| 100 |
WR |
NA |
PPE: 100% or When Required |
Yes |
No |
NA |
Administrative: |
Use |
Inc |
NA |
Observed: (Using or Incomplete) |
| |
|
|
PPE Assessment |
|
|
|
Written Safety Manual |
|
|
|
Egress: Path, Em. Lighting, Marked |
| |
|
|
Hard Hats: 100% or When Required |
|
|
|
New Employee Orientation |
|
|
|
Fire Hazards:Flamable, Gr. & Bond |
| |
|
|
Eye Protection |
|
|
|
Visitor Orientation & PPE |
|
|
|
Fire Extinguishers: Provided, Maint. |
| |
|
|
Respirator Fit & Med.: Y N |
|
|
|
OSHA Partnership: Alliance, VPP |
|
|
|
Fire System: |
| |
|
|
Hearing Prot. Noise Test: Y N |
|
|
|
Safety Rules: Enforced, Policy |
|
|
|
|
| |
|
|
Steel Toe Shoes |
|
|
|
Safety Committee |
|
|
|
Haz. Communication: Chemicals |
| |
|
|
Fall Protection |
|
|
|
Emergency Action Plan |
|
|
|
W. Program, Label, MSDA, Train |
| |
|
|
Other: |
|
|
|
First-Aid – CPR Responders |
|
|
|
Process Safety Management |
| Yes |
No |
NA |
Hazard Assessment: |
|
|
|
Fire Dept. Minutes____ |
|
|
|
|
| |
|
|
Weather (Hot-Cold) F |
|
|
|
Safety Inspections – Audit |
|
|
|
Walk-Work Surface – Holes: |
| |
|
|
Slips, Trips & Falls |
|
|
|
Safety Meetings |
|
|
|
Fall Protection – Falling Object Prot. |
| |
|
|
Physical Contact – Falling Objects |
|
|
|
Report Near Misses |
|
|
|
Guardrailing – Stair Railing: |
| |
|
|
Absorption |
|
|
|
Investigate Incidents |
|
|
|
Ladders: Insp., Training |
| |
|
|
Inhalation – Fume, Mist, Dust, Vapors |
|
|
|
|
|
|
|
Scaffolding: Type |
| |
|
|
Violence |
Yes |
No |
NA |
Items Onsite: |
|
|
|
Lifts: Scissor, Aerial |
| |
|
|
Noise |
|
|
|
OSHA Poster |
|
|
|
|
| |
|
|
Light – Dark |
|
|
|
300 Log: On-Site |
|
|
|
Cranes – Hoist – Slings: Insp., Rated |
| |
|
|
Vibration or Ergonomics |
|
|
|
300 summary (2/1-4/30) posted |
|
|
|
Forklift: Insp. – Training – Blind Spots |
| |
|
|
Traffic- Street or Road |
|
|
|
Emergency Alarm System – Drills |
|
|
|
Propane: Storage, Secured |
| |
|
|
|
|
|
|
Emergency Numbers Posted |
|
|
|
Machine Guard: Train, Insp, Assess |
| Yes |
No |
NA |
Facility: |
|
|
|
First Aid Kit – Sign – Insp. |
|
|
|
Lockout:Procedures – Train – Audit |
| |
|
|
Number of Floors: B – 1 – 2 – 3 – 4 |
|
|
|
AED |
|
|
|
|
| |
|
|
Shut-off Location: Gas, Water, Elect. |
|
|
|
Bloodborne Path Kit – Sign – Insp. |
|
|
|
Confined Space: # |
| |
|
|
Security: Person, Cameras |
|
|
|
Eye Wash Station – Sign – Insp. |
|
|
|
Permit, Sign, Monitor, Rescue, Train |
| |
|
|
Smoke Free ____ Areas____ |
|
|
|
Toilet Facilities |
|
|
|
|
| |
|
|
|
|
|
|
Drinking Water |
|
|
|
Electric: Panels, Wire, GFCI, 70E |
| Yes |
No |
NA |
Employees |
|
|
|
Material Safety Data Sheets |
|
|
|
Tools: Insp., PPE |
| |
|
|
Union – Non Union |
|
|
|
OSHA Standards |
|
|
|
|
| |
|
|
Number of Employees |
|
|
|
|
|
|
|
Welding: Area, Ventalation, Permit |
| |
|
|
Temp. Empl. |
Yes |
No |
NA |
OSHA Safety Training: |
|
|
|
Cylinders: Sign, Storage, Secured |
| |
|
|
Hisp. Workers |
|
|
|
Management OSHA 10 or 30 Hr. |
|
|
|
Vehicles – Trucks – Semi: (Insp) |
| |
|
|
Other: |
|
|
|
Employees – Specific Trained |
|
|
|
Traffic: |
| |
|
|
|
|
|
|
|
|
|
|
Lead / Asbestos / Mold: |
| Yes |
No |
NA |
Type of Work: |
Yes |
No |
# |
Contractors Requirements: |
|
|
|
Ergonomics: Lifting, Job set-Up |
| |
|
|
Manf.___ Warehouse___ Dock____ |
|
|
|
Written Job Agreement |
|
|
|
Signage: |
| |
|
|
Shift Work – AM. / PM. 1 – 2 – 3 |
|
|
|
Orientation____ OSHA 10/30____ |
|
|
|
|
| |
|
|
|
|
|
|
Safety Manual____ MSDS’s____ |
Yes |
No |
NA |
Behavior Observed: |
| Yes |
No |
NA |
Site Condition: |
|
|
|
Safety – Competent Person |
|
|
|
Site Attitude – Good – Helpful |
| |
|
|
Housekeeping – Good |
|
|
|
Contractors Site Inspection |
|
|
|
Unsafe Acts or Conditions |
| |
|
|
Exits Paths – Maintained |
|
|
|
Sub of Sub Notification |
|
|
|
Reported to the Company |
| |
|
|
|
|
|
|
|
|
|
|
|
| Due to the constantly changing nature of government regulations, conditions, and the human factors involved, no safety audit can possibly reveal all conditions existing at the audit site that may lead to injury, property damage, or fines. Furthermore, no safety audit can possibly render an opinion on conditions existing at the inspection site before or after the performance of the audit. The Company understands that it must also provide or conduct frequent and regular inspections on the job site. The audits performed by Safety Alliance LLC shall be used only to aid not relieve the company in complying with this requirement. Safety Alliance will have no authority to stop, correct or supervise employees but will inform company representative of any specific safety concerns known to it. This is considered a walk through inspection not a comprehesive safety inspection. This form may not be complete for your site. You will need to review and revise. 6/1/08 |
| |
| Note: Topic-PPE: 100% means PPE is required 100% on site. W/R means “When Required”. |
| |
| |
| Company: Contact Person: Date: ,2008 |
