Title Page

  • Company

  • Conducted on

  • Prepared by

  • Location

Assessment

  • Does your team use forklifts?

  • Could you provide evidence of Forklift Operator Training?

  • Could you provide evidence of Forklift Inspections?

  • Does your team use Mobile Elevated Work Platforms (MEWPs)? - Aerial Lifts to include scissor lifts or boom lifts

  • Could you provide evidence of MEWP Operator Training?

  • Could you provide evidence of MEWP inspections?

  • Does your team have to work above 4' from working surface

  • Working at a height of 4' requires fall protection measures to be in place. Do you have a work at heights program that identifies fall hazards and has a means to protect your workers from the falling hazard?

  • Could you provide evidence of Fall Protection Training?

  • Does your team use a personal fall arrest system (PFAS)?

  • Could you provide evidence of Fall Protection Equipment Inspections?

  • Does your team lift material with a hoist/crane/or other equipment?

  • Could you provide evidence of Lifting/Rigging Training?

  • Could you Provide Evidence of rigging equipment inspections?

  • Does your team have the expectation that they will or could use a fire extinguisher to put out a fire?

  • Could you provide evidence of annual fire extinguisher training?

  • Do you have eye wash and shower stations in your facility?

  • Could you provide evidence of inspections of the eye wash and shower stations?

  • Does your team use or have respirators?

  • Could you provide evidence of respirator training?

  • Could you provide evidence of respirator fit testing?

  • Could you provide evidence of medical evaluations for respirator users?

  • Do you have an Emergency Action Plan?

  • could you provide evidence of training of Emergency Action Plan?

  • Could you provide evidence of drills or effectiveness of Emergency Action Plan?

  • Are you compliant with OSHA recordkeeping standards?

  • Could you provide OSHA logs for previous 5 years?

  • Do you require your team to wear Personal Protective Equipment?

  • Could you provide evidence of PPE training?

  • Could you provide evidence that fit and use are in compliance to the standard?

  • Does your team practice energy isolation or Lock out / Tag out of your equipment?

  • Could you provide evidence of LOTO Training for your workers (Authorized)

  • Could you provide evidence of LOTO Annual Audit

  • Do you have equipment that has or should have Machine Guarding?

  • Do you have evidence of Machine Guarding Training for your workers?

  • Do you have evidence of Machine Guarding Assessment or Audits?

  • Does your team use ladders?

  • Do you have evidence of training for Walking & Working Surface, which includes ladders?

  • Does your team perform work in confined spaces?

  • Could you provide evidence of confined space training for entrant, attendant, supervisor?

  • Could you provide evidence of confined space permitting practices?

  • Could you provide evidence of confined spaces in facility?

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.