Information

  • Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Housekeeping / 6 S

  • Work and storage areas are clean and tidy.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Work stations are well organized and no trip hazards are present.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Circulation paths are kept clear of any item.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Emergency equipment (eyewash, fire extinguishers) is constantly accessible.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Emergency routes and emergency doors are kept clear of any item and fully accessible. Emergency doors are not locked.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Safety signage

  • Signs indicating required Personal Protective Equipments are in place.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Signs indicating eyewash/safety shower, emergency exits, fire extinguishers, etc. are in place.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Personal Protective Equipment (PPE)

  • Liquid chemicals are stored on secondary containment.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • PPE are appropriately stored when not in use and kept in good condition.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Environment

  • Liquid chemicals are stored on secondary containment.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Flammable chemicals are stored in flammable cabinets (or in a dedicated storage room in case of high volume) when not in use.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Waste area is well maintained.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Warnings , signs and barricades

  • Pits, overhead work, maintenance activities are properly identified and protected.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Maintenance

  • Pits, overhead work, maintenance activities are properly identified and protected.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Foot protection

  • Steel-toed safety shoes are used as required.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Hand protection

  • Gloves are used as required.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Gloves are not worn around rotating equipment.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Eye/face protection

  • Safety goggles or face shield are used as required.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Haring protection

  • Ear plugs / muff are used in identified high noise area

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Respiratory protection

  • Respiratory protection is used as required.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Ergonomics

  • No awkward position, no excessive or overhead reach; limited bending and twisting.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Tools, equipment and machines

  • Tools, equipment and machines are operating properly.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Safety guards are in place.

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

  • Electrical wiring in good condition

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Other

  • Other

DESCRIPTION

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PROPOSED CORRECTIVE ACTION

Accomplishments : select one or two items for which the employees or the site should be recommended :

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.