Ash Grove Seattle Monthly Area Inspection Form

Areas Inspected

Audit Prepared by:

• Conducted on

  Date

Access in and through the area(s)

• Are designated access ways provided?

  Yes

  No

  N/A

• Describe conditions and actions taken.

• Are access pathways free of trip or other hazards?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are areas properly tapped or tagged if required?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is appropriate signage present warning of hazards (falling material, noise, access...)?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is material accumulation spilling over toe boards or into walkways?

  Yes

  No

  N/A

• Describe conditions and actions taken

Housekeeping

• Are all areas neat, clean and orderly?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is all equipment, tools, and materials staged properly?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is trash & debris being adequately managed?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all areas free from piles of spilled material?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are cords and hoses being stored off the ground hanging on hooks?

  Yes

  No

  N/A

• Describe conditions and actions taken

Lighting

• Are all passageways and access ways well lit?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are portable lights undamaged (power cords intact and ground checked, ground prong intact...) and have guards installed?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are any light bulbs burned out?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is water present inside light covers?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all lighting covers/guards in place?

  Yes

  No

  N/A

• Describe conditions and actions taken

Electrical

• Is cord management in place?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are cords protected from damage?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all local disconnects labeled?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all breakers labeled?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are LOTO procedures required and being followed by all persons?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all electrical components undamaged and in good condition- conduit, junction boxes, knockouts intact...?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is there clear access to electrical panels and disconnects?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are outlets and covers undamaged and in good condition?

  Yes

  No

  N/A

• Describe conditions and actions taken

Fire Control

• Are fire extinguishers present and easily accessible?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all flammables stored in metal cans or in a flame locker when not in use?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is all combustible waste and debris removed daily?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all containers are properly labeled as to it's contents?

  Yes

  No

  N/A

• Describe conditions and actions taken

Tools

• Do all grinders have guards in place and with no more than 1/8" gap?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all power cords undamaged with ground prongs intact and have proof of annual ground check?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are whip checks installed properly?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is the proper tool for job being used?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all compressed gas cylinders secured upright, turned off, and have caps installed?

  Yes

  No

  N/A

• Describe conditions and actions taken

Ladders

• Are all step ladder in use being properly used?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all extension ladders in use being safely used?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all ladders free from damage such as bent rungs, cracked rails, missing rubber feet, undamaged top-plate...?

  Yes

  No

  N/A

• Describe conditions and actions taken

Machine Guarding

• Are any guards being held in place by something other than bolts or welds?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all moving parts guarded?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are any guards missing parts?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are conveyor belt's pull cords sagging below the level of the belt?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is material spilling from a belt or chute?

  Yes

  No

  N/A

• Describe conditions and actions taken

Fall Protection

• Are all working/walking surfaces guarded/protected from a fall?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are employees properly wearing fall protection gear?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are proper tie-off point is being used?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all employees using a Self Retracting Lifeline (SRL)?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all wall and floor openings/holes covered or guarded?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all guardrails and handrails (42" +/- 3") with mid-rail and toe boards in place?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are all cable guardrails are tight with less than 3" deflection?

  Yes

  No

  N/A

• Describe conditions and actions taken

Environmental

• Are all air quality/dust issues controlled?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is any runoff present that could harm the environment?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are there adequate number/type of spill kits available?

  Yes

  No

  N/A

• Describe conditions and actions taken

Hot Work

• Are fire-watch protocols in use?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are areas of hot work inspected to be free from combustible materials, and sparks are being controlled?

  Yes

  No

  N/A

• Describe conditions and actions taken

• Are gas cylinders/torches properly used/secured/stored?<br>

  Yes

  No

  N/A

• Describe conditions and actions taken

• Is a fire extinguisher present?

  Yes

  No

  N/A

• Describe conditions and actions taken

General Notes:

• Was a 'Stop The Job' triggered at any point during the inspection

  Yes

  No

  N/A

• Describe in great detail conditions and actions taken

• Narrative to describe the conditions of all areas inspected.

Corrective Actions Carried Over From Previous Inspections / Not Completed:

• Action 1

• Action 2

• Action 3

Personnel Present During Inspection:

• List all persons present during any part of the inspection

Area Inspector

• Add signature

  Sign

Hourly employee

• Add signature

  Sign

• Send a copy of completed inspections to the Safety Manager and maintain for your record.