UFCW Sample Checklist

• Area of inspection

  Select

• Date of inspection:

  Date

• Inspection team members: (names)

• Union members:

• Management members:

• Prepared by

• Location
  Address

Fire/Chemical Releases/Emergency Evacuations

• Is there a written Emergency Action Plan?

  Yes

  No

• Have all workers received training about what do to in an emergency?

  Yes

  No

• Have all workers received training about evacuation procedures?

  Yes

  No

• Are evacuation routes well marked?

  Yes

  No

• Are all exits clearly marked and free of obstructions?

  Yes

  No

• Yes

  No

Electrical Hazards

• Are electrical boxes covered?

  Yes

  No

• Is all electrical equipment grounded (three-pronged plugs)?

  Yes

  No

• Is electrical wiring, including all temporary wiring, regularly inspected for breaks, fraying or other deterioration?

  Yes

  No

• Are fuses and circuit breakers the right type and size for the load?

  Yes

  No

Machine Guarding

• Are the following areas guarded?

  Yes

  No

• Moving machinery parts?

  Yes

  No

• Points of operation?

  Yes

  No

• Pinch points and nip points?

  Yes

  No

• Chains, sprockets, gears, pulleys?

  Yes

  No

• Rotating shafts?

  Yes

  No

• Are band saw blades guarded above guide rollers?

  Yes

  No

• Are machine guards only removed when the machine has been locked/tagout out?

  Yes

  No

• Are on/off switches/emergency stop buttons easy to reach?

  Yes

  No

Walking/Working Surfaces

• Are floors free from protruding nails, holes, ruts, loose or uneven grates?

  Yes

  No

• Is there adequate drainage to prevent water accumulation?

  Yes

  No

• Are slip-proof mats or flooring materials used at work stations?

  Yes

  No

• Does the company ensure that fat, blood, pieces of meat or other products that could cause slippery conditions are regularly cleaned up and removed?

  Yes

  No

Lockout/Tagout

• Are all machines/equipment capable of being locked out?

  Yes

  No

• Are machines and equipment properly locked out when maintenance, repair, unjamming, cleaning, adjusting or making tool changes takes place?

• Are all “authorized employees” trained in lockout/tagout?

  Yes

  No

• Have all “affected employees” been trained in lockout/tagout?

  Yes

  No

Ergonomics – Musculoskeletal Disorders (MSDs)

• Are jobs evaluated for risk factors that can cause MSDs?

  Yes

  No

• Are ergonomics controls used to reduce or eliminate the risk factors that have been identified to cause MSDs ?

  Yes

  No

• Is there a knife/scissor sharpening schedule in place?

  Yes

  No

• Is a medical surveillance program in place for workers who are suffering from early symptoms of carpal tunnel syndrome or other MSDs?

  Yes

  No

• Are adjustable work stands available to all workers who need them?

Noise

• Have noise surveys been conducted to identify high noise areas?

  Yes

  No

• Have all workers who are exposed to noise levels greater than 85 dBA been identified?

  Yes

  No

• Have workers exposed to high noise levels (greater than 85 dBA) received the following:

  Yes

  No

• Baseline hearing exams (conducted with 6 months of exposure to high noise levels)?

  Yes

  No

• Annual hearings exams (audiograms)?

  Yes

  No

• Copies of their hearing exam results?

  Yes

  No

• Free hearing protection (ear muffs or ear plugs)?

  Yes

  No

• Training on effects of high noise exposure?

  Yes

  No

• In areas of noise levels greater than 90 dBA, has the company tried to use engineering controls to reduce noise levels?

  Yes

  No

Heat

• Are workers in high heat areas given time to adjust to working in the heat (this takes about a week)?

  Yes

  No

• Are fans used in hot areas?

  Yes

  No

• Is local exhaust ventilation used to remove heat and humidity?

  Yes

  No

• Are workers and supervisors trained to recognized symptoms of heat stress?

  Yes

  No

• Are water and liquids made available to workers in hot areas?

  Yes

  No

• Are these workers allowed to drink water whenever they need to?

  Yes

  No

Cold

• Can coolers/freezers be opened from the inside?

  Yes

  No

• Are workers provided adequate clothing (gloves, hats, boots, freezer suits) when working in cold work areas?

  Yes

  No

• Are freezer tunnels guarded to prevent worker exposure to blasts of cold air?

  Yes

  No

• Are workers in cold areas protected from wind chill caused by blowers, fans, air distribution systems?

  Yes

  No

Forklifts and Powered Industrial Trucks

• Are walkways and passageways clearly marked for safe operation of forklifts?

  Yes

  No

• Are forklift and powered industrial truck operations properly trained?

  Yes

  No

• Are fork trucks equipped with overhead guards?

  Yes

  No

• Are forklifts that need repair taken out of service?

  Yes

  No

Chemical Exposure

• Have workers received training about hazardous chemicals?

  Yes

  No

• Is the training provided in a language workers can understand?

  Yes

  No

• Do all workers know how to get access to Material Safety Data Sheets?

  Yes

  No

• Are eye wash stations located in areas where caustic chemicals are used?

  Yes

  No

• Are eye wash stations in good working order?

  Yes

  No

• Are workers working around hazardous chemicals supplied with proper personal protective equipment (PPE)?

  Yes

  No

• Is the PPE provided at no cost to the worker?

  Yes

  No

• Does the PPE fit properly?

  Yes

  No