Inspections/Observations Report Form

Identify Unsafe Conditions and Unsafe Acts in your workplace

Goal: Identify and correct hazards that could cause injury or illness to plant personnel or adverse impact to the environment and ensure compliance with applicable regulations and OSHA standards.

EXCEPTIONAL JOB (Start positive! Note an area or employee, clearly demonstrating "Think Safety/Work Safely")

SAFETY RULE VIOLATION (Actual observation, or the evidence that a rule has been violated.)

UNSAFE ACT (An act, obviously unsafe, not covered by a written rule or practice.)

UNSAFE CONDITION (A condition, obviously unsafe.)

We request you check only one EJ, SRV, UA, or UC, so that we may "track the inspection items" in order to determine where to place increased emphasis. A safety rule violation may indicate that the safety training or enforcement is inadequate or the rules are not clear/consistent/enforced. An unsafe act may indicate employees need behavioral safety training. Safety is not automatic for many people, it has to be learned and reinforced. An unsafe condition may indicate that OSHA and other regulations are not clearly understood or that it requires budget considerations to correct.

ONLY check one EJ, SRV, UA, or UC

Item:	Comments or Corrective Actions	EJ	SRV	UA	UC	Grid # Asset #	Work Order
1. Egress and Emergency Plans:
Emergency Evacuation Plan posted?
Other Emergency Plan posted?
All exits properly/clearly marked?
Snow/ice hazards removed promptly or controlled?
2. Machine/Equipment:
Are machines adequately guarded to protect against hazards such as point of operation, nip points, rotating parts, flying chips or sparks?
Are all emergency stops clearly identified?
Are appropriate portable ladders available?
Are daily hoists, cranes, slings, chains inspections completed?
Are capacity for hoists, cranes, slings, chains clearly marked?
Are grinder rests set tongue guard 1/8" and tool rest 1/16"?
Are hand tools adequate/good condition?
Are floor holes protected/covered so no more than 1" wide opening?
Pits guarded by a cover or removable standard railings
Are there frayed wires, cords exposed, knock-out plugs missing?
Do all electrical control panels have 36" clearance?
Are all electrical disconnects clearly marked?
Item:	Comments or Corrective Actions	EJ	SRV	UA	UC	Grid # Asset #	Work Order
3. Fire Protection:
Locations of Portable Fire ext: Class A fires 75 feet less; Class B fires 50 feet or less
Fire protection equipment in designated place/clearly marked/not blocked?
Monthly fire ext. checks?
Annual fire ext. checks?
Adequate eye wash/showers available and clearly identified?
Flammable cabinets adequate/clearly marked?
Chemicals in piped in systems clearly marked?
Hazmat storage areas designated as restricted access?
Hazmat tanks, LP containers protected from physical damage?
4. Safe Operating Procedures & LOTO:
Are SOP procedures in place/adequate?
Are LOTO procedures in place/adequate?
5. General Work Environment:
Adequate lighting?
Total items in categories
Additional comments:

Item:	Comments or Corrective Actions	EJ	SRV	UA	UC	Grid # Asset #	Work Order
1. Housekeeping/Orderliness:
Are all aisles marked/kept clear?
Are all exits marked/kept clear?
Are tubs, pallets (not exceed 6’), parts properly stacked and/or stored?
Is trash in appropriate containers?
Fire extinguishers not blocked?
2. Personal Protective Equipment:
Safety glasses:
Hearing Protection:
Steel Toe Shoes
Appropriate gloves worn?
Goggles/Face shield for sanding and/or grinding?
3. Positions of People (Injury causes):
Potential for employees to be struck by or against objects?
Pinch Points: Caught in, on , or between objects
Slip/Trip/Fall hazards
Machine Guards/blocks in place/used?
Are ergonomic postures & lifting techniques appropriate?
Item:	Comments or Corrective Actions	EJ	SRV	UA	UC	Grid # Asset #	Work Order
4. Safe Operating Procedures & LOTO:
Are procedures followed?
5. General Work Environment:
Employees know location of MSDS’ ?
Chemicals properly labeled/stored?
Compressed Gas Cylinders secured?
Appropriate ladder or fall protection when work is 6' off walking/working surface?
Light Guarding/two hand controls used for press/press brakes?
6. Forklift /scooter Operations:
Does forklift operator have a valid license?
Are the daily forklift inspections current?
Are seatbelts used if equipped?
Are speeds appropriate?
Are driving lights used?
Truck loading: wheels chocked? Anti-nose dive device in place?
Total items in categories
Additional comments:

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An EHS Network of Central Kansas "Safety Training Article"

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Last updated: October 2003