Walkaround Form

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

• Form

Supervisors Walk around Checklist

• LOCATION

• DATE

  Date

• IF NO PLEASE EXPLAIN

• Are walking surfaces free of water, snow/ice, oils, or other fluids?

  Yes

  No

  N/A

• Are walkways, doorways and stairways clear of obstructions and properly marked?

  Yes

  No

  N/A

• Are steps and handrails in good condition?

  Yes

  No

  N/A

• Are work areas and equipment cleared of excessive debris or tools?

  Yes

  No

  N/A

• Are machine guards in place on all operating equipment?

  Yes

  No

  N/A

• Is general housekeeping ok?

  Yes

  No

  N/A

• Are ladders free of defects?

  Yes

  No

  N/A

• Are all conveyors properly guarded?

  Yes

  No

  N/A

• Are lights in good working condition?

  Yes

  No

  N/A

• Do all electrical panels have a 3ft clear radius in front of them?

  Yes

  No

  N/A

• Are all electrical panel boxes properly marked and free of openings?

  Yes

  No

  N/A

• Are all power points and switches free of obvious defects?

  Yes

  No

  N/A

• Are all electrical cords free from any fluids or debris, or show wear or fraying?

  Yes

  No

  N/A

• Are grinders in compliance? (Workrest 1/8" max and tongue guard 1/4" max)

  Yes

  No

  N/A

• Does all machinery have the proper LOTO instructions?

  Yes

  No

  N/A

• Are all containers holding fluids properly marked?

  Yes

  No

  N/A

• Are daily equipment checklists done for equipment in your area; with defects noted?

  Yes

  No

  N/A

• Are equipment cabs clean of debris? (IE: Cranes, loaders, Forklifts, etc.)

  Yes

  No

  N/A

• Are Vehicle Condition Reports done for all trucks and trailers with defects noted?

  Yes

  No

  N/A

• Are truck cabs clean of debris?

  Yes

  No

  N/A

• Are trucks complying the five minute noidling law?

  Yes

  No

  N/A

• Are walkarounds, safety talks, safety huddles and spill inspections complete/on time?

  Date

• Are all employees wearing the proper PPE?

  Yes

  No

  N/A

• Are all fire extinguishers properly inspected and locations marked?

  Yes

  No

  N/A

• Are all cylinder bottles properly secured?

  Yes

  No

  N/A

• Are all unused pieces of mobile equipment locked and the key removed?

  Yes

  No

  N/A

• Are all piles of scrap stable?

  Yes

  No

  N/A

• Are all gaylords and bales properly stacked?

  Yes

  No

  N/A

• Are eyewash station inspections current?

  Yes

  No

  N/A

• Are specific safety procedures being followed? (IE: LOTO, Confined Space, Fall Protection)

  Yes

  No

  N/A

• Are outside contractors safety compliant and the form signed?

  Yes

  No

  N/A

• Employee behavior observed (Whether within the confines of Co. policy or in violation)

  Yes

  No

  N/A

• Employee safety suggestions

  Yes

  No

  N/A

• SUPERVISOR REVIEWING: Print

• Signature

  Sign

• SUPERVISOR CONDUCTING: Print

• Signature

  Sign

• EMPLOYEE CONDUCTING: Print

• Signature

  Sign