Facility Inspection Report Quarterly
Inspector
First Name
Last Name
Branch
Date
-
Month
-
Day
Year
Date Picker Icon
A Exterior/Yard
Evaluation
Comment
A1 General appearance of grounds/landscape?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A2 Designated smoking area outside?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A3 Building exterior appearance?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A4 When working in the yard, Is a positive “Lockout/Tag out” system provided to render machines,trucks, and equipment inoperable while repairs or adjustments are being made? Are locks individually keyed and under the exclusive control of the employee? (29 CFR 1910.147)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A5 Fences, Gates and locks in good condition?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A6 Perimeter of property has no evidence of discharge of pollutants?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A7 Manhole and other confined spaces clearly marked? (1910.146 c 4)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A8 Parking area and Entrance/Exits are well lighted?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A9 Paved surfaces free of potholes, debris and other trip slip and fall hazards?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A10 Walkways and steps in good repair? (1910.124)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A11 Are step risers on stairs uniform from top to bottom? (1910.124)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A12 Are barriers and bollards painted yellow?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A13 Are steps on stairs and stairways designed to with a surface that’s renders them slip resistant? (1910.24f)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A14 Fuel Island Dispensers Hoses and Nozzles in good repair? (1910.106, NFPA#30,Local Fire Codes)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A15 Fuel Island – No Smoking and Shut off Engine signs (1910.106 (d) 7 iii, NFPA #30, Local Fire Codes)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A16 Fuel Island – Emergency Shut off clearly marked? (1910.106, NFPA #30, Local Fire Codes)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A17 Fuel Island - Adequate barrier protection? (1910.106, NFPA #30, Local Fire Codes)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A17 Fuel Island - Adequate number of Fire Ext? Charged/Tagged/inspected?(1910.106(d)7
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A18 Fuel Island - Spill Kit dry and well marked? (1910.106, NFPA #30, Local Fire Codes)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A19 Fuel Trailer - Dispensers Hoses and Nozzles in good repair? (1910.106, NFPA #30, Local Fire Codes)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
A20 Fuel Trailer - No leaks or signs of deterioration of tank integrity (1910.106, NFPA #30, Local Fire Codes)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B Office/Storage/FacilityAreas
Evaluation
Comment
B1 Are portable fire extinguishers kept at their designated places at all times (accessible, mounted, charged, pinned and sealed)? Is each extinguisher marked with a sign and does each sign have a corresponding extinguisher? Are annual and monthly inspections documented on the tag? Is there an adequate number of extinguishers for the prevailing fire hazards? Are extinguishers free from obstructions to access?(1910.157)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B2 Are first aid kits available and maintained? Any items expired? No oral Meds? (1910.151)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B3 Are interior lights adequate and all in working order? Do emergency lights work when tested? (NFPA 101)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B4 Is clear working space in front of an electrical panel maintained at no less than 36"? (1910.303)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B5 Are all live parts of electrical equipment operating at 50 volts or more guarded against accidental contact? Are outlet boxes in good condition? No exposed wiring. Are GFCI outlets used in wet or damp areas? (1910.303 g 2)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B6 Are panel box doors and individual electrical circuit breakers (and fueled pump switches) legibly identified? (1910.303)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B7 Are electric cords, extension cords, and trouble light of approved 3-wire ground type and in good condition? Is there any temporary wiring that should be permanent? (1910.305)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B8"Company required postings Commitment to Drug and Alcohol Free Work Place Sexual Harassment Policy Americans with Disability Act Policy First Aid Responders and CPR trained employee names"
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B9"Federal Required Posting Federal 5 in 1 poster OSHA ""It's the Law"" Poster OSHA 300a Summary from Feb 1 to April 30 Evacuation Map,1910.3 Emergency Contact Numbers Fair Labor Standards Act Family and Medical Leave Act Equal Employment Opportunity Uniform Services Employment Act Invitation to Self Identify Notice of viewing Affirmative Action Plans"
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B10 State and Local Requiring Position State OSHA Workers Compensation Poster State Wage and Hour (minimum wage)"
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B11 Is the injury record (OSHA 300 log) maintained up to date with copies at satellite facilities? (1904.7)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B12 Is Clinic name, address, and phone number posted for after hours use?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B13 Are the site emergency exit plans posted throughout the facility? (1910.38)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B14 "Records present and complete: OSHA 300 log,Safety Meeting/training Hazard communication SARA Title II PPE/Hazard Assessments,SPCC/SWPPP Plans Accident and Injury Data Facility Inspections"
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B15 Are aisle ways and passageways kept clean and in good repair and are there no obstructions across aisle ways that could create a hazard?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B16 Are floor openings and platforms or workstations 48" or higher guarded by a cover, a guardrail, or equivalent on all sides?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B17 Are changes of direction or elevations readily identifiable? (painted Yellow)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B18 Are stairs adequately lighted, treads and risers uniform from top to bottom, have appropriate handrails and slip resistant surfaces (1910.24 f)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B19 Are "No Smoking" signs posted through the facility if required by State and Local Law? Designated smoking area outside?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B20 Are automatic sprinkler fusible links clean, unpainted and undamaged? Is the minimum vertical clearance between automatic sprinklers and material below them at least 18 inches (36 inches for bales)?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B21 Is the sprinkler header marked with a tag indicating inspection and service in the last 12 months? (1910.159)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B22 Are emergency exit doors functioning and not locked from the inside? (1910.36 d)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B23 Are exits marked with appropriate signage? (1910.37 b 2) Are interior doors leading to areas that could be mistaken for an exit, marked "Not an Exit" (1910.37 b 5)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B24 Are toilets and washing facilities clean and sanitary with warm water and soap, and means of hand drying?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B25 Are lunch rooms, and break rooms kept clean?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B26 Is ventilation system functioning adequately?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
B27 Is bump test checklist up to date on all H2S moniotors?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1 SHOP Personal Protection Equipment/First Aid
Evaluation
Comment
C1.1 Are protective eye and face equipment worn where required and are safety glasses worn over corrective lenses or do corrective lenses conform to ANSI Z-87.I-1968)(1910.133 a 1) (1910.133 a 3)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.2 Is there a supply of loaner safety glasses located at all entrance points to the shop? Are safety glass cleaning stations located in the shop?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.3 Are caution signs present at entrance points and at machines generating eye and face hazards, which state; "Caution Eye Protection Required"?(1910.145 c 3)(1910.133 a)(1910.252 b 2)(1910.252 b 2 iii)(1910.252 b 3)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.4 Is a safe passage area clearly marked by a painted yellow line?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.5 Are employees who are exposed to the hazards created by welding, cutting or brazing operations protected by appropriate personal protective equipment?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.6 Are suitable gloves, hearing protection, and protective clothing available to be worn as necessary?(1910.132 a)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.7 Are appropriate safety glasses face shields, tec. Used while using hand tools or abrasive wheels or equipment which might produce flying materials or be subject to breakage?(1910.132 a)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.8 Are respirators; clean, properly stored, and respirator program in effect? (1910.134 h 1)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.9 Is there a clean, accessible, functioning eyewash station in any area where hazardous or corrosive materials are used? (1910.151)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.10 If emergency showers are present - are they clean, operable and accessible? (1910.151 c)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C1.11 Are first aid kits available and maintained? Any items expired? (1910.151 b)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C2 SHOP Fire Protection
Evaluation
Comment
C2.1 Are portable fire extinguishers kept at their designated places at all times (accessible, mounted, charged, pinned and sealed)? Is each extinguisher marked with a sign and does each sign have a corresponding extinguisher? Are annual and monthly inspections documented on teh tag? Are there an adequate number of extinguishers for the prevailing fire hazards? Are extinguishers free from obstructions to access?(1910.157)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C2.2 Have all Fire Extinguishers been inspected and serviced within the past 12 months by a licensed Fire Protection Company?(1910.151 e 3)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C2.3 Are reels and cabinets for hose systems in good working order, conspicuously identified accessible and used only as fire equipment?(1910.158. c 1)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C2.4 No Smoking Signs posted in; fuel area, battery charging area, paint booths and storage?(1910.106 b 6)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C2.5 Test Emergency lighting equipment to ensure proper working order (NFPA 101)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3 SHOP Electrical/Lighting
Evaluation
Comment
C3.1 Are interior lights adequate and all in working order?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3.2 Is clear working space in front of an electrical panel maintained at no less than 36"? (1910.303 i)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3.3 Are all live parts of electrical equipment operating at 50 volts or more guarded against accidental contact? Are outlet boxes in good condition? No exposed wiring. Are GFCI outlets used in wet or damp areas? (1910.303 g 2)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3.4 Are panel box doors and individual electrical circuit breakers (and fueled pump switches) legibly identified? (1910.303 f)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3.5 Are electric cords, extension cords, and trouble light of approved 3-wire ground type and in good condition? (1910.304 f) (1910.305 a 2 iii c)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3.6 Are overhead doors and controls in good working order? (1910.305 g 1 iii)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3.7 Are outlet boxes in good condition? Are all outlets grounded? Are GFCI outlets used in wet or damp areas? (191.305 b) (1910.303 g2) (1910.304 f 5 iv b)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3.8 Is a positive "Lockout/Tag out" system provided to render machines, trucks and equipment inoperable while repairs or adjustments are being made? Are locks individually keyed and under the exclusive control of the employee. Is there a means of identifying the individual who placed the lock (tag)? (1910.147)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C3.9 Is the Hazard Communication Program complete and are the Material Safety Data Sheets present and available? Is the Chemical Inventory present and complete? (1910.1200 e 1 i) (1910.1200 g 10)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C4 SHOP Walking and Working Surfaces
Evaluation
Comment
C4.1 Are floor opening and platforms or workstations 48" or higher guarded by a cover, a guardrail, or equivalent on all sides? (1910.23 c 1)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.2 Are grates or covers over floor openings such as floor drains, secured? (1910.23 a 8 iii)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.3 Are step risers on stairs uniform from top to bottom? (1910.24) Are steps on stairs and stairways designed to provide a surface that renders them slip resistant?(1910.24 f)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.4 Are aisles and passageways kept clear and marked as appropriate? (1910.22 b)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.5 Are wet surfaces cleaned up or coverd with non-slip materials? (1910.22 a 2)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.6 Are changes of direction or elevations readily identifiable? (painted Yellow)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.7 Are aisles and walkways protected from potential hazards of adjacent work areas? Are aisles and passageways kept clean and in good repair and are there no obstructions across aisles that could create a hazard? (1910.176a)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.8 Are floor loading capacity limits posted for 2nd floor storage?(1910.22d) Are there toe boards and guard rails for second floor storage?(1910.23 e 4)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.9 Is the exit pathway clearly marked by signs from all points within the working area? Are doors which could be mistaken for an exit identified with signs which read, "Not an Exit"? (1910.37b)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.10 Where mechanical handling equipment is used, are there sufficient safe clearances allowed for aisles, at loading docks, through doorways and wherever a turn or passage must be made?
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.11 Does the storage of material not create a hazard - stacked , blocked, interlocked and limited in height to ensure they are stable and secured against sliding or collapse? (1910.176b)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C4.12 Manhole and other confined spaces clealry marked? (1910.146 c 2)
Pas
Fail
Yes
No
N/A
Pas
Fail
Yes
No
N/A
C5 SHOP Ladders
Evaluation
Comment
C5.1 Are portable ladders in good condition with slip proof feet and no cracks, paint or splinters on the rungs? (1910.26 c) Are fixed metal ladders painted or treated to resist corrosion and rusting? (1910.27)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C5.2 Is the fixed ladder's clearance distance at least 36 inches between the nearest permanent object and the center line of the rungs?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C5.3 Are all bolts or rivets properly secured? (1910.179 j 3 ii)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C5.4 Is there a documented Inspection program with annual certifications and monthly inspections in file? (1910.179j) (1910.179m)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C5.5 Is the load rating clearly marked on each side of the crane? (1910.179 b 5)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6 SHOP Flammables/Liquid Storage
Evaluation
Comment
C6.1 Are only approved metal storage cans used for flammable liquids, including gasoline? Are all containers marked as to contents? (1910.106 d)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.2 Are flammable and combustible liquids (fuels, solvents, paints, etc.) stored in a UL/FM approved flammable storage cabinet? (1910.106 d 3)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.3 When transferring flammable/combustible liquids are containers grounded and bonded? (1910.106 b 6)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.4 Parts washer is in good working order, with fusible link attached and no obstructions for lid closure? Protective gloves and eye protection available? (CCR article 36)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.5 Are drums of petroleum products kept in secondary containment?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.6 Are spills cleaned up in the liquid storage areas?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.7 Are closeable containers provided for soiled rag disposal? (1910.106 h 8 iii)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.8 Is pressure washer in good working order? (hoses, vent and fuel lines)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.9 No Smoking signs, adequate ventilation, eye and face protection and no spark or flame sources in battery charging/storage areas?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C6.10 Is MSDS book available to employees, complete and updated? (1910.1200)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C7 SHOP Compressors
Evaluation
Comment
C7.1 Do all compressors prominently display a sign stating "Caution - this machine starts automatically" (CCR 3320)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C7.2 Are compressors equipped with pressure relief valves, pressure gauge, and spring-loaded safety valves, a totally enclosed belt drive system, and are air filters installed and maintained on the compressor intake? (CCR 3320)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C7.3 is pressure reduced to 30 p.s.i. for cleaning? (1910.242 b)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C8 SHOP Welding Equipment
Evaluation
Comment
C8.1 Are welder cables, clamps and guards in good condition? (1910.254) Are torch hoses, regulators and valves equipped with anti-flash back valves? (1910.253 e iii)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C8.2 Are "Hot Work Permits" used when welding is conducted outside of designated areas? (1910.252 a 2 IV) Is the designated welding area at least 35 feet from combustible materials, spray painting, etcA? (1910.253)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C9 SHOP Compressed Gas Cylinders
Evalutaion
Comment
C9.1 Are all stored cylinders effectively secured to prevent tipping? Are Cylinder valve protector in place unless in use? (1910.253 b 2 ii)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C9.2 Are cylinders legibly marked and labeled to clearly identify the gas contained? (1910.253 b 1 ii)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C9.3 Are oxygen and acetylene (or other fuel) tanks stored separated by 20' or with a 5' high 1 half hour fire resistant wall between oxygen and fuels? (1910.253 b 4 iii)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C9.4 Are cylinders stored in areas which are protected from heat and flame, located at least 25 feet from electrical equipment and people and at least 20 feet from flammable liquids or combustible materials? (1910.253 b 2 ii)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C10 SHOP Machine Guarding
Evaluation
Comment
C10.1 Are chop saws equipped with a retracting blade guard and functioning spring return? Do they have proper feet to prevent movement while in use?(1910.212 a 1)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C10.2 Are power machines, shears, grinders, saws, drill presses, etc. properly anchored maintained and guarded? (1910.212 b)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C10.3 Do fixed grinders have side guards that cover the spindle, nut, and flange and 75% of the wheel diameter? (1910.215 a 4) Tool rests adjusted to within 1/8" ? (1910.215 a 2) Tongue guard adjusted to within 1/4" of wheel? (1910.215 b 9)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C10.4 Before new abrasive wheels are mounted, are they visually inspected and ring tested? (1910.215d)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C10.5 Is the appropriate eye protection caution sign, and full face shield located at Grinder? (1910.133a)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C10.6 Have all hazards from points of operation, ingoing nip points, rotating parts, flying chips, sparks, moving chains, gears, pulleys and belts (1910.212a), including fan blades (within 7 feet of the floor) (1910.212 a 5) been guarded?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C11 SHOP Tools and Jacks
Evaluation
Comment
C11.1 Are tools and equipment (both company and employee-owned) in good condition and used with the correct handle, shield, guard, or attachment, recommended by the manufacturer? (1910.242 a)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C11.2 Are hand tools such as chisels, punches, wrenches, etc. which are worn , bent or mushroomed during use, reconditioned or replaced as necessary? (1910.242a)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C11.3 Are appropriate handles used on files and similar tools?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C11.4 Are all cords-connected, electrically-operated tools and equipment effectively grounded or of the approved double insulated type? (1910.243 a 5)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C11.5 Are pneumatic and hydraulic hoses on power-operated tools free of deterioration or damage? (1910.243b2)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
C11.6 Are all jacks and jack stands in good condition, with OEM pin and labeled with load capacity? (1910.244a)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D Forklift
Evaluation
Comment
D1 Are all nameplates and marking in place and legible on powered industrial trucks? (1910.178 a 6)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D2 Are industrial trucks kept in clean condition, free of lint, excess oil and grease? (1910.178 q 10)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D3 Is directional lighting provided on each industrial truck?
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D4 Does each industrial truck have a warning horn, or other device which can be clearly heard above the normal noise in the areas where operated? Does each industrial truck have a reverse signal alarm audible above the surrounding noise level? (1910.178 a 2) Is directional signal lighting provided? (1910.178 h 2)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D5 Are the brakes on each industrial truck capable of bringing the vehicle to a complete and safe stop when fully loaded and does the parking brake effectively prevent the vehicle from moving when unattended? (1910.178 a 2)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D6 Does the forklift have a working seat belt and working strobe? (1910.178 a 2)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D7 Are powered industrial trucks driven by trained and authorized personnel only? (1910.178 i)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D8 Is an examination of industrial trucks made at least daily and after each shift and is a vehicle condition report completed? (1910.178 q 7)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D9 Are industrial trucks left in an off position when unattended or when the operator is more than 24 feet from the vehicle? (1910.178 m 5 i)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D10 Is the rated capacity of the truck clearly posted within the view of the operator? (1910.178 a 2)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D11 Do all forklifts have a mounted, inspected and pinned fire extinguisher? (1910.157 d 5)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
D12 Is the overhead guard clear of obstruction, enabling the operator to view raised loads? (1910.178 e)
Pass
Fail
Yes
No
N/A
Pass
Fail
Yes
No
N/A
Comments
Submit
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