Work Health & Safety checks - duplicate

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Emergency Response/Fire Protection

• Fire extinguishers inspected monthly and unblocked?

  Yes

  No

  N/A

• Employees aware of emergency procedures and where assembly areas are? (Interview >=2 employees)

  Yes

  No

  N/A

• Eyewash/Safety Shower stations inspected and unblocked?

  Yes

  No

  N/A

• Sufficient emergency equipment installed in the area?<br> -Fire extinguishers, eyewash, safety shower, spill kits, alarm pull stations, etc.

  Yes

  No

  N/A

Electrical

• Is there any loose wiring?<br>

  Yes

  No

  N/A

• Are the power points in good condition?

  Yes

  No

  N/A

Employee questions

• Employee Name

  Sign

• Do you know who the Health and Safety Officer is?

  Yes

  No

  N/A

• Where are the SDS located?

  Yes

  No

  N/A

• Do you know what SDS stands for?

  Yes

  No

  N/A

• Where is the first aid kit located?

  Yes

  No

  N/A

• Can you point out where a fire extinguisher or hose reel is located?

  Yes

  No

  N/A

• How do you report an in ident or hazard?

  Yes

  No

  N/A

• Where can you find the incident and hazard forms located?

  Yes

  No

  N/A

• How do you request a repair?

  Yes

  No

  N/A

• Where is the emergency assembly area?

  Yes

  No

  N/A

• Who is the depots fire warden?

  Yes

  No

  N/A

• Who is the depots first aid officer?

  Yes

  No

  N/A

First aid

• Are the emergency personnel displayed?

  Yes

  No

  N/A

• Are there incident and hazard forms available?

  Yes

  No

  N/A

Forklifts

• Equipment inspected per inspection frequency requirements?

  Yes

  No

  N/A

• Operators using horns and warning devices where required?

  Yes

  No

  N/A

• No passengers on equipment designed for operators only?

  Yes

  No

  N/A

• Are the PRE trip books being completed?

  Yes

  No

  N/A

• Are the forklift drivers keeping to the walking pace speed limit?

  Yes

  No

  N/A

General Safety and Housekeeping

• Trash, debris, and equipment not left laying around?

  Yes

  No

  N/A

• Are the bins being emptied regularly?

  Yes

  No

  N/A

Hazard Substances

• Employees know how to find SDS (Interview >=2 employees)

  Yes

  No

  N/A

• Are the SDS current?

  Yes

  No

  N/A

• Chemicals are stored in proper containers and labeled properly?<br> -Secondary containers that are not in control of current shift labeled with HMIS label or equivalent?<br> -Labels legible and accurately indicates the chemical that is inside the container?

  Yes

  No

  N/A

• Chemicals stored properly?<br>

  Yes

  No

  N/A

Loading Zones

• Are the keys to the trucks on the hooks?

  Yes

  No

  N/A

• Is there only one person per dock?

  Yes

  No

  N/A

• Do the trucks have the hand brake applied and the keys out of the ignition?

  Yes

  No

  N/A

PPE

• Are PPE requirements sufficient?<br>

  Yes

  No

  N/A

• Is PPE supplied adequate for the task?<br>

  Yes

  No

  N/A

• Is PPE being worn properly? <br><br>

  Yes

  No

  N/A

• PPE supplies readily available to operators

  Yes

  No

  N/A

Spill kits

• Spill kits are available where needed and are equipped/inspected as required?

  Yes

  No

  N/A

• Is the spill kit in good condition?

  Yes

  No

  N/A

Signage

• Is the SAFTY signage clear, visible and appropriate?

  Yes

  No

  N/A

Smoking

• Is there evidence of smoking on site?

  Yes

  No

  N/A

Walkways

• Are the walkways clear of obstruction?

  Yes

  No

  N/A

• Are employees and visitors using the walkway?

  Yes

  No

  N/A

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