Safety Walk (Draft)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Are there any action items from prior inspections, that you checked on for resolution?

  Yes

  No

  N/A

Emergency Equipment and Exits

• Where any egress exits identified as being blocked, or not having a clear 28" of clear pathway?

  Yes

  No

  N/A

• Where there any electrical panels identified as being blocked, or not having 36 inches of clearance?

  Yes

  No

  N/A

• Where there any eye wash stations identified being blocked, or not having a clear unobstructed path to the station?

  Yes

  No

  N/A

• Where there any fire extinguishers identified as being blocked, or not having 36 inches of clearance around the extinguisher?

  Yes

  No

  N/A

Employee Safety

• Where there any teammates that stand out on conducting unsafe behavior?

  Yes

  No

  N/A

• Who was the teammate? What was the identified unsafe behavior?

• Where there any teammates that stood out conducting safe behavior, while performing a potentially hazardous task?

  Yes

  No

  N/A

• Who was the teammate? What was the identified safe behavior?

  Yes

  No

  N/A

Associate Interaction

• What associates did you interact with today, including having safety conversations with?

• What safety topic was discussed?

Employee Reporting

• Did a teammate mention any concerns, accolades, suggestions, or ideas regarding health and/or safety?

  Yes

  No

• Did we engage the team well enough to discuss these topics?

  Yes

  No

• What did the teammate discuss with you?

• Anything else to add regarding todays safety walk?

  Yes

  No

  N/A