Title Page

  • Site conducted

  • Store #, Store Name, & Store Location

  • Store Contact(s)

  • Store email address

  • Inspection Date

  • Prepared by

  • Loss Control Contact Info

Risk & Safety Mgmt

Focus 4 Hazards

  • Is the store management aware of the Focus 4 Hazards?

  • It was a pleasure meeting with you to review the safety plan we will be suggesting for the purpose of protecting employees and customers. As we transition from year to year, we will add additional activities and services to the safety program. As I mentioned, the policies and activities I would like for you to begin implementing are listed below. Our goal is to raise awareness and understanding of the safety hazards present in our stores and the corrective measures that can be taken to control the hazards.

    If you or your safety delegates have any questions related to my recommendations, do not hesitate to call me and we can discuss. All of the activities we will be recommending have a purpose with the goal of spreading safety responsibilities and protecting people.

    1. Designate safety delegates to implement policies and activities. As the store manager, it is your discretion in selecting your safety delegates, but if you are uncertain, I would suggest considering, at a minimum, the assistant managers to become delegates. Beyond the assistants, appoint employees you feel will be an asset to store safety. These employees could be department managers, key employees, or employees that have had specialized training, such as a volunteer fireman, first aid training, or previous safety training at a past employer.
    2. Use the monthly safety email for each department to hold a department safety meeting. Attendance sheets must be kept with the date and topic(s) discussed. Utilize the safety meeting topic as the safety focus for the month.
    3. Teach all safety delegates what the Focus 4 hazards are. Throughout the day, the safety delegates should monitor the Focus 4 hazards (listed below) that we have identified as the primary cause of our employee and customer injuries and the cause of many of our insurance costs.
    4. Safety guidelines require daily inspections of the baler and electric pallet jack by a safety delegate. Custom inspection forms are enclosed for the baler and electric pallet jack. The forms are set up for weekly inspections, and I suggest making multiple front and back copies and keeping them in a 3-ring binder.
    5. Supply the safety delegates with this and all other safety inspection reports, so they understand the hazards that need to be monitored.
    6. Completion of enclosed recommendations. We understand that many recommendations cannot be corrected quickly so a simple statement indicating the plan of action is fine. An example would be: contacted the property landlord and requested repair of the holes in the parking lot.

  • Reviewed Focus 4 hazards and the impact these hazards have on both employee and customer safety. Discussed the importance of monitoring the Focus 4 by delegating safety responsibilities throughout the management team. By delegating these responsibilities, communicating expectations and documenting inspections, these hazards will be reduced.

  • 1. Ladder Safety Training & Inspection

  • CORRECTIVE ACTION TAKEN:

  • Please Explain Activity -

  • Ladder & Step ladder safety tips. (Review with delegates and new employees. Ensure current employees understand these safety suggestions)
    1. Always face the ladder, NEVER climb with your back to the ladder.
    2. Use 3-point contact, meaning 2 feet and 1 hand or 2 hands and 1 foot at all times.
    3. Use the ladder rungs to grip with your hands.
    4. Always inspect ladder before using; if damaged, DO NOT use.
    5. Ladder inspection should include:
    a. missing, damaged or loose rungs (steps)
    b. damaged or missing non-slip feet on bottom of ladder
    c. loose or damaged spreaders or locks that hold ladder in position.
    6. DO NOT stand on top two rungs of a ladder.
    7. Only use on level and stable surface.
    8. Do not attempt to move ladder while standing on ladder.
    9. Do not exceed maximum load rating for ladder. Load rating is found on ladder. If sticker is missing, load rating can be determined by the color of a fiberglass ladder.
    Never use a bucket or milk crate for an item out of reach, always use a step stool.

  • 2. Slip Trip Fall Controls & Policies

  • CORRECTIVE ACTION TAKEN:

  • Please Explain Activity -

  • Slip, Trip and Fall hazards. Hazards to monitor include: (Review with SAFETY DELEGATES, all EMPLOYEES DURING THE NEXT SAFETY MEETING, and with NEW EMPLOYEES DURING ORIENTATION. Ensure current employees understand these safety suggestions)
    1. Be aware of any liquids on all walking/working surfaces. If observed, address and clean up immediately.
    2. Make sure aisle ways are clear. Ensure display bases, table legs or shelves do not protrude into aisle.
    3. When stocking, keep boxes, carts, merchandise, etc. in line. This will improve housekeeping and possibly prevent a trip/fall accident.
    4. Displays should be kept parallel to the aisleway, thus, eliminating any corners from protruding into the customer/ employee walking space.
    5. Monitor rugs and mats. Rugs/mats out of position should be re-positioned and rugs/mats with turned up corners should be replaced.

  • 3. Material Storage & Lifting

  • CORRECTIVE ACTION TAKEN:

  • Please Explain Activity -

  • Merchandise Storage & Lifting safety tips: (Review with SAFETY DELEGATES, all EMPLOYEES DURING THE NEXT SAFETY MEETING, and with NEW EMPLOYEES DURING ORIENTATION. Ensure current employees understand these safety suggestions)
    1. Store heavy and awkward shaped boxes on middle shelves. This reduces the amount of bending and lifting required of the employee.
    2. When loading carts with merchandise, ensure there is ample room to lift properly.
    3. Do not lift in a “crane” motion (bending at the waist). Bend the knees as much as possible and do not allow your back to “round-out” into an arch shape.
    4. Never “Lift and Twist” to move and place any sized piece of merchandise. Lifting and twisting puts your back in its weakest position.
    5. Before lifting, know the weight of the box. A simple push with your foot, leg or hip will help you determine weight.
    6. Keep boxes/merchandise close to your body in the safe lifting zone. Waist level or between thighs & belly button.
    7. Lift smoothly, never lift in a jerky, quick motion.
    8. Know where you want to place the box and clear a path to that spot before lifting the object.

  • 4. Box Cutter Training, Use, Observation, Re-training

  • CORRECTIVE ACTION TAKEN:

  • Please Explain Activity -

  • Box cutter safety tips: (Review with SAFETY DELEGATES, all EMPLOYEES DURING THE NEXT SAFETY MEETING, and with NEW EMPLOYEES DURING ORIENTATION. Ensure current employees understand these safety suggestions)
    1. Maintain a sharp blade and replace when dull or broke.
    2. Retract blade when not in use.
    3. Angle blade away from the body
    4. Hold box cutter with the thumb wrapped around cutter, not over the cutter or blade top.
    5. Keep blade adjusted to its shortest needed length.
    6. Use a firm and consistent cut without being excessive in pressure.
    7. Use your arm to move the blade, not your wrist, this will lessen the chance of the blade slipping out of the box.
    8. Be aware of your other hand. DO NOT place the other hand in the path of the blade.
    9. When changing blades, dispose of blades in a safe manner.

General Safety

  • Mgmt Involvement in Safety (store &/or dept)

  • CORRECTIVE ACTION TAKEN:

  • Please Explain Activity -

  • The path to an effective safety program is to delegate responsibilities for employee and customer safety. Store safety monitoring, as a part of job duties, should be assigned to assistant managers, department managers, and key employees. These responsibilities should include (but are not limited to) identifying slippery floors & directing proper clean-up, daily safety check of the baler, electric pallet jack or forklift, & store, conducting monthly safety meetings, accident investigations, and the enforcement of the Focus 4 program. Safety Delegates must be assigned so that there is always a safety delegate on duty. Safety delegates should understand the safety steps of the above-listed Focus 4 in order for the delegate to be able to identify and correct these hazards when observed. It is also suggested to review Focus 4 with new employees during orientation and review the safety steps listed under each.

  • Safety Meeting (frequency)

  • CORRECTIVE ACTION TAKEN:

  • Please Explain Activity -

  • On the last Thursday of each month, you will receive an email. Use the safety meeting handout to have a brief safety meeting reviewing the safety focus of the month. These meetings must be held, at a minimum, monthly during department meetings, by small group meetings, or individually to enable all employees to attend. We suggest having the dept managers either hold the meeting themselves or delegate to a key employee. The attendance sheet and topics discussed must be kept on file.

  • Inspections / Baler, Forklift / Electric Pallet Jack, Store, Fire Ex

  • CORRECTIVE ACTION TAKEN:

  • Please Explain Activity -

  • 1. Baler and the electric pallet jack (or forklift) must have a documented inspection daily per regulation and safety glasses must be worn when making up a bail. 2. Fire extinguishers must be inspected monthly to ensure it is charged, properly mounted and is not obstructed from view. Inspection tag will be found on extinguisher for inspector to write date and their initials 3. A daily store walk-through should be completed and documented by a safety delegate, monitoring hazards within the Focus 4 program

  • Accident Investigation

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  • New Employee Safety Orientation

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  • Additional Recs

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  • Comments:

Safety

  • Haz Com / SDS / Training / Labels

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  • Lockout

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  • Forklift / Training

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  • Please Explain Activity -

  • PPE / Shoes / Gloves / Glasses

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  • Please Explain Activity -

  • Safe Box Cutter Use Training

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  • Please Explain Activity -

  • Fire Extinguisher (monthly check)

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  • Please Explain Activity -

  • Wet Floor Procedures & Clean Up

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  • 1st Aid & BBP Kit Locations & Supplies

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  • Emergency Preparedness / Tornado's

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  • Robbery & Shoplifter Policy

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  • Procedure for Cash Deposit

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  • Additional Recs

Injury Reporting

  • Injury Reporting Process for WC / GL:

  • OSHA 300 & 300-A Summary Posted

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  • Please Explain Activity -

  • Return to Work

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  • Most Common & Most Severe Employee & Customer Injury & Cause

  • Additional Recs

  • Summary / Comments

Survey Results

Parking Lot / Exterior of Store

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Grocery & Merchandise / Sales Floor

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Stock / Back Room

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Meat Dept

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Produce Dept

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Deli

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Restaurant

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other

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  • DISCLAIMER: The recommendations/suggestions contained in this report are concerned with the practices and condition of your operation observed by us at the time of the visit. The sole reason for providing you with this information is to assist you in your responsibility of preventing accidents and losses. This letter/report is neither a determination that the condition and practices, whether observed or not, are safe nor a warranty that reliance upon it will prevent accidents and losses or satisfy local, state nor federal regulations.

  • COMPLETION OF RECOMMENDATIONS: When recommendations have been received from your recommendation coordinator, address the hazards noted in this report and return to the rec coordinator, with Corrective Action Taken, within 20 days of receiving the report.

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