SMCH Safety Walk Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location / Areas being Inspected
  Address

• Personnel

General Housekeeping

• Are workspaces clean and orderly?

  Yes

  No

  N/A

• Are floors clear of debris?

  Yes

  No

  N/A

• Are floor surfaces dry and free of slip hazards?

  Yes

  No

  N/A

• Are aisles, hallways, stairs, and exits free of obstruction?

  Yes

  No

  N/A

• Are materials stored securely and limited in height to prevent collapse?

  Yes

  No

  N/A

• Are ladders stored properly?

  Yes

  No

  N/A

• Are stairway doors closed?

  Yes

  No

  N/A

• Are Ceiling Tiles in place and in good condition?

  Yes

  No

  N/A

Emergency Exits and Lighting

• Are Emergency Exits signs in working order?

  Yes

  No

  N/A

• Are emergency exit maps posted and clearly marked?

  Yes

  No

  N/A

• Are emergency exits free from obstructions?

  Yes

  No

  N/A

• Is emergency lighting in working order?

  Yes

  No

  N/A

• Are areas adequately illuminated?

  Yes

  No

  N/A

Chemical Safety

• Are all hazardous materials properly stored and labeled?

  Yes

  No

  N/A

• Are Refrigerators labeled as "Food Only" or "Drugs Only"

  Yes

  No

  N/A

• Are Eye Wash and/or Emergency Shower stations properly maintained and labeled?

  Yes

  No

  N/A

Fire Safety

• Is 18" of vertical clearance maintained below all sprinkler heads?

  Yes

  No

  N/A

• Are fire extinguishers current on inspection?

  Yes

  No

  N/A

• Do fire extinguishers show as charged and in designated locations?

  Yes

  No

  N/A

• Are all ANSUL valves covered over fryers and grills?

  Yes

  No

  N/A

• Is there a clear path to access fire extinguishers?

  Yes

  No

  N/A

• Are combustibles stored near electrical or heat sources?

  Yes

  No

• Are there any open punctures / penetrations in ceilings and walls?

  Yes

  No

• Do fire doors close and latch properly?

  Yes

  No

  N/A

Electrical Safety

• Is 36" clearance maintained in front of electrical panels?

  Yes

  No

  N/A

• Are power cords/strips used as designated? (No daisy chains)

  Yes

  No

  N/A

• Do electrical enclosures have any exposed openings? (i.e.- missing breakers, KO plugs, etc...)

  Yes

  No

  N/A

• Are extension cords being used as "permanent wiring"?

  Yes

  No

  N/A

• Is the ground prong present on all power cords?

  Yes

  No

  N/A

Behavioral / Culture (Questions to ask staff in the area)

• Do team members know where to access the SDS's ? (Have someone show you)

  Yes

  No

  N/A

• If you see a Safety issue, who do you report it to?

• Do you understand the safety practices of SMCH and your job? (Record their name and ask for an example)

• Do you have any other safety concerns or barriers preventing you from working safe and following our safety practices? (Record name and list items)

• Comments:

• Select date

  Date

• Person Completing Inspection

  Sign

• Select date

  Date

• Other Persons Involved in Completing Inspection

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