Safety Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Personnel

• Machine/Equipment guarding in place?

  Safe

  At Risk

  N/A

• Drain covers in place?

  Safe

  At Risk

  N/A

• Equipment switches and disconnects intact, operational and in good repair?

  Safe

  At Risk

  N/A

• Emergency stop buttons/controls working properly?

  Safe

  At Risk

  N/A

• Saws/Power Equipment operating in a safe condition?

  Safe

  At Risk

  N/A

• Limit/proximity switches working properly?

  Safe

  At Risk

  N/A

• Control/electrical panels closed and latched?

  Safe

  At Risk

  N/A

• Tools (knives/scissors) in good condition & properly staged or stored?

  Safe

  At Risk

  N/A

• Employee work stations in good repair and properly set up?

  Safe

  At Risk

  N/A

• Safety Chains/Cables on overhead equipment (whizard motors, balancers, etc)?

  Safe

  At Risk

  N/A

• Stairs, Railings, and Guardrails in good condition?

  Safe

  At Risk

  N/A

• Outlets have a self-closing cover with rubber gasket?

  Safe

  At Risk

  N/A

• Conveyors/Augers operating in a safe condition?

  Safe

  At Risk

  N/A

• S/O cords wrapped around any conductive material?

  Safe

  At Risk

  N/A

• Emergency and Exit lighting in working order?

  Safe

  At Risk

  N/A

• Fire extinguishers in place and fully charged?

  Safe

  At Risk

  N/A

• Eyewash/Drench showers in place and in good repair?

  Safe

  At Risk

  N/A

• Housekeeping acceptable?

  Safe

  At Risk

  N/A

• Any other unsafe conditions which may pose a hazard to our employees?

  Safe

  At Risk

  N/A

5 Touch n Goes

Review

• Talk with Supervisor Daily about their Inspection

  Off

  On

• Review any Corrective Action Recommendations with the supervisor that is still open

• Auditor's Signature

• Add signature

  Sign

• Reviewer's Signature

• Add signature

  Sign