Title Page
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Host Employer
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Site Location
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Conducted on
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Evaluation Members
General Safety
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Are the required OSHA and workers' compensation posters displayed
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Does the host employer have a procedure to report workplace injuries
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Was onsite orientation conducted
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Was site-specific training conducted
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Does the employee have clear direction on their job duties
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Is the facility well-lit
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Is the workplace clean and walkways clear of obstructions
Emergency Management
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Are exits clear marked and free of obstructions
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Are fire alarm pull stations readily available
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Are fire extinguishers readily available and inspected
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If necessary, are eye wash stations readily available
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Are first-aid kits available and adequate
Hazard Communication (Chemicals)
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Do employees receive hazard communication training
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Are safety data sheets (SDS) readily available
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Are chemicals properly labeled
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Are spill kits or contamination equipment available
Personal Protective Equipment (PPE)
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Does the employee have the required PPE
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Is the employee properly wearing the required PPE
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Is the PPE in good working condition
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Does the host employer conduct job specific PPE training
Material Handling/Powered Industrial Trucks (PIT)
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Are traffic aisles clearly marked
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Are worker/pedestrian walkways clearly marked
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Are employees practicing safe lifting techniques
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Are products stored/stacked so they are stable/secure
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Are all PIT operators trained and certified
Machine Operations & Guarding
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Are moving machinery parts protected from contact
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Does the host employer implement lockout/tagout procedures
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Are automatic shutoffs installed in a conspicuous location
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Is the employee wearing jewelry or loose fitting clothing (Client-Specific)
General Notes
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