Title Page
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Office/Operating Unit
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Location
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Conducted on
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Prepared by
Job details & specifics of job at time of evaluation
Federal and State Required Information
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OSHA Poster visible and Current
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Work Comp poster visable and current
Housekeeping
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General housekeeping and floor condition
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Doorways not obstructed.
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Work area free of debris
Personal Protective Equipment
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Safety Glasses
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Gloves (Appropriate for the task)
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Face Shield/Goggles (If required)
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Foot Protection
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Hearing Protection
Electrical Hazrds
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GFCI is provided and operational (within 24" of water supply and outdoors)
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Clearance at electrical boxes is 30"-36"
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Electrical box cover is kept closed
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Are Plug holes filled
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Are all Breakers labeled
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General condition of light fixtures, switch & plug plate guarding
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Extension Cord for signs of damage
Fire Protection
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Are EXITS properly marked and light is operational
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Fire extinguishers location marked and visiable
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Fire extinguisher inspected
Health and Safety
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Is proper social distancing being used (6')
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If not are nose and mouth coverings utilized
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Are hand wash stations/ sanitizer available
Power hand Tools and Equipment
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General Condition
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Proper Guards
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Check guarding on pedestal/ bench grinders (1/8" bottom and 1/4" top)
Compressed Gas Cylinders
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Properly Located
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Properly Secured/Guarded
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Check regulator gauges, hose & torch condition for damage
Flammable Liquids
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Appropriate cabinet
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Approved containers
Material Storage
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Safely piled or stacked
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Properly bundled or contaninerized
Safety Data Sheets/Right To Know Station
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Are Safety Data Sheets available
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Eye wash available.
Forklift
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Daily Inspection Complete
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Seatbelt being used
Notes
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Briefly describe daily work or tasks
SIGN OFF
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Safety Representative
