Information

  • Client / Site

  • Conducted on

  • Prepared by:

Postings

  • 6-in-1 Poster is in on site and in an area where staff congregate.

  • Posting of what to do and where to go in case of an emergency.

  • Emergency phone numbers are posted by phones, and includes the venue location, the venue phone number and the venue address (building).

  • Fire emergency exit procedure and rally point is posted.

  • Accident reporting procedure is posted or may be included in the UDS safety binder.

  • Safety meeting minutes are posted and available for staff to review.

SDS Binder

  • The SDS binder is on site and is available for staff to review.

  • An index of SDSs is included in the binder.

  • Chemical is chosen at random and the SDS is in the binder and index.

  • The record of training information document is included in the SDS binder.

UDS Safety Binder

  • The employee Right To Know written program is accessible for staff to review. The PPE hazard assessment must be included in the binder as well.

  • Hard copies of the monthly training sessions must be in the binder training section.

  • The staff training roster must be in the training section. The names and signatures of the staff, the date of training and the trainer must be included on the roster.

Personal Protective Equipment

  • All staff must be aware of the proper PPE required for tasks in the venues.

  • Staff must be aware of the procedures to replace lost, damaged or worn PPE, or whom to contact for assistance.

  • PPE use is enforced. Look for evidence of use and care. Specifically look for cut gloves, hot towels, eye protection.

Equipment

  • Eyewash is present, and the weekly documentation is completed.

  • Slicers, choppers and mixer guards are in place.

  • Slicers are unplugged if not in use, or if being serviced cleaned or maintained.

First Aid

  • A first aid kit is available, and is stocked with adequate supplies.

Housekeeping

  • The house floors, cooler floors, and freezer floors are dry.

  • Safety cones or sandwich signs are used for wet areas.

  • The venue is clear of trip hazards.

  • Knives are stored to prevent cuts. They are not left in sinks nor extending past the edges of tables.

  • Swinging doors have see through panels.

  • Broken glass is placed in clearly marked containers.

Ergonomics

  • Tasks that require hours of repetitive hand work, bending or stooping are structured to provide periodic relief.

  • Heavy items over 30 lbs. are not stored above shoulder height.

  • Heavy items over 30 lbs. are not stored below knee height.

  • A step ladder is available that is in good repair, and is tall enough to reach without standing upon the top rung.

Fire Safety

  • Fire extinguishers are properly mounted, and the inspections are up to date.

  • Egress routes are not blocked.

  • Materials on storage shelves are at least 18'' from ceiling and sprinkler heads.

  • Exits have signs and are illuminated if required.

  • Fire alarm pull stations are not blocked.

  • Flammables are stored properly and quantities are not excessive for the building control area.

Chemical Safe Use

  • Chemicals are stored away from food.

  • Chemicals are titrated properly.

  • Chemical containers are properly labeled.

  • Instructions for chemical safe use are available and training has been completed (SOPs for safe use).

  • All chemicals are labeled with manufacturer lable (GHS standard). Labels for secondary containers display the contents and a hazard warning. Manufacturer supplied secondary containers are acceptable.

Electrical Safety

  • Extension cords are in good condition and not used as a substitute for permanent wiring.

  • Plug ends, strain relief and cord insulation are in good condition and the ground prong is intact.

  • Electrical panels have 36 inches of unobstructed space in front of panel.

Other

  • Staff jewelry does not dangle if worn.

  • CO2 cylinders are secured or chained.

  • Scoring:
    95-100 % - Excellent.
    87-94 % - Acceptable.
    80-86 % - Needs Improvement. A written response to this evaluation is requested within 30 days.
    79% - or below. Unacceptable. An action plan is required within 48 hours.
    You may send your response by email to Nelson Hard at: hardx012@umn.edu.
    Please use the subject line of this report as the subject line of your email.

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.