Warehouse Safety Inspection Report

• Kodiak Entity:

  DNI

  KURS

  Nevada
• Location
  Address

• Conducted On

  Date

• Performed By:

  Select David Nash Jesus Oliva Keith Gurczynski Kelly Butler

  • David Nash
  • Jesus Oliva
  • Keith Gurczynski
  • Kelly Butler

Documentation

• Warehouse Supervisor

  Select Jeff Haas Mark Spencer Shawn VanCromphaut

  • Jeff Haas
  • Mark Spencer
  • Shawn VanCromphaut

• Tailgate Safety Meetings Held Weekly & Documented?

  Yes

  No

• What Was Discussed? (ask this question to a warehouse worker)

• Employee State Posting Requirements Current?

  Yes

  No

• Powered Industrial Trucks California Poster Displayed In Warehouse?

  Yes

  No

  N/A

• Safety Data Sheet SDS Binder Current & Accessible?

  Yes

  No

• Emergency Evacuation Site Maps Displayed?

  Yes

  No

• Emergency Contact Phone Numbers Listed? (near evacuation maps or entrances)

  Yes

  No

• All Warning Signs / Posters Are Current & Legible Throughout The Warehouse? (authorized persons, no smoking, eyewash station, etc.)

  Yes

  No

Personal Protective Equipment & Housekeeping

• Warehouse Personnel & Visitors Utilizing Required PPE?

  Yes

  No

• What PPE Was Not Being Utilized?

  Select Safety Glasses Class II Safety Vest/ Shirt Boots Other

  • Safety Glasses
  • Class II Safety Vest/ Shirt
  • Boots
  • Other

• PPE Is Identifiable By Employees Name or Initials, If Not Stored In A Locker?

  Yes

  No

• Drinking Containers & Other Personal Items In Work Station Areas Are Identifiable By The Employee?

  Yes

  No

• Are There Any Exposed Fall Hazards Greater Than Four (4) feet? (i.e. Loading Docks, etc.)?

  Yes

  No

  N/A

• Is Fall Protection Available & Is It Being Used?

  Yes

  No

  N/A

• Housekeeping Throughout The Warehouse Is Acceptable? (floors free of trash, materials & equipment are stored out of the way, etc.)

  Good

  Fair

  Poor

• What Areas Need To Be Addressed?

• Floors Are Cleared Of Slips, Trips, and Fall Hazards?

  Yes

  No

• Floors Are Striped or Guarded Around Equipment. Machinery Striping or Guards Are In Good Condition (no peeling striping, guards fully shut, no sharp edges, etc.)

  Yes

  No

• First Aid Kit Stocked & Accessible?

  Yes

  No

• Are Contents Sterile & Unexpired?

  Yes

  No

• Eyewash Station Is Clean, Maintained & Easily Accessible?

  Yes

  No

• Eyewash Station Inspection Has Been Completed & Documented?

  Yes

  No

• When Eye Wash Fluid Last Changed?

• Fire Extinguishers Can Be Quickly Accessible?

  Yes

  No

• Fire Extinguishers Inspected & Documented Monthly?

  Yes

  No

• Fire Extinguishers Mounted On A Wall or Pole With Identifiable Signage?

  Yes

  No

• Exit / Egress Routes Are Clear & Free of Stored Materials / Items?

  Yes

  No

• Egress Routes Must Be Equal To or Greater Than 28"

• Exit Signs Lit & Unobstructed?

  Yes

  No

• Emergency Shut Off Valves Are Unobstructed?

  Yes

  No

• Material Storage Stacked Securely Within Load Limits

  Yes

  No

Chemical and Cylinder Storage

• Flammable Liquids & Chemicals Stored In Fire-Proof Storage Cabinet(s)?

  Yes

  No

• Is the Fire-Proof Storage Self-Closing?

  Yes

  No

• Is Toxic or Flammable Waste Being Disposed of Accordingly?

  Yes

  No

• Warning Signs / Posters Current & Legible?

  Yes

  No

• Chemical Containers Appropriately Labeled With Contents & Warnings?

  Yes

  No

  N/A

• Alternate Chemical Containers Labeled Properly?

  Yes

  No

  N/A

• Compressed Gas Cylinders Are Properly Secured / Stored?

  Yes

  No

  N/A

• Cylinder Valves / Caps Are Closed When Not In Use?

  Yes

  No

  N/A

• Is There Adequate Ventilation In The Warehouse From Chemicals/ Fumes?

  Yes

  No

  N/A

Electrical / Extension Cords & Hand Tools

• Note: Flexible (extension) cords are for temporary use only, interpreted as "no more than 30 days". OSHA prohibits flexible cords from being routed through doorways, window or walls. Extension Cords must be Disconnected and Stored at the End of Each Day

• Electrical Corded Hand Tools in Use?

  YES

  NO

• Electrical Corded Hand Tools Condition?

  Safe

  At Risk

  N/A

• Electrical Corded Tool Condition(s) Observed

  Select Cut/Torn/Burnt Power Cords Ground Prong Missing Guards Missing/Damaged Damaged Grips/Handles

  • Cut/Torn/Burnt Power Cords
  • Ground Prong Missing
  • Guards Missing/Damaged
  • Damaged Grips/Handles

• Are Unused Extension Cords Unplugged From Outlets?

  Yes

  No

  N/A

• Extension Cords Used in Compliance With OSHA Regulations?

  Yes

  No

  N/A

• Extension Cords In Good Condition?

  Yes

  No

  N/A

• Extension / Power Cords Routed Safely &/or Protected From Vehicle and Pedestrian Traffic?

  Yes

  No

  N/A

• Power Strips Plugged Directly Into Electrical Outlets And Not Extension Cords?

  Yes

  No

  N/A

• Are All Electrical Outlets In The Warehouse Covered?

  Yes

  No
Equipment & Machinery

Equipment & Machinery

• Is Equipment or Machinery In Use?

  Yes

  No

• Equipment Type & Model #:

  Select Amerecon Pyramid Roller Axis Panel Builder Dewalt DWS780 Chop Saw Ellis Mitre Band Saw Famco Hydraulic Shear Forstner De-Coiler & Slitter Grizzly 12 Speed Drill Press High Speed Pittsburgh Machine Jornes Brake Blue Machine Jornes TwinMatic Brake (21ft) MagnaBend Brake Pexto Manual Pyramid Roller Rockwell-Delta Table Saw Roper Whitney AutoBrake AB1016T Roper Whitney Manual Brake Schechtl Manual Finger Brake Striebig Panel Saw Taloc Clincher Tennsmith Shear Training Checklist Generic

  • Amerecon Pyramid Roller
  • Axis Panel Builder
  • Dewalt DWS780 Chop Saw
  • Ellis Mitre Band Saw
  • Famco Hydraulic Shear
  • Forstner De-Coiler & Slitter
  • Grizzly 12 Speed Drill Press
  • High Speed Pittsburgh Machine
  • Jornes Brake Blue Machine
  • Jornes TwinMatic Brake (21ft)
  • MagnaBend Brake
  • Pexto Manual Pyramid Roller
  • Rockwell-Delta Table Saw
  • Roper Whitney AutoBrake AB1016T
  • Roper Whitney Manual Brake
  • Schechtl Manual Finger Brake
  • Striebig Panel Saw
  • Taloc Clincher
  • Tennsmith Shear
  • Training Checklist Generic

• Equipment / Machinery in Safe Working Condition?

  Yes

  No

• Equipment / Machinery Operators Trained in Safe Operations & Procedures?

  Yes

  No

• Are Equipment / Machinery Inspections Completed and Documented Daily?

  Yes

  No

• Equipment / Machinery Warning Decals, Labels, & Signs Are Legible & In Place?

  Yes

  No

• Guards & Safety Devices in Place & Are In Good Condition?

  Yes

  No

• Hoses, Wires, Switches, & Pedals Are In Good Condition?

  Yes

  No

• Are Workers Practicing Safe Working Methods?

  Yes

  No

• Is The work Station Free Of Clutter/ Protruding Objects or Sharp Corners?

  Yes

  No

• Other Comments

LOTO Equipment & Machinery

• Any Equipment/ Machinery Under Lock Out Tag Out?

  YES

  NO

• Equipment Type & Model #:

  Select Amerecon Pyramid Roller Axis Panel Builder Dewalt DWS780 Chop Saw Ellis Mitre Band Saw Famco Hydraulic Shear Forstner De-Coiler & Slitter Grizzly 12 Speed Drill Press High Speed Pittsburgh Machine Jornes Brake Blue Machine Jornes TwinMatic Brake (21ft) MagnaBend Brake Pexto Manual Pyramid Roller Rockwell-Delta Table Saw Roper Whitney AutoBrake AB1016T Roper Whitney Manual Brake Schechtl Manual Finger Brake Striebig Panel Saw Taloc Clincher Tennsmith Shear Training Checklist Generic

  • Amerecon Pyramid Roller
  • Axis Panel Builder
  • Dewalt DWS780 Chop Saw
  • Ellis Mitre Band Saw
  • Famco Hydraulic Shear
  • Forstner De-Coiler & Slitter
  • Grizzly 12 Speed Drill Press
  • High Speed Pittsburgh Machine
  • Jornes Brake Blue Machine
  • Jornes TwinMatic Brake (21ft)
  • MagnaBend Brake
  • Pexto Manual Pyramid Roller
  • Rockwell-Delta Table Saw
  • Roper Whitney AutoBrake AB1016T
  • Roper Whitney Manual Brake
  • Schechtl Manual Finger Brake
  • Striebig Panel Saw
  • Taloc Clincher
  • Tennsmith Shear
  • Training Checklist Generic

• Is Equipment/Machinery Currently Under Service or Repair? (including tooling changes)

  Yes

  No

• Describe Safety Deficiency or Problem:

• Who is Performing the Service or Repair?

  Select Kodiak Personnel Factory Technician Outside Indepentdent Contractor

  • Kodiak Personnel
  • Factory Technician
  • Outside Indepentdent Contractor

• All Authorized Personnel Have Applied Their Own Lock to the Lock Out Device?

  Yes

  No

• Are All LOTO Tags Properly Completed? (legible name/date, remarks & a unused new tag)

  Yes

  No

Warehouse Vehicles

• Is There Any Warehouse Vehicle(s) Currently In Use?

  YES

  NO

• What Vehicle(s) Is Currently In Use?

  Select Forklift Sweeper Other

  • Forklift
  • Sweeper
  • Other

• What Forklift(s) are being used?

  Select CAT Hysters Komatsu Other

  • CAT
  • Hysters
  • Komatsu
  • Other

• Who Is The Forklift Operator?

  Select

• Forklift Operators Certified & Certifications Current?

  Select Yes No

  • Yes
  • No

• Have All Forklifts Been Inspected Daily & Documented?

  Yes

  No

• Forklift Operators Observed:

  Select Operating Safely Not Wearing Seatbelt Not Using Horn as Needed No Look Behind Before Reversing Travelling w/ Load Raised Reckless Operation Other

  • Operating Safely
  • Not Wearing Seatbelt
  • Not Using Horn as Needed
  • No Look Behind Before Reversing
  • Travelling w/ Load Raised
  • Reckless Operation
  • Other

• Are Forklifts Equipped With A Fire Extinguisher?

  Yes

  No

• Has It Been Inspected For The Month & Is It Fully Charged?

  Yes

  No

• Has The Sweeper Been Inspected Daily & Documented?

  Yes

  No

• Sweeper Operators Observed:

  Select Operating Safely Not Wearing Seatbelt Not Using Horn as Needed No Look Behind Before Reversing Travelling w/ Load Raised Reckless Operation Other

  • Operating Safely
  • Not Wearing Seatbelt
  • Not Using Horn as Needed
  • No Look Behind Before Reversing
  • Travelling w/ Load Raised
  • Reckless Operation
  • Other

• What Equipment Is Being Used?

• Does This Equipment Require A Certification?

  Yes

  No

• Is The Operator Certified?

  Select Amerecon Pyramid Roller Axis Panel Builder Dewalt DWS780 Chop Saw Ellis Mitre Band Saw Famco Hydraulic Shear Forstner De-Coiler & Slitter Grizzly 12 Speed Drill Press High Speed Pittsburgh Machine Jornes Brake Blue Machine Jornes TwinMatic Brake (21ft) MagnaBend Brake Pexto Manual Pyramid Roller Rockwell-Delta Table Saw Roper Whitney AutoBrake AB1016T Roper Whitney Manual Brake Schechtl Manual Finger Brake Striebig Panel Saw Taloc Clincher Tennsmith Shear Training Checklist Generic

  • Amerecon Pyramid Roller
  • Axis Panel Builder
  • Dewalt DWS780 Chop Saw
  • Ellis Mitre Band Saw
  • Famco Hydraulic Shear
  • Forstner De-Coiler & Slitter
  • Grizzly 12 Speed Drill Press
  • High Speed Pittsburgh Machine
  • Jornes Brake Blue Machine
  • Jornes TwinMatic Brake (21ft)
  • MagnaBend Brake
  • Pexto Manual Pyramid Roller
  • Rockwell-Delta Table Saw
  • Roper Whitney AutoBrake AB1016T
  • Roper Whitney Manual Brake
  • Schechtl Manual Finger Brake
  • Striebig Panel Saw
  • Taloc Clincher
  • Tennsmith Shear
  • Training Checklist Generic

• Has That Equipment Been Inspected Before Use?

  Yes

  No

• Observations

  Select Operating Safely Not Wearing Seatbelt Not Using Horn as Needed No Look Behind Before Reversing Travelling w/ Load Raised Reckless Operation Other

  • Operating Safely
  • Not Wearing Seatbelt
  • Not Using Horn as Needed
  • No Look Behind Before Reversing
  • Travelling w/ Load Raised
  • Reckless Operation
  • Other

• Additional Observations & Feedback?

  Select No Additional Notes Positive Feedback Safety Observations

  • No Additional Notes
  • Positive Feedback
  • Safety Observations

• I have reviewed this Report/Audit and will address the deficiencies noted herein

  Yes

  No

  N/A

• Supervisor/Responsible Person:

  Sign