Workplace Examination - Designated Areas

• Site conducted
  Address

• Conducted on

  Date

• Prepared by

• Document number

• Areas inspected

• Are there any JHA's currently open in this area?

  Yes

  No

  N/A

Ground Control

• Areas free of dangers including loose material, cracks, etc. Applicable danger zones barricaded to prevent unwanted access in area?

  Yes

  No

  N/A

• Stockpiles well maintained, bermed?

  Yes

  No

  N/A

• Floatation device & rope nearby? Fences/barricades well maintained?

  Yes

  No

  N/A

• Berms and ramps maintained and free of cracks and falling material?

  Yes

  No

  N/A

• Roads well maintained, no spillage, or ruts? Roads properly bermed? Proper signage & in good condition?

  Yes

  No

  N/A

General Conditions

• Housekeeping - Organized, clean, waste cans/skips emptied, lids in place?

  Yes

  No

  N/A

• Walkways are properly maintained free of slip, trip, and fall hazards?

  Yes

  No

  N/A

• Handrails/Toe boards are maintained in good condition, free of cracks, damages?

  Yes

  No

  N/A

• Stairs/Ladders - rungs, steps handholds, safety chains/gates in good condition, free of build-up?

  Yes

  No

  N/A

• Guarding is in place, secured properly, well maintained?

  Yes

  No

  N/A

• Horns/Alarms are maintained, working, audible above surrounding noise?

  Yes

  No

  N/A

• Parking Ditches are adequate and maintained?

  Yes

  No

  N/A

• Signage is in good condition, and properly secured in place?

  Yes

  No

  N/A

• Fall Protection is maintained in good working order?

  Yes

  No

  N/A

• Barricades & Flagging - are hazards taped off & properly tagged?

  Yes

  No

  N/A

MAINTENANCE & ELECTRICAL

• Power Cords are secured to machinery/boxes/panels/outlets, no visible wear/damage?

  Yes

  No

  N/A

• Panels/Outlets/Switch plates are not blocked, free of damages, hazards, properly labeled?

  Yes

  No

  N/A

• Lockout/Tagout procedures are in place and being followed correctly?

  Yes

  No

  N/A

• Power tools are free of damage/wear?

  Yes

  No

  N/A

• Hand tools are lean, free of hazards, in good working condition?

  Yes

  No

  N/A

Emergency Preparedness

• First Aid/CPR/AED stations are maintained, stocked, free of damage, within date?

  Yes

  No

  N/A

• Eye wash stations/Safety Showers are maintained, stocked, operational, free of damage?

  Yes

  No

  N/A

• Fire Extinguishers are checked, maintained, not expired, in good working condition, free of damages? Only attach a picture once weekly at beginning of shift on your first day.

  Media

• Emergency Procedures are posted with phone numbers, evacuation maps, and muster points?

  Yes

  No

  N/A

FUEL, OIL, CYLINDERS, FLAMMABLES

• Fuel/Oil Storage is properly labeled, free of leaks, and damage?

  Yes

  No

  N/A

• Flammable cabinets/Flammables are properly labeled/stored, caps, lids secured, free of spills, free of items stored on or around?

  Yes

  No

  N/A

• MSDS sheets either located on site for employee review or have access to?

  Yes

  No

  N/A

• Cylinders are properly labeled, secured, valves closed, stored in proper locations?

  Yes

  No

  N/A

Concerns for Hazards/Safety/Management

• Is the area safe and deemed safe to work in?

  Yes

  No

  N/A