Title Page

  • Conducted on

  • Conducted by

  • Department

General

Housekeeping & General Work Environment

  • 1. Walking-working surfaces are kept clean, orderly, and free of debris?<br>(Walking-working surfaces: any horizontal vertical surface on or through which a worker walks, works, or gains access to a work area or workplace location)

  • Specify work station(s)

  • 2. Access to and from work stations and work areas are a minimum of 24 inches, free of obstructions and constantly accessible?

  • Specify work station(s)

  • 3. Work stations are free of trash accumulation, clean, tidy, well organized and free of trip hazards?

  • Specify work station(s)

  • 4. Storage areas are clean, orderly and tidy?

  • Specify work station(s)

  • 5. Are employees addressing housekeeping issues as they see them?

  • Specify work station(s)

  • 6. Emergency routes and emergency doors are kept clear and fully accessible at ALL TIMES?

  • Specify work station(s)

  • 7. Emergency equipment (Fire Extinguishers, eyewash stations etc) free from obstructions and are constantly accessible?

  • Specify work station(s)

  • 8. Sufficient access and working space is provided and maintained around all electrical equipment to permit safe operations and maintenance?<br>(Clear space is maintained in front of electrical panels; minimum 3 feet in front, and at least the width of the panel, but not less than 2 ½ feet?)

  • Specify work station(s)

  • 9. Material and equipment is stored in such a way that projections do not interfere with walkways?

  • Specify work station(s)

  • 10. Aisles and walkways that pass near moving or operating machinery, welding operations and similar operations are arranged so employees are not subjected to potential hazards?

  • Specify work station(s)

  • 11. Fan blades are protected with a guard having openings no larger than l/2 inch when operating within 7 feet (2.1336 meters) of the floor or working level.

  • Specify work station(s)

  • 12. Are pallets and materials laying flat and stacked securely and neatly?

  • Specify work station(s)

  • 13. Are pallets that are in use in good condition?

  • Specify work station(s)

Facility Security: Visitor Management

  • 1. Contractors & Visitors are signing in and out of facility as required per Visitor Management Procedure?

  • Provide Name and Company of each

  • 2. Contractor & Visitor Badges worn as required per Visitor Management Procedure?

  • Provide Name and Company of each

Behavior Based Safety

General EHS Rules

  • 1. Employees wearing ID Badges as required per EHS General Rules?

  • Specific Area(s)

  • Provide name(s) of non-compliant employee(s) in notes

  • Are Red or Pink Badge employees operating equipment alone, with another Red or Pink Badge Employee or without supervision?

  • Provide employee names

  • 2. Forklift Operators are wearing Forklift ID Badges & training is current?

  • List employees not wearing Forklift ID Badges

  • 3. Are employees adhering to cell phone and earbud policy?

  • Specify work station(s)

  • 4. Are proper lifting procedures being followed?

  • Specify work station(s)

  • 5. Are employees using caution around machines?

  • Specify work station(s)

Personal Protective Equipment (PPE)

  • 1. Are employees wearing appropriate PPE?

  • Specify lack of or inappropriate PPE

  • Specify work station(s)

  • 2. Is PPE being worn correctly?

  • Specify work station(s)

  • 3. Is PPE maintained in a sanitary condition and ready for use?

  • Specify work station(s)

Hazard Communication & Chemicals

  • 1. GHS Labels are kept on shipped containers; including: product identifier, signal word, hazard statement(s), pictogram(s), precautionary statement(s), and supplier information.

  • Specify work station(s)

  • 2. GHS Compliant Labels on workplace containers where required (e.g., chemicals received in large containers that are transferred to smaller containers such as pails, vats, storage tanks etc).

  • Specify work station(s)

  • 3. All spray bottles are labeled with a GHS Compliant Label.

  • Specify work station(s)

  • 4. Employees understand labels received on shipped containers and details of the workplace labeling system. (e.g., where to get GHS Labels for spray bottles)

  • Specify work station(s)

  • 5. Employees understand SDS and where to find them.

  • Specify work station(s)

  • 6. Chemicals are kept in closed containers when not in use.

  • Specify work station(s)

  • 7. Aerosol cans are punctured and emptied before disposal.

  • Specify work station(s)

  • 8. Lid of Aerosol Disposal Puncturing Unit is kept closed when not in use.

  • Specify work station(s)

Environmental Management System

  • 1. Drums of new and/or used oil stored on a proper secondary containment pad.

  • 1b. Secondary containment pads is in good condition (no leaks, damage, dents).

  • Specify work station(s)

  • Indicate any issues found during inspection

  • Specify work station(s)

  • 2. Used absorbent pads and/or used absorbent materials disposed in proper container.

  • Specify work station(s)

  • 3. Used oil containers and/or pails are in good condition and labeled as "Used Oil".

  • Specify work station(s)

Electrical

  • 1. Disconnecting switches and circuit breakers are labeled to indicate their use or equipment served.

  • Specify work station(s)

  • 2. Cables and/or flexible cords with exposed wiring, frayed or deteriorated insulation, splices or taps present in work area.

  • Specify work station(s)

  • 3. Flexible cords are only used in continuous lengths without splice or tap.

  • Specify work station(s)

  • 4. Strain reliefs are free of exposed wiring, frayed/deteriorated insulation, splices or taps.

  • Specify work station(s)

  • 5. Electrical enclosures such as switches, receptacles, junction boxes, etc., equipped with tight-fitting covers or plates.

  • Specify work station(s)

  • 6. Multiple plug adaptors (e.g., power strips) are not used.

  • Specify work station(s)

  • 7. All extension cords are equipped with grounding conductor.

  • Specify work station(s)

  • 8. Extension cords are being used as permanent powers sources.

  • Specify work station(s)

Tools, Equipment and Machines

Grinders

  • 1. Bench and pedestal grinders are permanently mounted.

  • Specify work station(s)

  • 2. Abrasive grinders have safety guards that cover the spindle, nut and flange projections; the guards are mounted to maintain proper alignment with the wheel.

  • Specify work station(s)

  • 3. Safety Guards on Vertical or Right Angle Head portable grinder are located between the operator and wheel during use, and have a maximum exposure angle of 180 degrees.

  • Specify work station(s)

  • 4. The maximum revolutions per minute (rpm) rating of each abrasive wheel is compatible with the rpm rating of the grinder motor.

  • Specify work station(s)

  • 5. Each grinder has an individual on and off control switch.

  • Specify work station(s)

  • 6. New abrasive wheels are visually inspected and ring tested before they are mounted.

  • Specify work station(s)

  • 7. Splash guards are mounted on grinders that use coolant to prevent the coolant from reaching workers.

  • Specify work station(s)

Machinery & Equipment

  • 1. Fixed machines are anchored to prevent tipping or other movement.

  • Specify work station(s)

  • 2. Operator and other workers in the machine area are protected from hazards created at the point of operation, ingoing nip points, rotating parts, flying chips, and sparks.

  • Specify work station(s)

  • 3. Safe guards are in use (light curtains, cage doors, mezzanine gates, machine guards, dock chains, LOTO if applicable etc.)?

  • Specify work station(s)

  • 4. Moving chains and gears are properly guarded.

  • Specify work station(s)

  • 5. A power shut-off switch is provided within reach of the operator’s position at each machine.

  • Specify work station(s)

  • 6. Foot-operated switches are guarded or arranged to prevent accidental actuation by a person or falling object.

  • Specify work station(s)

  • 7. Manually operated valves and switches controlling operation of equipment/machines are clearly identified and readily accessible.

  • Specify work station(s)

  • 8. Emergency stop buttons are mushroom shaped, colored red and have a yellow collar legend plate labeled "EMERGENCY STOP".

  • Specify work station(s)

Cranes & Hoists

  • 1. All equipment with obvious signs of deterioration, leakage, or deformation is inspected daily.

  • Specify work station(s)

  • 2. Hooks with deformation or cracks and hoist chains, including end connections, are visually inspected daily.

  • Specify work station(s)

  • 3. The rated load of each hoist is legibly marked and visible to the operator.

  • Specify work station(s)

  • 4. Pendant control boxes are constructed to prevent electrical shock and have clearly labelled functions.

  • Specify work station(s)

  • 5. Pendant control stations are kept clean and function labels kept legible.

  • Specify work station(s)

  • 6. Are employees using twisted or kinked hoist chains or hoist ropes?

  • Specify work station(s)

  • 7. Are employees wrapping hoist ropes or hoist chains around the load as a substitute for a sling?

  • Specify work station(s)

  • 8. Loads are well secured and properly balanced before lifted more than a few inches.

  • Specify work station(s)

  • 9. Operators are instructed to avoid carrying loads above people, and provisions are made to ensure that no one is below hoisted material or equipment.

  • Specify work station(s)

  • 10. All unsafe conditions, identified by inspections, are corrected by designated workers before crane operation resumes.

  • Specify work station(s)

  • 11. Safety latches and other devices are used to prevent slippage of materials off hoisting hooks.

  • Specify work station(s)

  • 12. Chains, ropes, chokers, and slings are adequate for the materials they are securing.

  • Specify work station(s)

  • 13. Hoist controls are plainly marked to indicate the direction of travel or motion.

  • Specify work station(s)

Sign-off

Sign-off

  • Auditor

  • Plant Manager

  • Plant EHS

  • Additional Personnel

  • Additional Personnel

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