SMI CO.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Overview job pictures

  Media

• Performance rating: 10 being the best(little to no risk) , and 1 being (high risk for injuries and fines)

Previous inspection

• Has the last inspection been reviewed, items correct from last audit.

  Yes

  No

  N/A

Housekeeping

• Are walkways and working surfaces clearly marked or communicated?

  Yes

  No

  N/A

• Are the floor surfaces free of clutter, debris, or waste products?

  Yes

  No

  N/A

• Are walking and working surfaces maintained in good condition (no slick surfaces, uneven surfaces,ect.)?

  Yes

  No

  N/A

• Are spilled liquid cleaned up promptly , and are reclaimed or discarded?

  Yes

  No

  N/A

• Are all materials (pallets,stacks of wood,ect.) restrained or stored properly to prevent tipping,falling,or damage?

  Yes

  No

  N/A

• Are stairways (including stair treads,landing areas,and railings) kept clear of materials,clutter,or debris?

  Yes

  No

  N/A

Emergency Exits and Entrances

• Are the exit and entry routes kept clear of clutter,debris, or materials (minimum of 28'' wide continuous path.)?

  Yes

  No

  N/A

• Are all illuminated emergency exits signs operable?

  Yes

  No

  N/A

• Are the exit doors able to be open from the direction of exit of travel without the use of a key, special knowledge,or effort?

  Yes

  No

  N/A

Loading Docks and receiving areas

• Is the loading and receiving area clean and tidy to prevent slips,trips,falls, or falling objects hazard?

  Yes

  No

  N/A

• Are open docks with a fall hazard exceeding 36'' protected with restraints and warning signage?

  Yes

  No

  N/A

• Can all over head doors be operated by employees without undue force or pressure?

  Yes

  No

  N/A

• Are all doors free of any obvious signs of damage or defect(bent tracks,dented doors panels,ect.)?

  Yes

  No

  N/A

Flammable chemicals

• Are flammable chemicals containers stored in approved self-closing flammable safety cabinet?

  Yes

  No

  N/A

• Are flammable chemicals stored in a flammable safety can with spring- loaded lid ?

  Yes

  No

  N/A

• Are flammable cabinets being used for their intended purpose(no tools,PPE,food,corrosive chemicals,ect.)?

  Yes

  No

  N/A

• Is at least one fire extinguisher located within a 50'radius of the flammable storage areas?

  Yes

  No

  N/A

Compressed Gasses

• Are compressed gas cylinders properly restrained to prevent them from tipping or falling?

  Yes

  No

  N/A

• Are compressed gas cylinders capped with a valve cover when not in use?

  Yes

  No

  N/A

• Do empty cylinders have their valves closed?

  Yes

  No

  N/A

• (When stored inside a building) Is LP gas storage kept to 300 pounds or less or 2,000 cubic feet?

  Yes

  No

  N/A

• Are propane tanks stored in a secure cage or rack to prevent them from tipping?

  Yes

  No

  N/A

Hazcom

• Hazcom notebook present?

  Yes

  No

  N/A

• Hazcom check list present?

  Yes

  No

  N/A

Administration

• Are labor laws posting available in a accessible place?

  Yes

  No

  N/A

• Are safety data sheets (SDS sheets) on site for every potential chemical exposure?

  Yes

  No

  N/A

• Has a site safety plan been developed and followed?

  Yes

  No

  N/A

• Is a emergency medical card posted?

  Yes

  No

  N/A

• Is an approved first Aid kit present?

  Yes

  No

  N/A

Power machinery

• Are all documented inspections completed before each use?

  Yes

  No

  N/A

• Are all pieces of power equipment operating well without leaks or obvious signs of defects?

  Yes

  No

  N/A

• Are all attachments secured from movement?

  Yes

  No

  N/A

• Are all equipment operators trained and certified on the equipment they are running?

  Yes

  No

  N/A

PPE

• Are employees wearing safety glasses 100% of the time?

  Yes

  No

  N/A

• Are employees wearing appropriate safety glasses for their environment?( no sun glasses in dark areas, no fogging , no defects)

  Yes

  No

  N/A

• Have face shields been selected for appropriate hazards?(grinding, drawing overhead)

  Yes

  No

  N/A

• Is eyewash in a accessible area and properly set up?

  Yes

  No

  N/A

• His hearing protection being used?

  Yes

  No

  N/A

• Respirators if use are they being used properly?

  Yes

  No

  N/A

Fire Protection

• Are all flammable safety cans properly labeled?

  Yes

  No

  N/A

• Are all fire extinguishers posted near flammable storage areas and hot work zones?

  Yes

  No

  N/A

• Do you all fire extinguishers have a tag demonstrating they have received documented annual inspection?

  Yes

  No

  N/A

• Are all fire extinguishers in good working order?(Pin and temper seal present,good pressure, and hose free of debris?)

  Yes

  No

  N/A

Electrical Equipment

• Are all extension cords in good working condition?

  Yes

  No

  N/A

• Are all manufacturers recommended guards properly mounted and used?

  Yes

  No

  N/A

• When equipment is being worked on are employees locking the electrical panels our? So that it can not be turned on?

  Yes

  No

  N/A

• Are cords not strung in walk ways or being run over by equipment?

  Yes

  No

  N/A