Information
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Conducted on
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Prepared by
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Date/Time
1.0 - Confined Spaces
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1.1 - Are confined spaces marked with appropriate signage?
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1.2 - Comments/Other Observations
2.0 - Electrical
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2.1 - Insulation on flexible and extension cords?
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2.2 - Ground pins on flexible and extension cords?
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2.3 - Extension cords used as temporary wiring only?
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2.4 - Comments/Other Observations
3.0 - Fire Prevention
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3.1 - Are fire extinguishers available and unobstructed?
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3.2 - Are fire extinguishers inspected monthly?
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3.3 - Flammable liquids stored properly (safety cans or storage cabinets)?
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3.4 - Comments/Other Observations
4.0 - First Aid and Emergency Action
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4.1 First aid supplies are available and stocked?
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4.2 - Chemical spill kits are available and stocked?
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4.3 - Are exits clearly marked and access is unobstructed?
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4.4 - Comments/Other Observations
5.0 - Hand and Power Tools
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5.1 - Electrical power tools are grounded or double insulated?
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5.2 - Insulation is intact?
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5.3 - Appropriate PPE is worn with Hand/Power Tool?
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5.4 - Knives are stored properly (in sheaths or on wall)? Safety knives are functional (blade is covered when not in use)?
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5.5 - Comments/Other Observations
6.0 - Hazard Communication
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6.1 - Chemical containers are labeled appropriately (product identifier, pictograms, signal word, hazard and precautionary statements)?
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6.2 - Chemical containers are kept closed when not in use?
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6.3 - Comments/Other Observations
7.0 - Material Handling and Storage
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7.1 - Are all containers, skids, pallets, materials, and equipment arranged neatly and orderly in assigned areas?
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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)
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7.3 - Are pre-shift inspections documented for powered industrial trucks (forklifts, electric pallet jacks, walkie-stackers)?
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7.4 - Are heavy items stored on lower shelves?
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7.5 - Have items been properly secured to prevent tipping/falling?
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7.6 - Are materials stored or stacked in a safe manner?
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7.7 - Are safety devices functioning on forklifts (horns, lights, back-up alarms)?
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7.8 - Storage racks are maintained (not damaged)?
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7.9 - Comments/Other Observations
8.0 - Personal Protective Equipment
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8.1 - Are lab coats worn by lab personnel?
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8.2 - Appropriate PPE is worn with autoclaves?
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8.3 - Appropriate PPE is worn while using cleaning chemicals?
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8.4 - Comments/Other Observations
9.0 - Signs, Signals, Barricades
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9.1 - Wet floor signs are used during cleaning or liquids on the floor?
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9.2 - Caution signs are used when hoses are on the floor?
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9.3 - Comments/Other Observations
10.0 - Walking-Working Surfaces
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10.1 - Are areas free of trip hazards?
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10.2 - Are aisles free from obstructions (skids, scrap, banding)?
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10.3 - Portable ladders are used properly?
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10.4 - Safe access/egress is provided and used for walking-working surfaces?
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10.5 - Comments/Other Observations
11.0 - Welding and Cutting
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11.1 - Hot work permit is completed?
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11.2 - A fire watch is provided?
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11.3 - Combustibles and flammables are 35 ft from operations or are effectively shielded?
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11.4 - Comments/Other Observations
Sign Off
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Reviewer's signature