• Storage designed to minimise lifting problems?

  Yes

  No

  N/A

• Floors around racking clear of rubbish?

  Yes

  No

  N/A

• General condition of racks and pallets?

  Yes

  No

  N/A

Work Benches

• Clear of rubbish?

  Yes

  No

  N/A

• Tools not in use kept in safe place?

  Yes

  No

  N/A

• Damaged hand tools removed from service?

  Yes

  No

  N/A

• Damaged power tools removed from use?

  Yes

  No

  N/A

• Work height correct for the type of work and the employee?

  Yes

  No

  N/A

• Sharp edges protected?

  Yes

  No

  N/A

• Electrical cords and air hoses coiled when not in use?

  Yes

  No

  N/A

Written Programs (In place and Functional)

• Respirator

  Yes

  No

  N/A

• HAZCOM/GHS

  Yes

  No

  N/A

• Lockout/Tagout

  Yes

  No

  N/A

• Machine Guarding

  Yes

  No

  N/A

• Forklift

  Yes

  No

  N/A

• Ergonomics

  Yes

  No

  N/A

• Emergency Procedures

  Yes

  No

  N/A

• Injury and Illness Prevention Program

  Yes

  No

  N/A

• Heat Illness Prevention Plan

  Yes

  No

  N/A

Sign Off

• On site representatives

  Sign

• Chuck Vancura President Safety in Motion, LLC

  Sign

• 36" of clearance maintained in front of electrical panels and disconnects?

  Yes

  No

  N/A