Section 1: Electrical
1. 1. Are electrical cords in good repair?
Yes
No
N/A
2. 2. Is there clear access to electrical panels and switch gear?
Yes
No
N/A
3. 3. Are electrical cords secured?
Yes
No
N/A
4. 4. Are proper plugs used?
Yes
No
N/A
5. 5. Are plugs, sockets, and switches in good condition?
Yes
No
N/A
6. 6. Are ground fault circuit interrupters available, if required?
Yes
No
N/A
7. 7. Are portable power tools in good condition?
Yes
No
N/A
8. 8. Other:
Section 2: Equipment And Machinery
1. 1. Are equipment and machinery kept clean?
Yes
No
N/A
2. 2. Is the equipment regularly maintained?
Yes
No
N/A
3. 3. Are operators of all equipment properly trained?
Yes
No
N/A
4. 4. Are motor start-stop switches clearly marked and in easy reach?
Yes
No
N/A
5. 5. Is machinery adequately guarded (for example, grain mill hopper access)?
Yes
No
N/A
6. 6. Is there enough work space?
Yes
No
N/A
7. 7. Are noise levels controlled?
Yes
No
N/A
8. 8. Are fumes and exhaust controlled?
Yes
No
N/A
9. 9. Do you have a lockout procedure in place for operational equipment and electrical switch gear?
Yes
No
N/A
10. 10. Other:
Section 3: Ergonomics
1. 1. Is equipment seating properly adjusted for the operator?
Yes
No
N/A
2. 2. Are computer display screens positioned at a comfortable viewing level?
Yes
No
N/A
3. 3. Other:
Section 4: Fire Safety And Security
1. 1. Are fire extinguishers clearly marked?
Yes
No
N/A
2. 2. Are fire extinguishers properly installed on walls?
Yes
No
N/A
3. 3. Have fire extinguishers been inspected within the last year?
Yes
No
N/A
4. 4. Are workers trained to use fire extinguishers?
Yes
No
N/A
5. 5. Are flammable liquids properly stored?
Yes
No
N/A
6. 6. Will space heaters shut off automatically if tipped over?
Yes
No
N/A
7. 7. Are emergency phone numbers close to phones?
Yes
No
N/A
8. 8. Are smoke, fire, and burglar alarms in place?
Yes
No
N/A
9. 9. Are emergency exits clearly marked?
Yes
No
N/A
10. 10. Are emergency lights in working condition?
Yes
No
N/A
11. 11. If sprinkler systems are in place, have they been inspected regularly?
Yes
No
N/A
12. 12. Other:
Section 5: Entrances And Exits
1. 1. Is there safe access for workers and visitors?
Yes
No
N/A
2. 2. Are emergency exits clear of materials or equipment?
Yes
No
N/A
3. 3. Are emergency exit signs working?
Yes
No
N/A
4. 4. Are emergency lighting units provided? Are they working?
Yes
No
N/A
5. 5. Are confined space procedures in place where workers are required to enter a confined space that has been identified and provided with warning signage by the employer?
Yes
No
N/A
6. 6. Other:
Section 6: First Aid
1. 1. Is the first aid kit accessible and clearly labelled?
Yes
No
N/A
2. 2. Is the first aid kit adequate and complete?
Yes
No
N/A
3. 3. Is the first aid kit clean and dry?
Yes
No
N/A
4. 4. Are emergency numbers displayed?
Yes
No
N/A
5. 5. Do workers know where to go in an emergency and who to call for first aid?
Yes
No
N/A
6. 6. Are injury report forms readily available (Form 7)?
Yes
No
N/A
7. 7. Do workers know who the first aid attendant is?
Yes
No
N/A
8. 8. Other:
Section 7: Garbage
1. 1. Are bins located at suitable points?
Yes
No
N/A
2. 2. Are bins emptied regularly?
Yes
No
N/A
3. 3. Are hoses arranged and stored to prevent tripping hazards?
Yes
No
N/A
4. 4. Other:
Section 8: Hazardous Products
1. 1. Are safety data sheets (SDSs) provided for all hazardous products?
Yes
No
N/A
2. 2. Are containers clearly labelled?
Yes
No
N/A
3. 3. Are hazardous products properly stored?
Yes
No
N/A
4. 4. Are hazardous products disposed of properly?
Yes
No
N/A
5. 5. Are the safety showers or eyewash units working?
Yes
No
N/A
6. 6. Are incompatible chemicals stored away from each other?
Yes
No
N/A
7. 7. Other:
Section 9: Environment
1. 1. Are workers protected from the cold or excessive heat?
Yes
No
N/A
2. 2. Are workers protected from excessive or irritating noise?
Yes
No
N/A
3. 3. Other:
Section 10: General Worker Questions
1. 1. Do workers know where to find SDSs for chemical products?
Yes
No
N/A
2. 2. Do workers know where to find PPE (for example, gloves or eye protection)?
Yes
No
N/A
3. 3. Do workers know how to use PPE?
Yes
No
N/A
4. 4. Do workers use PPE properly : Eye/face protection
Yes
No
N/A
5. 5. Do workers use PPE properly : Footwear
Yes
No
N/A
6. 6. Do workers use PPE properly : Gloves
Yes
No
N/A
7. 7. Do workers use PPE properly : Protective clothing
Yes
No
N/A
8. 8. Do workers use PPE properly : Aprons
Yes
No
N/A
9. 9. Do workers use PPE properly : Respirators
Yes
No
N/A
10. 10. Do workers use PPE properly : Other PPE
Yes
No
N/A
11. 11. Other:
Section 11: Safe Work Practices
1. 1. Do workers use proper manual lifting techniques?
Yes
No
N/A
2. 2. Are wastes disposed of properly?
Yes
No
N/A
3. 3. Do workers know the procedures for working alone or in isolation?
Yes
No
N/A
4. 4. Do workers know how to work safely when handling and moving kegs?
Yes
No
N/A
5. 5. Do workers operate forklifts and machinery safely, following safe work procedures?
Yes
No
N/A
6. 6. Other:
Section 12: Floors And Walkways
1. 1. Are floors kept dry?
Yes
No
N/A
2. 2. If supplies or materials are stored on the floor, are they away from doors and aisles?
Yes
No
N/A
3. 3. Other:
Section 13: Stairs, Ladders, And Platforms
1. 1. Are ladders safe and in good condition?
Yes
No
N/A
2. 2. Are stair handrails fastened to the wall securely?
Yes
No
N/A
3. 3. Are stairwells clear of materials and equipment?
Yes
No
N/A
4. 4. Are stairs and handrails in good condition?
Yes
No
N/A
5. 5. Are ladders and stairs provided with anti-slip treads?
Yes
No
N/A
6. 6. Other:
Section 14: Walls
1. 1. Are signs and fixtures securely fastened to the wall?
Yes
No
N/A
2. 2. Other:
Section 15: Lighting
1. 1. Are lighting levels in work areas adequate?
Yes
No
N/A
2. 2. Are work areas free of glare or excessive lighting contrast?
Yes
No
N/A
3. 3. Is task lighting provided in areas of low light or high glare?
Yes
No
N/A
4. 4. Does emergency lighting work?
Yes
No
N/A
5. 5. Other:
Section 16: Storage
1. 1. Are supplies and materials stored safely so they will not fall?
Yes
No
N/A
2. 2. Are trolleys, dollies, and wheelbarrows available to move heavy items?
Yes
No
N/A
3. 3. Are floors around shelves clear of rubbish?
Yes
No
N/A
4. 4. Are racks and shelves in good condition?
Yes
No
N/A
5. 5. Other: