1.0 - Confined Spaces

  • 1.1 - Are confined spaces marked with appropriate signage?

  • 1.2 - Comments/Other Observations

2.0 - Electrical

  • 2.1 - Insulation on flexible and extension cords?

  • 2.2 - Ground pins on flexible and extension cords?

  • 2.3 - Extension cords used as temporary wiring only?

  • 2.4 - Comments/Other Observations

3.0 - Fire Prevention

  • 3.1 - Are fire extinguishers available and unobstructed?

  • 3.2 - Are fire extinguishers inspected monthly?

  • 3.3 - Flammable liquids stored properly (safety cans or storage cabinets)?

  • 3.4 - Comments/Other Observations

4.0 - First Aid and Emergency Action

  • 4.1 First aid supplies are available and stocked?

  • 4.2 - Chemical spill kits are available and stocked?

  • 4.3 - Are exits clearly marked and access is unobstructed?

  • 4.4 - Comments/Other Observations

5.0 - Hand and Power Tools

  • 5.1 - Electrical power tools are grounded or double insulated?

  • 5.2 - Insulation is intact?

  • 5.3 - Appropriate PPE is worn with Hand/Power Tool?

  • 5.4 - Knives are stored properly (in sheaths or on wall)? Safety knives are functional (blade is covered when not in use)?

  • 5.5 - Comments/Other Observations

6.0 - Hazard Communication

  • 6.1 - Chemical containers are labeled appropriately (product identifier, pictograms, signal word, hazard and precautionary statements)?

  • 6.2 - Chemical containers are kept closed when not in use?

  • 6.3 - Comments/Other Observations

7.0 - Material Handling and Storage

  • 7.1 - Are all containers, skids, pallets, materials, and equipment arranged neatly and orderly in assigned areas?

  • 7.2 - Is material stored so it does not obstruct sprinkler heads, electrical panels, eyewash stations and fire extinguishers? (18” from sprinklers, 3’ for other equipment)

  • 7.3 - Are pre-shift inspections documented for powered industrial trucks (forklifts, electric pallet jacks, walkie-stackers)?

  • 7.4 - Are heavy items stored on lower shelves?

  • 7.5 - Have items been properly secured to prevent tipping/falling?

  • 7.6 - Are materials stored or stacked in a safe manner?

  • 7.7 - Are safety devices functioning on forklifts (horns, lights, back-up alarms)?

  • 7.8 - Storage racks are maintained (not damaged)?

  • 7.9 - Comments/Other Observations

8.0 - Personal Protective Equipment

  • 8.1 - Are lab coats worn by lab personnel?

  • 8.2 - Appropriate PPE is worn with autoclaves?

  • 8.3 - Appropriate PPE is worn while using cleaning chemicals?

  • 8.4 - Comments/Other Observations

9.0 - Signs, Signals, Barricades

  • 9.1 - Wet floor signs are used during cleaning or liquids on the floor?

  • 9.2 - Caution signs are used when hoses are on the floor?

  • 9.3 - Comments/Other Observations

10.0 - Walking-Working Surfaces

  • 10.1 - Are areas free of trip hazards?

  • 10.2 - Are aisles free from obstructions (skids, scrap, banding)?

  • 10.3 - Portable ladders are used properly?

  • 10.4 - Safe access/egress is provided and used for walking-working surfaces?

  • 10.5 - Comments/Other Observations

11.0 - Welding and Cutting

  • 11.1 - Hot work permit is completed?

  • 11.2 - A fire watch is provided?

  • 11.3 - Combustibles and flammables are 35 ft from operations or are effectively shielded?

  • 11.4 - Comments/Other Observations

Sign Off

  • Reviewer's signature

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