Safety Self-Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Electrical

• Is there use of grounded recepticles?

  Yes

  No

  N/A

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  Media

• Are extension cords used? (if yes, explain)

  Yes

  No

  N/A

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• Are extension cords in good condition?

  Yes

  No

  N/A

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• Are covers on junction boxes, switches and recepticles?

  Yes

  No

  N/A

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• Is wiring and other equipment in good working condition?

  Yes

  No

  N/A

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• Is there a minimum of 3 ft. clearance in front of panel boxes?

  Yes

  No

  N/A

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Walking and Working Surfaces

Housekeeping

• Are floors clean and dry?

  Yes

  No

  N/A

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• Are floors made of or provided with a non-skid surface?

  Yes

  No

  N/A

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• Is carpeting in good condition and repair?

  Yes

  No

  N/A

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• Are tripping hazards eliminated?

  Yes

  No

  N/A

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• Is there a minimum 3 ft. aisle marked leading to an approved egress?

  Yes

  No

  N/A

Stairs

• Are handrails available?

  Yes

  No

  N/A

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• Are stair treads in good condition and free from tripping hazards?

  Yes

  No

  N/A

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• Is there illumination on stairs?

  Yes

  No

  N/A

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Ladders

• At a minimum, are ladders checked at least monthly for defects?

  Yes

  No

  N/A

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• Are defective ladders removed from service?

  Yes

  No

  N/A

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• Is the use of the top step of ladders prohibited?

  Yes

  No

  N/A

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Machinery

• Do all machine safeguards prevent the operators hands, arms, and other body parts parts from making contact with dangerous moving parts? Example blades, bits, belts, gears, etc.

  Yes

  No

  N/A

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• Are guards in place when machinery is an operation?

  Yes

  No

  N/A

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• Are all starting and stopping controls within easy reach of the operator?

  Yes

  No

  N/A

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• Have appropriate measures been taken to safeguard students against noise hazards?

  Yes

  No

  N/A

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• Are all special guards, enclosures or personal protective equipment utilized when necessary to protect staff and students on or off campus?

  Yes

  No

  N/A

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• Is there enforcement of a safe dress code for the job? Example no loosefitting clothing or jewelry etc.

  Yes

  No

  N/A

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• Does staff and students have the necessary training in how to use the safeguards and know why prior to the machine usage?

  Yes

  No

  N/A

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Personal protective equipment

• Are eye and face protection provided where a flying particle or chemical hazard exist?

  Yes

  No

  N/A

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• Are staff and students provided with and instructed in the proper use of personal protective equipment?

  Yes

  No

  N/A

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• When protective equipment is required, is it appropriate for the job, in good condition, kept clean and sanitary, and stored carefully when not in use? Example hearing, eye, head, etc.

  Yes

  No

  N/A

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• If applicable, is there an emergency eye wash station provided?

  Yes

  No

  N/A

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• Is the emergency eye wash station tested at least monthly?

  Yes

  No

  N/A

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Exhaust, ventilation, heat producing units

• Are ventilation systems in proper working condition?

  Yes

  No

  N/A

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• Are heat dispensing devices properly located and free from obstruction and flammable materials?

  Yes

  No

  N/A

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Compressed gases

• Are all cylinders and pressure vessels identified as to contents?

  Yes

  No

  N/A

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• Are all cylinders and pressure vessels stored in a protective manner to prevent tampering and physical damage?

  Yes

  No

  N/A

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• Are all cylinders and pressure vessels secured to prevent falling or upset?

  Yes

  No

  N/A

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• Are protective caps in place when cylinders are stored or transported?

  Yes

  No

  N/A

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• Are oxygen and nonflammable cylinders stored a minimum of 20 feet away from flammable gas cylinders?

  Yes

  No

  N/A

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Fire prevention and protection

• Are fire extinguishers accessible?

  Yes

  No

  N/A

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• Are fire extinguishers in good working condition?

  Yes

  No

  N/A

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• Are fire pull stations/suppression systems in good working condition?

  Yes

  No

  N/A

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• Are fire suppression systems inspected on a regular basis?

  Yes

  No

  N/A

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• Are approved safety cans and cabinets provided for flammable liquids?

  Yes

  No

  N/A

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• Are flammable liquids stored in a flammable cabinet and labeled?

  Yes

  No

  N/A

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• Is there proper grounding and bonding on flammable liquid containers?

  Yes

  No

  N/A

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• Are solvent rags stored in a self-closing container?

  Yes

  No

  N/A

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• Are waste cans provided and emptied on a daily basis?

  Yes

  No

  N/A

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• Are doors operating properly and not wedged or blocked open?

  Yes

  No

  N/A

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• Are fired evacuation signs posted near the exit?

  Yes

  No

  N/A

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• Are means of ingress clear and unobstructed at all times?

  Yes

  No

  N/A

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• Are exit signs illuminated??

  Yes

  No

  N/A

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• Are rescue windows properly identified and clear at all times?

  Yes

  No

  N/A

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• Are first aid kit provided, stocked, and accessible?

  Yes

  No

  N/A

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Miscellaneous

• Is there documentation of safety training for staff and students?

  Yes

  No

  N/A

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• Does staff and students have the appropriate footgear for the instruction being provided?

  Yes

  No

  N/A

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• Are combustible decorations kept 2 feet from the ceiling and do not exceed 20% of the wall surface when placed in corridors?

  Yes

  No

  N/A

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• Are power handtools inspected for proper working order at least monthly?

  Yes

  No

  N/A

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• Are all accidents reported within 24 hours?

  Yes

  No

  N/A

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• Are all products stored in an inappropriate manner?

  Yes

  No

  N/A

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• Are dust collection systems checked and emptied on a daily basis?

  Yes

  No

  N/A

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• Are TV/VCR carts and other equipment transporter and stored properly?

  Yes

  No

  N/A

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Other safety concerns