Inspector:
Date:

Ladders & Stairs

yes or no – 1. Are ladders made of wood or fiberglass to reduce electrical shock hazards where electrical hazards are present?

yes or no – 2. Are ladders the proper height for the task being performed?

yes or no – 3. Are ladder components free of damage such as cracks, broken side rails, or rungs?

yes or no – 4. Are employees using ladders safely (not standing on or above the second step from the top on step ladders)? Straight ladders must extend at least 42 inches above the height being reached.

yes or no – 5. Are steps or rungs of ladders free of oil, mud, or other slippery substances?

yes or no – 6. Are straight ladders tied off at the top before use?

yes or no – 7. Do employees climb ladders with both hands free? Carrying tools or objects in hands while climbing is prohibited.

yes or no – 8. Are stairs clean and free of obstructions such as tools, lunch pails or machine parts?

yes or no – 9. Do employees use the hand rails and ascend or descend the stairs in a safe manner? Employees should not run up and down the stairs.

Lockout / Tagout

yes or no – 10. Are employees locking out electrical power to motors of equipment before cleaning, adjusting, or performing maintenance of any kind?

Housekeeping

yes or no – 11. Are floors, stairs, walkways, and ladders kept clean and free of obstructions such as trash, tools, clothes, fire extinguishers and machine parts?

yes or no – 12. Are unnecessary items removed from the work area to reduce slip, trip, and fall hazards?

Slip & Fall Hazards

yes or no – 13. Is the work area free of tripping/slipping hazards such as water hoses, electrical conduit, water, tools, machine parts, etc.?

yes or no – 14. Do employees refrain from climbing on machinery, ladders, stairs, trucks, or other heights in an unsafe manner?

yes or no – 15. Do employees refrain from running or walking so fast that they risk falling or colliding with persons or objects?

yes or no – 16. Do employees refrain from taking unsafe positions on or around equipment?

yes or no – 17. Are floor holes or pits properly covered?

yes or no – 18. If floor holes or pits are uncovered, are safety barricades placed around the hazard?

yes or no – 19. Do employees refrain from engaging in horseplay, scuffling, or other needless activities?

Personal Protective Equipment

yes or no – 20. Are employees in the plant wearing their hearing protectors properly?

yes or no – 21. Are employees wearing dust masks if conditions are dusty?

yes or no – 22. Are employees wearing safe footwear? Shoes should be of good construction with non-slip (not leather) soles. Steel-toed shoes or boots with rubber soles are preferred.

Welding & Cutting Operations

yes or no – 23. Are welders and welders’ helpers wearing safety eyewear to protect against flashburn or flying particles?

yes or no – 24. Are oxygen and fuel gas cylinders stored in designated areas when not in use?

yes or no – 25. Are oxygen and fuel gas cylinders in use securely fastened in an approved cart?

yes or no – 26. Are the caps securely replaced on oxygen and fuel gas cylinders when not in use?

yes or no – 27. Is an approved fire extinguisher nearby when welding or cutting operations are in progress?

yes or no – 28. Are proper precautions taken to prevent fire around welding and cutting operations?

Manual Lifting and Material Handling

yes or no – 29. Are employees performing manual lifting tasks in a safe manner? Check for the following:

A. Size up the load.

B. Place the load as close to the body as possible.

C. Lift with the legs, keep the back straight.

D. Get help with heavy loads.

E. Use mechanical lifting devices where possible.

F. Use gloves or other personal protective equipment as needed.

G. Avoid harsh jerking movements when pushing, pulling, or lifting a load.

Machine Guarding and Safety Interlocks

yes or no – 30. Are all machine guards in place before operating the equipment?

yes or no – 31. Are all safety interlocks working properly?

yes or no – 32. Are all safety signs on the machinery clean and easily readable?

Portable Hand Tools

yes or no – 33. Are power cords or electrical tools free from damage or defects? Check for frayed cords, damaged or missing prongs or plugs. If male or female plugs are replaced, be sure hot, neutral and ground wires are properly connected. Splices are not allowed in extension cords.

yes or no – 34. Are striking tools such as chisels free from mushroomed heads?

yes or no – 35. Do employees wear proper protective equipment such as safety glasses or goggles when using striking tools or power saws?

yes or no – 36. Are hammer handles free from cracks or looseness?

yes or no – 37. Do employees use the proper stance to maintain balance when using wrenches?

Motor Vehicles

yes or no – 38. Do operators drive slowly on the premises?

yes or no – 39. Do operators stop at all corners of buildings (inside and out) and honk before proceeding?

yes or no – 40. Are backup alarms used on front end loaders and other large vehicles which are confined mainly to the yard area?

yes or no – 41. Do operators ascend and descend the vehicle in a safe manner? Grab bars and footholds must be used so that at least three points of contact are used at all times. Jumping onto or off any vehicle is prohibited.

TOTAL NUMBER CHECKED “NO” = (total) = N
SCORE = (40 – N)/40 X 100 =

Signature of Inspector:
Date: