Title Page

  • Auditor Name

  • Date

  • Machine #

  • Shift #

Safety LPA

  • Select the note button to add a comment or a corrective action taken statement.

  • For corrective actions:

    Near Misses - Entries can be made in the Near Miss Log or through Gensuite - provide Work Order #

    Work Orders are submitted through the Data System under Safety and Gensuite categories - provide Near Miss #

    If unable to enter into Work Order Database or Near Miss Log/Gensuite contact Supervisor

Walking and Working Surfaces

  • Floors clean, dry and free of damage

  • No slip/trip hazards (elec. cords, air hoses, debris)

  • Are aisles and walkways clear and free of obstacles?

  • Guard rails and Gates not bent and functional

  • Safety chains/cables in place

  • No protruding storage/clutter

  • Stairs safe (hand rails, treads)

Electrical

  • 36" Access clearance around electrical panels

  • Extension cords inspected for damage and a ground plug

  • Covers in place on receptacles, boxes, switches

  • Electrical panels closed and secured

  • Lighting (blown bulbs, all working)

Machine Guarding

  • Pinch points guarded

  • Fan blades guarded

  • Belts and Pulleys guarded

  • Rotating shafts guarded

  • Grinders (1/8" toolrest, 1/4" Tongue guard)

  • Working Light curtains

  • Lights and alarms on hoist

Hazardous Material

  • Dispensing containers labeled

  • All non-manufacturer containers labeled

  • Are all labels on incoming containers of chemicals not removed or defaced

General Safety

  • All PPE worn and used correctly

  • All buttons and switches labeled

  • 30 psi blowguns used

  • All exits clear of obstruction

  • Al forklifts, manlifts checked out properly

  • Compressed gases stored properly

  • Any unsafe work conditions

  • Employees following proper ergonomics

  • Any blocked fire extinguishers

  • Any discharged fire extinguishers

  • Are all pre startup check list being done

  • Any damaged or missing safety latches on hoist hooks or on lifting devices

Lock Out - Tag out

  • Worn LOTO tags

  • Identification on locks

  • Safety Map up to date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.