Inspection Checklist

Location: Date:

Supervisor: Items to Review:

People
q Unsafe Acts q Unsafe Work Procedure q Improper Tool Use q Improper Equipment Use q Not using PPE q Not following Safety Rules q Operator Authorization

Worker Safety Rep: R S Need Action (list the specific hazard and mark in the chart below)
Materials
q Housekeeping q Controlled Products q MSDS Sheets q Storage / Stacking q Rough Edges q Heavy Material q Safety Bulletin Board

OK

Equipment
q Ladders q Scaffolds q Power Tools q Adequate Supply of PPE q Fire Extinguisher q First Aid Supplies q Electrical

Environment
q Noise q Ventilation q Lighting q Temperature q Ice / Snow q Slip / Trip Hazards q Sanitation

SEVERITY 1 2 3 4 5 Immediate Danger (death, disaster) Serious (major injury or damage) Minor (non-serious injury or damage) Negligible (first aid or less) Not Applicable

PROBABILITY A B C D Probable (immediately or soon) Reasonably Probable (eventually) Remote (could at some point) Extremely Remote (not likely)

Item #
1 2 3 4 5 6 7 8 9 10

Identified Hazard

Hazard Ranking

Control

Action By

Hazard identified should be ranked and controlled in priority. Inspection reports should be posted and communicated to employees as soon as practicable, at minimum during next toolbox talk 15