Title Page

  • Conducted on

  • Prepared by

  • Location?

  • Area Inspected?

  • Reason for Inspection?

  • Comments:

  • Sign after Inspection is completed.

1- Industrial Work Areas

  • Walkways are clear of obstructions, garbage, debris, and are clean/dry? Pallets, machinery, materials, and supplies are not crossing over onto walkways?

  • There is no trash, paper waste, dots, or misc. scrapes of material accumulating or presenting a S/T/F hazard around machinery, work stations, or in work paths?

  • Floors are clean, dry, and walkway paths and floor signs are clearly marked?

  • Under stairways do not have combustible materials stored under them? Any stacked or staged items are at least 18" from sprinkler heads?

  • Waste baskets and garbage cans are not overflowing, do not have debris or garbage on floor around, and are located in areas where there is need?

  • Materials, product, and supplies, are staged in a designated area that does not create hazards or S/T/F hazards?

  • General Housekeeping - Misc. items are not just set aside or piled in areas with no designated storage location. Corners of rooms, behind and under tables, shelving, and behind/between equipment are organized and without issue?

  • Workstations are organized and all tools, containers, and equipment has a proper storage location?

  • Ladders are put away when not in use and are stored correctly (secured in some manner)?

  • PITs, PIT equipment, and PIT charging station areas are organized and charging stations do not have combustibles such as wood, paper, fabric, trash near them?

  • Emergency Equipment such as fire extinguishers, eye wash stations, first aid kits, and emergency exits are not blocked or have access hindered with materials, debris, pallets stacked or staged items in front of them?

  • Nothing is stored on top of or in front of electrical panels or power control boxes, and have 36" of clearance around them?

  • RPTs are being used properly ?<br>-off the floor<br>-clean, dry, organized state<br>-no high volt or high amp equip plugged in (office type equipment only)<br>-are UL rated<br>-ARE plugged into single use, grounded plugs<br>-are not secured or fix to tables or equipment (can be attached provided you dont need tools to remove)

  • Electrical cord, extension cords, and power cables are not S/T/F hazards, are being used properly?

  • All containers with chemicals have either NFPA label with hazard diamond and chemical ID, or they have original Manuf. label which lists the name of the chemical and any hazards/precautions (and are legible)?

  • Flammable or combustible liquids are stored correctly?<br>- Rags with oils, solvents, or flam/comb liquids on them must be stored and disposed of correctly (they are not out all over work stations)?<br><br>- Flam/Comb liquids not being used must have caps/covers on and be stored in a designated area away from potential flame or ignition sources?<br><br>- Facilities and Mfg. Maintenance must have flammable storage cabinets in their shops and workstations.

  • SAA are organized, labels have ID (legible), and lids are on containers?

  • Comments:

2 - Office Work Areas

  • Walkways and isles are clear of obstructions, furniture, items that may present a S/T/F hazard?<br>

  • Walking Working Surfaces are clean, dry, and managed so as not to create a S/T/F/ hazard.<br>

  • Waste baskets and garbage cans are not overflowing, do not have debris or garbage on floor around, and are located in areas where there is need?

  • Workstations, cubicles, and offices are clean, organized and items have designated storage areas?

  • Under stairways do not have combustible materials stored under them? Stairways do not have items stored on them which could be a S/T/F hazard?

  • Storage areas are organized, clean, free from debris and garbage?

  • ERT storage area is clean and organized?

  • Janitorial storage is clean and organized?

  • Nothing is stored on top of or in front of electrical panels or power control boxes, and have 36" of clearance around them?

  • RPTs are being used properly ?<br>-Clean, dry, organized state<br>-No high volt or high amp equip plugged in (office type equipment only)<br>-Are UL rated<br>-ARE plugged into single use, grounded plugs<br>-Are not secured or fix to tables or equipment (can be attached provided you dont need tools to remove)

  • General Housekeeping - Misc. items are not just set aside or piled in areas with no designated storage location. Corners of rooms, behind and under tables, shelving, and behind/between equipment are organized and without issue?

  • If applicable, any flammable or combustible liquids storage locations have items properly stored and all chemicals are labelled properly?

  • Kitchen/break areas are in a clean and sanitary state, no dirty dishes in sinks, table and counter tops are clean, and areas are organized?

  • Bathrooms are clean and sanitary with toilets and urinals that are clean and there is no garbage on floors?

  • Outside housekeeping and landscaping areas are clean, organized, and there is no liter or items that need to be repaired/picked up?

  • Comments:

3 - Associate Concerns/Questions

  • Associate's Concern/Questions?

  • Associate's Concern/Questions?

  • Associate's Concern/Questions?

  • Associate's Concern/Questions?

  • Associate's Concern/Questions?

  • Associate's Concern/Questions?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.