Safety Inspection Form

• Department

• Date

  Date

• Prepared by

• Location
  Address

MACHINERY/EQUIPMENT

• Forklifts are operated only by trained & certified operators

  Yes

  No

  N/A

• All forklifts are operated in compliance with safety rules

  Yes

  No

  N/A

• Forklifts never drive with the load raised

  Yes

  No

  N/A

• Forklifts loads are never raised in the vicinity of people

  Yes

  No

  N/A

• There are no unguarded blades, chains, or pinch points

  Yes

  No

  N/A

• Grinders have properly adjusted tool (1/8") and toe (1/4") guards

  Yes

  No

  N/A

• All machine guards are in place and operating

  Yes

  No

  N/A

• All guards are checked by operators daily

  Yes

  No

  N/A

• The supervisor checks all guards at least weekly

  Yes

  No

  N/A

• All employees wear hearing protection where required

  Yes

  No

  N/A

• All employees are trained before operating machine

  Yes

  No

  N/A

• Jewelry and loose clothing is prohibited & long hair is contained

  Yes

  No

  N/A

• Employees practice Lockout/Tagout safety 100% of the time

  Yes

  No

  N/A

ELECTRICAL EQUIPMENT

• Each machine has an electrical disconnect

  Yes

  No

  N/A

• All electrical panels and shutoffs are accessible

  Yes

  No

  N/A

• All plugs have a ground connection (except double insulated)

  Yes

  No

  N/A

• All machines are properly grounded

  Yes

  No

  N/A

• Extension cords are for temporary use only

  Yes

  No

  N/A

• All cords are in good condition (no frayed or exposed wires)

  Yes

  No

  N/A

GENERAL SAFETY

• All employees support the safety program

  Yes

  No

  N/A

• All employees have received job specific safety training

  Yes

  No

  N/A

• Training is provided for new processes, procedures & equipment

  Yes

  No

  N/A

• The supervisor maintains documentation of safety training

  Yes

  No

  N/A

• The supervisor or lead attended both Supervisor SC meetings

  Yes

  No

  N/A

• A department employee attended both Employee SC meetings

  Yes

  No

  N/A

• Safety topics were discussed at both Safety Shutdowns

  Yes

  No

  N/A

• Identified hazards have been corrected or a work order generated

  Yes

  No

  N/A

• Lighting is adequate and working

  Yes

  No

  N/A

• All walking surfaces are in good condition

  Yes

  No

  N/A

INJURIES AND INCIDENTS

• All injuries, illnesses, and incidents have been reported

  Yes

  No

  N/A

• Employees with injuries pain, or discomfort see the nurse

  Yes

  No

  N/A

• Employees are encouraged to report work related discomfort

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• PPE is issued to all who need it

  Yes

  No

  N/A

• PPE is stored correctly

  Yes

  No

  N/A

• PPE is maintained in good condition

  Yes

  No

  N/A

• PPE is appropriate for the hazard

  Yes

  No

  N/A

• Employees are trained to use all required PPE

  Yes

  No

  N/A

• The supervisor ensures that PPE is worn when needed

  Yes

  No

  N/A

• The supervisor has inspected all PPE each week

  Yes

  No

  N/A

• Employees who wear dust masks have received dust mask tng.

  Yes

  No

  N/A

CHEMICALS AND CHEMICAL HANDLING

• There is an MSDS in the binder for each chemical in your dept.

  Yes

  No

  N/A

• Chemicals are stored & handled safely

  Yes

  No

  N/A

• Chemicals are labeled as to contents

  Yes

  No

  N/A

• Employees are trained on the chemicals they use

  Yes

  No

  N/A

• Employees practice good personal hygiene

  Yes

  No

  N/A

• Small spills and leaks are promptly cleaned up

  Yes

  No

  N/A

• Maintenance is called for all medium to large spills

  Yes

  No

  N/A

• Safety showers and eyewash stations are flowed monthly

  Yes

  No

  N/A

• There is free access to safety showers and eyewash stations

  Yes

  No

  N/A

• Connection on drums & tanks are vapor & liquid tight

  Yes

  No

  N/A

CHEMICAL WASTE

• Chemical containers are completely emptied before disposal

  Yes

  No

  N/A

• Chemical waste containers are correctly labeled

  Yes

  No

  N/A

• All chemical waste containers are kept under cover

  Yes

  No

  N/A

• No wastes can enter the stormdrains

  Yes

  No

  N/A

• Spill containment materials are available for your area

  Yes

  No

  N/A

HOUSEKEEPING

• Floors are swept up and kept clean

  Yes

  No

  N/A

• Aisles are free of obstructions at all times

  Yes

  No

  N/A

• Escape routes are clear at all times

  Yes

  No

  N/A

• Work areas are clean, neat, and organized

  Yes

  No

  N/A

• Outside work areas are clean, neat, & organized

  Yes

  No

  N/A

• Sawdust is kept cleaned up and not allowed to accumulate

  Yes

  No

  N/A

• Sawdust is vacuumed, not blown, to keep it from entering the air

  Yes

  No

  N/A

• No oil, grease, chemicals, or sawdust can flow into storm drains

  Yes

  No

  N/A

FIRE SAFETY

• Fire extinguishers are in place, checked monthly, & clear access

  Yes

  No

  N/A

• There are no accumulations of combustible materials

  Yes

  No

  N/A

• Fire doors and fire exits are never blocked

  Yes

  No

  N/A

• There is clear access to all fire equipment (Hydrants, risers, etc.)

  Yes

  No

  N/A

• Dirty and oily rags are stored in self-closing metal containers

  Yes

  No

  N/A

• Employees are aware of hazards and trained to work with them

  Yes

  No

  N/A

EMERGENCY PROCEDURE

• The escape plan is posted in the area

  Yes

  No

  N/A

• All employees know where to go and how to get there

  Yes

  No

  N/A

• All employees know how to report emergencies

  Yes

  No

  N/A

• All exits are at least 30" wide

  Yes

  No

  N/A

• The first aid kit is stocked

  Yes

  No

  N/A

• Ladders, stools, etc. are in good condition with non-slip feet

  Yes

  No

  N/A

• Ladders are free of oil, grease, and dirt

  Yes

  No

  N/A

• Non-conducting ladders are used for electrical work

  Yes

  No

  N/A

• Employees are trained on the correct use of ladders

  Yes

  No

  N/A

• Employees never stand on the top steps of step ladders

  Yes

  No

  N/A

TOOLS

• All tools and handles are maintained in good condition

  Yes

  No

  N/A

• Tools with damage or mushroomed heads are repaired/replaced

  Yes

  No

  N/A

COMPLETION

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