Information
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Kodiak Entity:
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Location
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Conducted On
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Performed By:
- David Nash
- Jesus Oliva
- Keith Gurczynski
- Kelly Butler
Documentation
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Warehouse Supervisor
- Jeff Haas
- Mark Spencer
- Shawn VanCromphaut
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Tailgate Safety Meetings Held Weekly & Documented?
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What Was Discussed? (ask this question to a warehouse worker)
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Employee State Posting Requirements Current?
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Powered Industrial Trucks California Poster Displayed In Warehouse?
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Safety Data Sheet SDS Binder Current & Accessible?
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Emergency Evacuation Site Maps Displayed?
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Emergency Contact Phone Numbers Listed? (near evacuation maps or entrances)
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All Warning Signs / Posters Are Current & Legible Throughout The Warehouse? (authorized persons, no smoking, eyewash station, etc.)
Personal Protective Equipment & Housekeeping
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Warehouse Personnel & Visitors Utilizing Required PPE?
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What PPE Was Not Being Utilized?
- Safety Glasses
- Class II Safety Vest/ Shirt
- Boots
- Other
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PPE Is Identifiable By Employees Name or Initials, If Not Stored In A Locker?
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Drinking Containers & Other Personal Items In Work Station Areas Are Identifiable By The Employee?
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Are There Any Exposed Fall Hazards Greater Than Four (4) feet? (i.e. Loading Docks, etc.)?
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Is Fall Protection Available & Is It Being Used?
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Housekeeping Throughout The Warehouse Is Acceptable? (floors free of trash, materials & equipment are stored out of the way, etc.)
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What Areas Need To Be Addressed?
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Floors Are Cleared Of Slips, Trips, and Fall Hazards?
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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.)
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First Aid Kit Stocked & Accessible?
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Are Contents Sterile & Unexpired?
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Eyewash Station Is Clean, Maintained & Easily Accessible?
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Eyewash Station Inspection Has Been Completed & Documented?
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When Eye Wash Fluid Last Changed?
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Fire Extinguishers Can Be Quickly Accessible?
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Fire Extinguishers Inspected & Documented Monthly?
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Fire Extinguishers Mounted On A Wall or Pole With Identifiable Signage?
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Exit / Egress Routes Are Clear & Free of Stored Materials / Items?
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Egress Routes Must Be Equal To or Greater Than 28"
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Exit Signs Lit & Unobstructed?
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Emergency Shut Off Valves Are Unobstructed?
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Material Storage Stacked Securely Within Load Limits
Chemical and Cylinder Storage
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Flammable Liquids & Chemicals Stored In Fire-Proof Storage Cabinet(s)?
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Is the Fire-Proof Storage Self-Closing?
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Is Toxic or Flammable Waste Being Disposed of Accordingly?
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Warning Signs / Posters Current & Legible?
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Chemical Containers Appropriately Labeled With Contents & Warnings?
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Alternate Chemical Containers Labeled Properly?
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Compressed Gas Cylinders Are Properly Secured / Stored?
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Cylinder Valves / Caps Are Closed When Not In Use?
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Is There Adequate Ventilation In The Warehouse From Chemicals/ Fumes?
Electrical / Extension Cords & Hand Tools
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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
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Electrical Corded Hand Tools in Use?
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Electrical Corded Hand Tools Condition?
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Electrical Corded Tool Condition(s) Observed
- Cut/Torn/Burnt Power Cords
- Ground Prong Missing
- Guards Missing/Damaged
- Damaged Grips/Handles
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Are Unused Extension Cords Unplugged From Outlets?
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Extension Cords Used in Compliance With OSHA Regulations?
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Extension Cords In Good Condition?
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Extension / Power Cords Routed Safely &/or Protected From Vehicle and Pedestrian Traffic?
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Power Strips Plugged Directly Into Electrical Outlets And Not Extension Cords?
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Are All Electrical Outlets In The Warehouse Covered?
Equipment & Machinery
Equipment & Machinery
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Is Equipment or Machinery In Use?
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Equipment Type & Model #:
- 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
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Equipment / Machinery in Safe Working Condition?
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Equipment / Machinery Operators Trained in Safe Operations & Procedures?
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Are Equipment / Machinery Inspections Completed and Documented Daily?
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Equipment / Machinery Warning Decals, Labels, & Signs Are Legible & In Place?
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Guards & Safety Devices in Place & Are In Good Condition?
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Hoses, Wires, Switches, & Pedals Are In Good Condition?
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Are Workers Practicing Safe Working Methods?
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Is The work Station Free Of Clutter/ Protruding Objects or Sharp Corners?
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Other Comments
LOTO Equipment & Machinery
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Any Equipment/ Machinery Under Lock Out Tag Out?
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Equipment Type & Model #:
- 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
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Is Equipment/Machinery Currently Under Service or Repair? (including tooling changes)
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Describe Safety Deficiency or Problem:
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Who is Performing the Service or Repair?
- Kodiak Personnel
- Factory Technician
- Outside Indepentdent Contractor
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All Authorized Personnel Have Applied Their Own Lock to the Lock Out Device?
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Are All LOTO Tags Properly Completed? (legible name/date, remarks & a unused new tag)
Warehouse Vehicles
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Is There Any Warehouse Vehicle(s) Currently In Use?
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What Vehicle(s) Is Currently In Use?
- Forklift
- Sweeper
- Other
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What Forklift(s) are being used?
- CAT
- Hysters
- Komatsu
- Other
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Who Is The Forklift Operator?
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Forklift Operators Certified & Certifications Current?
- Yes
- No
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Have All Forklifts Been Inspected Daily & Documented?
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Forklift Operators Observed:
- Operating Safely
- Not Wearing Seatbelt
- Not Using Horn as Needed
- No Look Behind Before Reversing
- Travelling w/ Load Raised
- Reckless Operation
- Other
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Are Forklifts Equipped With A Fire Extinguisher?
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Has It Been Inspected For The Month & Is It Fully Charged?
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Has The Sweeper Been Inspected Daily & Documented?
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Sweeper Operators Observed:
- Operating Safely
- Not Wearing Seatbelt
- Not Using Horn as Needed
- No Look Behind Before Reversing
- Travelling w/ Load Raised
- Reckless Operation
- Other
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What Equipment Is Being Used?
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Does This Equipment Require A Certification?
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Is The Operator Certified?
- 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
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Has That Equipment Been Inspected Before Use?
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Observations
- Operating Safely
- Not Wearing Seatbelt
- Not Using Horn as Needed
- No Look Behind Before Reversing
- Travelling w/ Load Raised
- Reckless Operation
- Other
Review
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Additional Observations & Feedback?
- No Additional Notes
- Positive Feedback
- Safety Observations
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I have reviewed this Report/Audit and will address the deficiencies noted herein
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Supervisor/Responsible Person: