Title Page

  • Host Employer

  • Site Location
  • Conducted on

  • Evaluation Members

General Safety

  • Are the required OSHA and workers' compensation posters displayed

  • Does the host employer have a procedure to report workplace injuries

  • Was onsite orientation conducted

  • Was site-specific training conducted

  • Does the employee have clear direction on their job duties

  • Is the facility well-lit

  • Is the workplace clean and walkways clear of obstructions

Emergency Management

  • Are exits clear marked and free of obstructions

  • Are fire alarm pull stations readily available

  • Are fire extinguishers readily available and inspected

  • If necessary, are eye wash stations readily available

  • Are first-aid kits available and adequate

Hazard Communication (Chemicals)

  • Do employees receive hazard communication training

  • Are safety data sheets (SDS) readily available

  • Are chemicals properly labeled

  • Are spill kits or contamination equipment available

Personal Protective Equipment (PPE)

  • Does the employee have the required PPE

  • Is the employee properly wearing the required PPE

  • Is the PPE in good working condition

  • Does the host employer conduct job specific PPE training

Material Handling/Powered Industrial Trucks (PIT)

  • Are traffic aisles clearly marked

  • Are worker/pedestrian walkways clearly marked

  • Are employees practicing safe lifting techniques

  • Are products stored/stacked so they are stable/secure

  • Are all PIT operators trained and certified

Machine Operations & Guarding

  • Are moving machinery parts protected from contact

  • Does the host employer implement lockout/tagout procedures

  • Are automatic shutoffs installed in a conspicuous location

  • Is the employee wearing jewelry or loose fitting clothing (Client-Specific)

General Notes

  • undefined

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.