Safety Risk Assessment - ZONE #12

• Document No.

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Safety Associate

• Second Auditor/ If Applicable

• Primary/Department Contact

Personal Protective Equipment

• Are the employee(s) wearing the minimum required PPE ? (e.g safety glasses, hearing protection)<br><br>

  Yes

  No

  N/A

• Do the employee(s) wear the respirator correctly? (e.g., tight‐fitting respirators' head straps correctly positioned, PAPR faceshield kept closed, etc.)<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Is all PPE available within the area or zone, ie. Hearing protection, respirators?

  Yes

  No

  N/A

• Are employees wearing harnesses and lanyards for task requiring fall protection?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are contractors wearing the appropriate PPE when required?

  Yes

  No

  N/A

Equipment Safety

• Where applicable Is the equipment/room properly locked out and tagged out? <br><br><br>

  Yes

  No

  N/A

• Are all electrical cords in good condition? Do all electrical cord plugs in the room have their grounding prongs intact?<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Operating equipment/tools have all machine guards in place.

  Yes

  No

  N/A

• Are plug locks being used when necessary?

  Yes

  No

  N/A

• Are all LOTO tags filled out correctly? (e.g information legible, no tape, contains name, date and reason for LOTO)

  Yes

  No

  N/A

• Has all equipment been properly grounded or bonded?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are all required warning tags on equipment accounted for, visible, and identifiable?

  Safe

  At Risk

  Non-Compliant

  N/A

Ergonomics

• Are the following basic lifting techniques being followed? Back straight, knees bent, load close to body, lifts with legs, does not twist at the waist.<br>

  Safe

  At Risk

  Non-Compliant

  N/A

Housekeeping & Walking/Working Surfaces

• Are materials that are staged/stored stable, neat and orderly?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are ladders in good working order, no noticeable damage?

  Yes

  No

  N/A

• Are all egress and exit areas clear of obstruction? <br>

  Yes

  No

  N/A

• Area all walking surfaces, platforms free of clutter and debris?

  Yes

  No

  N/A

• Are pallets stored appropriately in the area or zone?

  Yes

  No

  N/A

• n Construction or Maintenance areas, is the work area clean and orderly.

  Safe

  At Risk

  Non-Compliant

  N/A

• Are wet floor areas appropriately marked?

  Yes

  No

  N/A

Emergency Equipment & Evacuation

• Are emergency equipment and exits in the area free from obstructions and available for use?<br>

  Yes

  No

  N/A

• Do the employee(s) know their evacuation routes and evacuation assembly areas? <br><br>

  Yes

  No

  N/A

• Are Emergency supplies and Maps in-date or need updated?

  Safe

  At Risk

  Non-Compliant

  N/A

• Does emergency equipment (e.g eyewash, fire extinguisher) have inspection tag in place?

  Yes

  No

  N/A

Flammable/Combustible Material Handling

• Flammable/combustible liquids are being stored in proper containers and in designated storage areas?<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Are chemicals stored in their appropriate location? (e.g flammable cabinets)

  Yes

  No

  N/A

• Are appropriate labels for flammable and combustible liquids present?

  Safe

  At Risk

  Non-Compliant

  N/A

Environmental Compliance

• Are appropriate GHS labels present?

  Yes

  No

  N/A

• Waste drums are closed, grounded (flammable only), properly labeled and in good condition/clean?

  Safe

  At Risk

  Non-Compliant

  N/A

• Storm water drains are clean and clear of sediment or debris?

  Safe

  At Risk

  Non-Compliant

  N/A

• Metal stored outside is covered?

  Yes

  No

  N/A

• Containment dike drain valves are locked in a closed position?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are spill kits appropriately stocked?

  Yes

  No

  N/A

Permits

• Are Hot Work permits being utilized, and filled out correctly?

  Yes

  No

  N/A

• Are Red Tag Permits being utilized and filled out correctly?

  Yes

  No

  N/A

Documentation

• Photos

  Media

• Corrective Action Plan

Validation

• Safety Rep Signature

  Sign

• Second Auditor Signature

  Sign

Communication

• Forward to

  Select EHS Committee Quality Compliance Security Manufacturing Quality Operations Facilities HR

  • EHS Committee
  • Quality Compliance
  • Security
  • Manufacturing
  • Quality Operations
  • Facilities
  • HR