Weekly Department Inspection
Name of Department
Inspected By
Date
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Day
Year
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Time
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Minutes
AM
PM
AM/PM Option
What are your current hazards? Check all that all apply.
Fall hazards
Caught-in or between
Struck by
Electrocution
Crane
Welding or burning
Scaffolding
General
Facility Inspection
Are SDS's available upon request?
Yes
No
Other
Are pipelines identified by color painted bands/tape located at a reasonable height for visibility?
Yes
No
Are materials stacked in a manner that creates a safety hazard for personnel in area?
Yes
No
Have guardrail systems been installed along floor openings and pits?
Yes
No
Are employees observed smoking near flammable substances?
Yes
No
Are first aid kits and supplies easily accessible in each work area?
Yes
No
When exiting a department, are exit signs clearly marked above door?
Yes
No
Are employees aware of information concerning any toxic or harmful physical agents in the area?
Yes
No
Are restrooms adequately cleaned and maintained?
Yes
No
In the event of an eye injury, are eye wash stations clearly posted?
Yes
No
Additional comments
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Housekeeping
Has trash or other debri been identified and removed prior to employees beginning task?
Yes
No, it needs some work
Have all hoses (air, water) and electrical cords been placed back in secure area?
Yes
No
Are tools being placed back in designated areas?
Yes
No
Are there any oils spills or other slip hazards in the area?
Yes
No
Are spills kits or other methods of absorbing liquids equipped nearby?
Yes
No
Are aisles and other designated walkways clearly marked for employee use?
Yes
No
Are work areas adequately illuminated for employees to safely perform duties?
Yes
No, some areas need some more light
Additional comments
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Verification of iTrans Oxygen Monitor
What was the starting O2 Reading?
What was the data for 19.0% O2 Reading?
What was the data for 20.9% O2 Reading?
What was the ending O2 Reading?
What was the data for the alarm sounded @ 19% 02?
Additional Comments?
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COVID-19
Precautionary Measures
Do managers and supervisors lead by example wearing facemask and practicing social distancing?
Yes
No
Are employees observed wearing facemask over nose and mouth?
Yes
No
Are employees observed congregating in large crowds?
Yes
No
Are employees observed eating and drinking in work areas?
Yes
No
Are employees observed sharing hand tools and other equipment?
Yes
No
Are daily sanitizing/ disinfectant measures being performed?
Yes
No
Are disinfectant wipes and other sanitizing products readily available?
Yes
No
Additional comments
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Fire Prevention
Have fire alarm systems been tested on a routine basis (daily, monthly, or annual)?
Yes
No
Are flammable containers clearly marked and labeled?
Yes
No
Are flammable containers stored inside a fire retardant cabinet?
Yes
No
N/A
Are fire extinguishes clearly marked and hung in appropriate areas?
Yes
No
N/A
Have fire extinguishers undergone a yearly inspection?
Yes
No
Are employees trained on the proper use of a fire extinguishers?
Yes
No
Are employees familiar with emergency evacuation routes in the event of a fire?
Yes
No
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Lab Safety
Good housekeeping practiced throughout the lab?
Yes
No
Eyewash/shower been inspected and working properly?
Yes
No
Are exits and aisles clear and not obstructed?
Yes
No
Are SDS's readily available online to personnel?
Yes
No
Are up-to date spill response guide and kits present?
Yes
No
Workstations clear of clutter (materials and chemicals)?
Yes
No
Signage posted indicating location of emergency showers?
Yes
No
Are flammable chemicals placed back in FR cabinets?
Yes
No
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Material Handling
Material is properly stored?
Yes
No, some area need some work
N/A
Employees are using proper lifting techniques?
Yes
No
N/A
Proper amount of manpower to perform lifts?
Yes
No
N/A
Equipment operator (forklift/ crane) has documentation of training.
Yes
No
N/A
Tag lines are being used to guide loads?
Yes
No
N/A
Is a written Hazard Communication Program on site including SDS, materials list, container labeling, empolyee training?
Yes, it is all on the cloud
Is there an exposure to silica, such as sandblasting, using sand or cutting brick controlled?
Yes
No
N/A
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Fall Protection
Safety rails and cables are secured properly? If cable, flagged every 6'?
Yes
No
N/A
When working at or above 6ft. is fall protection being used?
Yes
No
N/A
Is 100% tie-off being observed when working at heights ?
Yes
No
N/A
Has an inspection been conducted of full body harness?
Yes
No
N/A
Are employees working more than 6' protected by guardrails, safety nets, or personal fall arrest system?
Yes
No
N/A
Are flights of stairs with 4 or more steps equipped with stair railing or hand rails?
Yes
No
N/A
Additional comments
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Fall Protection
Ladders
Ladders are secure to prevent slipping, sliding, or falling?
Yes
No
N/A
Base of ladder is 1' away from surface for every 4' to the top?
Yes
No
N/A
Ladder side rails extend at least 3' above the upper landing surface to which the ladder is used to gain access.
Yes
No
N/A
Ladders with split or missing rungs taken out of service?
Yes
No
N/A
Stepladders used in fully open position?
Yes
No
N/A
Is there anyone standing on the top two rungs of a step ladder?
Yes
No
Additional comments
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Fall Protection
scaffolding
Is there scaffolding onsite? If not, click no and next at the bottom of this page and the following page.
Yes
No
Erection properly supervised?
Yes
No
All scaffolding inspected daily?
Yes
No
Erected on sound rigid footing with mudsills in place?
Yes
No
Scaffolding is tied to structure as required?
Yes
No
Is the scaffolding plum and square with the connections sound and secure?
Yes
No
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Scaffolding
Continued
Are guardrails, intermediate rails, toe boards, and screens in place?
Yes
No
Is the planking properly overlapped with being sound and secure?
Yes
No
Planking is free of debris, ice and snow?
Yes
No
Proper access provided?
Yes
No
Employees below are protected from falling objects?
Yes
No
Material stored on scaffolding do not exceed supplies needed for immediate use?
Yes
No
Is there an overhead electrical exposure?
Yes
No
Additional comments
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Aerial Lift
JLG & Manlift
Has the pre-inspection checklist been completed?
Yes
No
Is the area clear of obstructions?
Yes
No
Is there any trash unsecure items located inside the basket?
Yes
No
Are anchor points installed inside the basket?
Yes
No
Is the aerial lift being operated on level surface?
Yes
No
Are personnel working nearby informed of the potential for dropped objects?
Yes
No
Is there a load capacity chart located inside the cab?
Yes
No
Additional comments
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Struck By Hazards
Hand, Power, and Powder Actuated Tools
Hand tools inspected daily? Broken handles and mushroom heads?
Yes
No
Guards in place on machines? Such as saws?
Yes
No
Correct tool being used for the job at hand?
Yes
No
Operators of powder actuated tools have been trained?
Yes
No
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Struck by Hazards
Floor and wall openings
All floor openings are planked over or barricaded?
Yes
No
Perimeter protection is in place? Toe kick?
Yes
No
Deck planks are secured?
Yes
No
Materials are stored away from edge?
Yes
No
Additional comments
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Struck By/ Airborne Hazards
Concrete and Masonry Construction
All employees are protected from cement dust?
Yes
No
Dust control being used? Such as Hepavac System?
Yes
No
Are all protruding reinforcing rods covered?
Yes
No
Limited access zone established during masonry wall construction?
Yes
No
Is lockout/ tag out procedure in place on any machinery where inadvertent operation could cause injury?
Yes
No
N/A
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PPE Requirements
Personal Protective Equipment
Are hardhats being worn during production activities?
Yes
No
Yes, during jobs with overhead hazards
Other
Safety glasses/ face shields being worn when required?
Yes
No
Other
Respirators are being used when required?
Yes
No
Are facemask being worn where 6 ft. is not feasible?
Yes
No
Is proper hand hand being worn when handling sharp tools, chemicals, etc.?
Yes
No
Hearing protection being used when required?
Yes
No
Are seat belts being worn as required?
Yes
No
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Struck by Hazards
Vehicles
Are seat belts fastened while equipment is in motion?
Yes
No
N/A
Is personnel being observed operating vehicle while on cell phone?
Yes
No
Is personnel operating at reasonable speed?
Yes
No
Prior to backing, does the driver look over his/over shoulder?
Yes
No
Glass on vehicle/ equipment is in good condition?
Yes
No
Other
Back
Next
Electrical
Extension cords with bare wires or missing ground prongs or damaged have been taken out of service?
Yes
No
Ground fault circuit interrupters being used?
Yes
No
Terminal boxes equipped with required covers?
Yes
No
Are flexible cords and cables protected from damage?
Yes
No
Are unused openings in cabinet boxes and fittings closed?
Yes
No
N/A
Are all cabinets, panels and switches located in wet locations enclosed in weather proof enclosures?
Yes
No
N/A
Electrical dangers are posted?
Yes
No
Access to breaker boxes are clear?
Yes
No
Lockout/ tag out procedures being used?
Yes
No
Overhead lines protection?
Yes
No
N/A
Power tools are grounded/ double insulated?
Yes
No
Cords for power tools are in good condition?
Yes
No, but was removed
Additional comments
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LOTO
Were LOTO steps documented and reviewed with personnel?
Yes
No
Have all sources of energy been verified at zero energy?
Yes
No
Does the number of locks installed correlate with personnel working on equipment?
Yes
No
Were isolation tags applied to every point?
Yes
No
Are signs/labels posted on equipment that has been LOTO?
Yes
No
N/A
Do personnel maintain possession of keys while safety locks are installed?
Yes
No
N/A
Do the tags include the name of employee, company name, and/or phone number?
Yes
No
Was there an attempt to initiate start-up of equipment to verify zero energy?
Yes
No
Is there a LOTO box available nearby so that employees can apply locks as needed?
Yes
No
Has all stored energy been released or blocked prior to initiating LOTO methods on equipment?
Yes
No
N/A
Additional comments
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Compressed Gas Cylinder
Are cylinders staged in a designated location?
Yes
No
Are valve caps/protectors installed on cylinders when not in use or connected?
Yes
No
Do cylinders have labels or stamping that clearly indicates its contents?
Yes
No
Are compressed gas cylinders stored in areas that ensure protection from external heat sources?
Yes
No
Are cylinders stored in the proper upright position?
Yes
No
N/A
Are hoses free of obvious defects (cracks, frays, etc.)?
Yes
No
N/A
Have the appropriate labels been installed on cylinders?
Yes
No
Have cylinders been checked periodically for any defects?
Yes
No
Is the proper device located in the facility for safe transportation?
Yes
No
Additional comments
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Crane Activities
Scrapyard/Remote/Cab Crane
Are the daily inspection forms filled out for lifting equipment in use?
Yes
No
Does the spotter demonstrate proper hand signals to crane operator?
Yes
No
When a lift is being made, is there clearance established to ensure safety of personnel in area?
Yes
No
Are walking paths clear of obstructions so that the spotter can move freely?
Yes
No
Other
Are there any visual defects in lifting devices (warped chains, loose cables/wire)?
Yes
No
Is the load stabilized at the center of gravity?
Yes
No
Does the load exceed the lifting capacity of the crane?
Yes
No
Does the spotter place any part of his body in the line of fire?
Yes
No
Are lifting devices installed with tags that clearly indicate manufacturer's rating?
Yes
No
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