Hand Tools & Equipment

Are all tools and equipment used by employees at their work place in good condition?

Are all hand tools such as chisels, punches, which develop mushroomed heads during use, reconditioned or replaced as necessary

Are all broken or fractured handles on hammers, axes and similar equipment replaced promptly

Are worn out or bent wrenches replaced regularly?

Are appropriate handles used on files and similar tools?

Are employees made aware of the hazards caused by faulty or improperly used hand tools?

Are appropriate safety glasses face shields, and similar equipment used while using hand tools or equipment that might produce flying materials or be subject to breakage?

Are jacks periodically checked to assure they are in good operating condition ?

Are hand tools wedged tightly in the head of all tools?

Are tool cutting edges kept sharp so the tool will move smoothly without binding or skipping?

Are tools stored in dry, secure location where they will not be tampered with?

Is eye and face protection used when driving hardened or tempered spuds or nails?

Add signature

Personal Protective Equipment & Clothing

Are protective goggles/face shields provided and worn where there is any danger of flying particles?

Are approved safety glasses required to be worn at all times in areas where there is a risk of eye injuries such as punctures, abrasions, contusions or burns?

Are protective gloves, shields, or other means provided against cuts, or abrasions?

Are hard hats provided and worn where danger of falling objects exists?

Are hard hats inspected periodically for damage to the shell and suspension system?

Is appropriate foot protection required where there is the risk of foot injuries from falling objects, crushing or penetrating actions?

Are approved respirators provided for regular or emergency use where needed?

Is all protective equipment maintained in a sanitary condition and ready for use?

Do you have eye washing facilities within the work area?

When lunches are eaten on the premises, are they eaten in areas where there is no exposure to toxic materials or other health hazards?

Is protection against the effects of occupational noise exposure provided when sound levels exceed those of the Cal/OSHA noise standard?

Add signature


Are all employees required to report as soon as practicable any obvious hazard to life or property observed in connection with electrical or lines?

Are portable electrical tools and equipment grounded or of the double insulated type?

Are electrical appliances such as vacuum cleaners, polishers, and vending machines grounded?

Do extension cords being used have a grounding conductor?

Are multiple plug adapters prohibited?

Do suitable disconnecting switches or plug connectors at the junction with permanent wiring protect all temporary circuits?

Is exposed wiring and cords with frayed or deteriorated insulation repaired or replaced promptly?

Are flexible cords and cables free of splices or taps?

In wet or damp locations, are electrical tools and equipment appropriate for the use or location or otherwise protected?

Is the use of metal ladders prohibited in area where the ladder or the person using the ladder could come in contact with energized parts of equipment, fixtures or circuit conductors?

Are all disconnecting switches and circuit breakers labeled to indicate their use or equipment served?

Are disconnecting means always opened before fuses are replaced?

Do all interior writing systems include provisions for grounding metal parts of electrical raceways, equipment and enclosures?

Are all electrical raceways and enclosures securely fastened in placed?

Are all energized parts of electrical circuits and equipment guarded against accidental contact by approved cabinets or enclosures?

Is sufficient access and working space provided and maintained about all electrical equipment to permit ready and safe operations and maintenance?

Are all unused openings (including conduit knockouts) in electrical enclosures and fittings closed with appropriate covers, plugs or plates?

Are electrical enclosures such as switches, receptacles, junction boxes, etc., provided with tight-fitting covers or plates?

Add signature

Walking, Tripping & Falling

Are aisles and passageways kept clear?

Are aisles and walkways marked as appropriate?

Are holes in the floor, sidewalk or other walking surface repaired properly, covered or otherwise made safe?

Is there a safe clearance for walking in aisles where motorized or mechanical handling equipment is operating?

Are spilled materials cleaned up immediately?

Are materials or equipment stored in such a way that sharp projectiles will not interfere with the walkway?

Are changes of direction or elevations readily identifiable?

Are aisles or walkways that pass near moving or operating machinery, welding operations or similar operations arranged so employees will not be subjected to potential hazards?

Is adequate headroom provided for the entire length of any aisle or walkway?

Are standard guardrails provided wherever aisle or walkway surfaces are elevated more than 30 inches above any adjacent floor or the ground?

Are bridges provided over conveyors and similar hazards?

Add signature

Portable Ladders

Are hardware and fittings securely attached, and movable parts operating freely without binding or undue play?

Are non-slip safety feet provided on each metal or rung ladder?

Are ladder rungs and steps free of grease and oil?

Is it prohibited to place a ladder in front of doors opening toward the laser except when the door is blocked open, locked or guarded?

Is it prohibited to place ladders on boxes, barrels, or other unstable bases to obtain additional height?

Are employees instructed to face the ladder when ascending or descending?

Are employees prohibited from using ladders that are broken, missing steps, rungs, or cleats, broken side rails or other faulty equipment?

Are employees instructed not to use the top 2 steps of ordinary stepladders as a step?

When portable rung ladders are used to gain access to elevated platforms, roofs, and the like does the ladder always extend at least 3 feet above the elevated surface?

Is it required that when portable rung or cleat type ladders are used the base is so placed that slipping will not occur, or it is lashed or otherwise held in place?

Are employees prohibited from using ladders as guys, braces, skids, gin poles, or for other than their intended purposes?

Are employees instructed to only adjust extension ladders while standing at a base (not while standing on the ladder or from a position above the ladder)?

Are metal ladders inspected for damage?

Are the rungs of ladders uniformly spaced at 12 inches, center to center?

Add signature

Compressors & Compressed Air

Are compressors equipped with pressure relief valves, and pressure gauges?

Are compressor air intakes installed and equipped to ensure that only clean uncontaminated air enters the compressor?

Are air filters installed on the compressor?

Are compressors operated and lubricated in accordance with the manufacturer recommendations?

Are safety devices on compresses air systems checked frequently?

Before any repair work is done on the pressure system of a compressor, are the pressure bled off and the system locked-out?

Is the belt drive system totally enclosed to provide protection for the front, back, top, and sides?

Is it strictly prohibited to direct compressed air towards a person?

Are employees prohibited from using highly compressed air for cleaning purposes?

If compressed air is used for cleaning off clothing, is the pressure reduced to less than 10 psi?

When using compressed air for cleaning, do employees use personal protective equipment?

Is it prohibited to use compressed air to clean up or move combustible dust if such action could cause the dust to be suspended in the air and cause a fire or explosion hazard?

Add signature

Hazardous Chemical Exposures

Are employees aware of the potential hazards involving various chemicals stored or used in the workplace-- such as acids, bases, caustics, epoxies, and phenols?

Is employee exposure to chemicals kept within acceptable levels?

Are all employees required to use personal protective clothing and equipment when handling chemicals (I.e. gloves, eye protection, and respirators)?

Are flammable or toxic chemicals kept in closed containers when not in use?

Where needed for emergency use, are respirators stored in a convenient, clean and sanitary location?

Are respirators intended for emergency use adequate for the various uses for which they may be needed?

Are employees prohibited from eating in areas where hazardous chemicals are present?

Is personal protective equipment provided, used and maintained whenever necessary?

Are there written standard operating procedures for the selection and use of respirators where needed?

If you have a respirator protection program, are your employees instructed on the correct usage and limitations of the respirators?

Are the respirators NIOSH approved for this particular application?

Are they regularly inspected and cleaned sanitized and maintained?

If hazardous substances are used in your processes, do you have a medical or biological monitoring system in operation?

Are you familiar with the Threshold Limit Values or Permissible Exposure Limits of airborne contaminants and physical agents used in your workplace?

Are there written standard operating procedures for the selection and use of respirators where needed?

If you have a respirator protection program, are your employees instructed on the correct usage and limitations of the respirators?

Do you use general dilution or local exhaust ventilation systems to control dusts, vapors, gases, fumes, smoke, solvents or mists which may generated in your workplace?

Add signature

Spraying Operations

Is adequate ventilation assured before spray operations are started?

Is mechanical ventilation provided when spraying operation is done in enclosed areas?

When mechanical ventilation is provided during spraying operations, is it so arranged that it will not circulate the contaminated air?

Is the spray area free of hot surfaces?

Is the spray area at least 20 feet from flames, sparks, operating electrical motors and other ignition sources?

Are portable lamps used to illuminate spray areas suitable for use in a hazardous location?

Is approved respiratory equipment provided and used when appropriate during spraying operations?

Do solvents used for cleaning have a flash point of 100 F or more?

Are "NO SMOKING" signs posted in spray areas, paint rooms, and paint storage areas?

Is the spray area kept clean of combustible residue?

Add signature

Protection During Contamination Producing Operation & Maintaining Cleanliness During Job Period

3.1.1 Prior to installation accomplish an inspection of protective covering to identify the current condition of equipment and surface prep area? Submit one legible copy in hard copy or electronic media of the result of inspection to supervisor, prior to beginning of contamination producing operation
**This must be signed by supervisor or ship force**

Install filter material on intake of supply and exhaust e d of ventilation system

Install double curtain baffles at the entrance of each access

Inspect the protective covering at the beginning of shift

Maintain cleanliness of work site daily

Remove protective covering and dispose of at completion

Add signature

Ergonomics (Human Engineering) An Applied Science

That coordinates the design of devices, systems, and physical working conditions with the capacities and requirements of the worker.

Does the task require prolonged raising of the arms?

Do the neck and shoulders have to be stooped to view the task?

Can the work be done using the larger muscles of the body?

Are there pressure points on any parts of the body (wrists, forearms, back if thighs)?

Can the work be done without twisting or overly bending the lower back?

Are there sufficient rest breaks, in addition to the regular rest breaks, to relieve stress from repetitive-motivation tasks?

Are all pieces of furniture adjusted, positioned and arranged to minimize strain on all parts of the body?

Add signature

Hazardous Substances Communication

Is there a list of hazardous substances used in your workplace?

Is there a written hazard communication program dealing with Material Safety Data Sheets (MSDS) labeling, and employee training?

Is there a Material Safety Data Sheet readily available for each hazardous substance used?

Do you inform other employers whose employees share the same work area where the hazardous substances are used?

Is there an employee-training program for hazardous substances?

Does this program include:

An explanation if what an MSDS is and how to use and obtain one?

MSDS contents for each hazardous substance or class of substances?

Explanation of "Right to Know"?

Identification of where employees can see the employer's written hazard communication program and where hazardous substances are present in their work area?

The physical and health hazards of substances in the work area, how to detect their presence, and specific protective measures to be used?

Details of the hazard communication program, including how to use the labeling system and MSDSs?

Add signature

Flammable & Combustible Materials

Are combustible scrap, debris and waste materials (I.e. oily rags) stored in covered metal receptacles and removed from the worksite promptly?

Are approved containers and tanks used for the storage and handling of flammable and combustible liquids?

Are all flammable liquid kept in closed containers when not in use (e.g. Parts cleaning tanks, pans)?

I liquified petroleum gas stored, handled and used in accordance with safe practices and standards?

Are all solvent wastes and flammable liquids kept in fire-resistant covered containers until they are removed from the worksite?

Is vacuuming used whenever possible rather than blowing or sweeping combustible dust?

Are employees trained in the use of fire extinguishers?

Are extinguishers free from obstructions or blockage?

Are all extinguishers serviced, maintained and tagged at intervals not to exceed one year?

Is a record maintained of required monthly checks of extinguishers?

Are safety cans used for dispensing flammable or combustible liquids at a point of use?

Is vacuuming used whenever possible rather than blowing or sweeping combustible dust?

Add signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.