Title Page

  • Building Number

  • Area Being Inspected

  • Conducted on

  • Prepared by

Part 1: Hazard Identification

Emergency

  • Are means of egress clear and unobstructed?ise

  • Is access to fire extinguishers and emergency equipment clear and unobstructed?

  • Are fire extinguishers and eyewash stations currwnt on inspections?

  • Are all entrance doors into stairwells & exterior exit doors identified with exit signage?

Housekeeping

  • Is the floor free of debris and slippery conditions?

  • Are items stored neatly to prevent hazards?

  • Does the housekeeping in the area meet site internal standards?

Machine - Equipment - Tools

  • Is all equipment in safe working condition?

  • Are tools and equipment being used properly?

  • Are proper guards in place on tools and equipment?

Lockout Tagout

  • During maintenance or potential exposure to hazardous energy, are all energy sources locked out?

  • Is one person - one lock on every point of power being locked out?

  • Are lockout procedures and equipment available?

Electrical Safety

  • Are all flexible cords and cables free of cracks, cuts, frays, and knots?

  • Are extension cords being used appropriately and only for temporary use?

  • Are all cords off the floor or inside of cord cover device

  • Are the faceplates on outlets and switches in good condition?

Other

  • Are all containers appropriately labeled? ( GHS Labels on secondary containers)

  • Is all mobile equipment in the area inspected and in good condition?

  • Are flammables stored properly and cabinets free of combustible materials with no items stored on top?

Identified Hazards and Corrective Actions:

  • Please list identified hazards and recommended corrective actions.

Part 2: Behavior Observation

PPE

  • Is required PPE available and being worn?

  • Is PPE adequate for the job?

  • Is PPE in good condition?

Safety Procedure

  • Are procedures in place to protect people from injury?

  • Are safety procedures being followed?

  • Are safety procedures adequate.to protect employees?

Position

  • Is there a possibility of an employee being struck by or against any object?

  • Is there a possibility for the employee to be caught in or between an object?

  • Is there a possibility for the employee to fall?

  • Does the potential for injury exist from overexertion, awkward postures, or repetative motions?

Reaction of People

  • Do employees appear to have eyes on task?

  • Do employees appear to be rushing?

Other

  • Was there any other unsafe behavior observed during your inspection?

  • Recognized unsafe behavior...

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