Facility Jeffersonville Safety Audit Form Insp.

By Sonya Staten/ Beverly Lewis Date 01/22/09

1 Walkways, Stairs and Exits Yes No N/R Comments and or Action
1 Are aisles and passageways free of obstructions and kept clear. x
2 Is there safe walking clearance in aisles where equipment is operated. x
3 Floors are even, no holes, no cracks, and no tripping hazards are present. x
4 Floors are kept as dry & non-slippery as practical, spills cleaned up immediately. x
5 Walk-off mats are available for wet weather x
6 Exits properly marked illuminated and unobstructed. x
7 Emergency lighting available in hallways and stairwells. x
8 Are aisles and routes to exits clearly marked and kept clear of obstructions. x
9 Are exit doors clearly marked and kept clear at all times. x
2 General Work Environment & Indoor Air Quality Yes No N/R Comments and or Action
1 All areas properly illuminated. x
2 Noise levels are within acceptable limits or engineering controls established. x

3 Work areas are clean, and good Housekeeping practices are in place x
4 Work area properly ventilated. x
5 Walls, ceilings, floors are clean and free of damage. x
6 Air intake areas free of odor causing materials or hazardous chemicals. x
3 Fire Prevention And Protection Yes No N/R Comments and or Action
1 Fire extinguishers properly mounted, located, and identified. x
2 Fire extinguishers adequate in number and type. x
3 Fire extinguishers inspected, recharged, and maintained as required. x
4 Fire aisles, exit ways, stairways, and fire equipment kept unobstructed. x
5 Exit lights properly illuminated and emergency lighting operable. x
6 Fire doors not blocked open or on magnets connected to fire alarm system. x
7 Proper storage of flammable/combustible materials to reduce risk of fire. x
8 No penetrations through walls or ceilings and all ceiling tiles are in place. x
9 Sprinkler heads clean and no storage within 18 inches. x
4 Electrical Safety Yes No N/R Comments and or Action
1 Extension cords are not used as permanent wiring. x
2 Extension cords and power strips are plugged directly into wall outlets. x
3 Electrical cords not under carpets/rugs, through doorways, or high traffic areas. x
4 Power cords are in good condition with no splices or broken insulation. x
5 Grounding prongs not removed from 3-way plugs. x
6 Outlet, switch and junction box covers are in place and in good repair. x
7 Electrical panels and emergency shut offs are unobstructed and labeled. x
5 Personal Protective Equipment (PPE) Yes No N/R Comments and or Action
1 Appropriate eye protection is available and used if hazard present. x
2 Appropriate hand protection is available and used if hazard present. x
3 Appropriate hearing protection is available and used if hazard present. x
4 Safety Shoes are required, and being worn by employees x
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 Safety Inspection Form
6 Material Handling Yes No N/R Comments and or Action
1 Is there safe clearance for equipment through aisles and doorways. x
2 Are containers stored, stacked, secured, and of limited height for stability. x
3 Forklifts and motorized pallet jacks operators have been properly trained. x
4 Forklift and motorized pallet jacks are inspected each shift prior to use. x
5 Are storage racks maintained in a safe condition. x
6 Manual pallet jacks, hand-trucks and dollies are in good condition. x
7 Forklift operators are wearing seat belts & sounding horn while operating the vehicle x
8 Employees are instructed in proper manner of lifting heavy objects. x
7 Hazard Communication Yes No N/R Comments and or Action
1 Material Safety Data Sheets (MSDS) readily available for employee review. x
2 Employees know what MSDS is and how to obtain one. x
3 Employees aware of hazards associated with chemicals used in their area. x
8 Ladders Yes No N/R Comments and or Action
1 Fixed ladder accessible to the public secured from unauthorized use. x
2 Fixed ladders over 20 ft. from landing have cages, wells or fall arrest systems. x
3 Fixed ladders extend 3 ft. beyond roof top. x
4 All ladders are free of sharp edges, splinters, or cracks. x
5 Ladders do not have any loose rungs or steps. x
6 Portable ladders have safety feet. x
7 Step ladders are less than 20 feet in length. x
9 Computer workstation Ergonomics Guidelines (non-mandatory) Yes No N/R Comments and or Action
1 Monitor directly in front, top of screen at or slightly below eye level. x
2 Monitor approximately 18 to 24 inches away, positioned to avoid glare. x
3 Anti-glare screen and/or wrist pad used, if needed. x
4 Chair/footrest heights adjusted to keep thighs parallel with the floor. x
5 Chair/keyboard heights adjusted properly for hands, wrists, and arms. x
6 Documents held next to and at the same level as the monitor screen. x
10 Bloodborne Pathogens Yes No N/R Comments and or Action
1 Biohazardous waste bags (red bags) provided for solid BBP waste. x
2 Employees regularly exposed to BBP have been offered HBV vaccine. x
3 Employees regularly exposed to BBP have been properly trained. x
4 All broken glass disposed of properly. x
5 All sharps injuries reported and logged. x
11 General & Safety Concerns Yes No N/R Comments and or Action
1 First aid kit is available and adequately supplied. x
2 Batteries are charged in a properly ventilated room. x
3 Open flames and sparks prevented in battery charging areas. x
4 Conveyors equipped with proper safety guards x Safety grd missing from chain, replaced the safety grd
6 Appropriate spill control kits are available and properly stocked. x
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 Safety Inspection Form
12 Office Equipment and Break room Appliances Yes No N/R Comments and or Action
1 Chairs in good condition and adjustable (if appropriate). x
2 Paper cutter has guard, blade spring functional, and locked when not in use. x Paper cutter was left in unlock position
3 Portable fans are equipped with appropriate guards. x
4 Bookcases, shelves, cabinets are not overloaded. x
5 Space heaters UL listed with tip switches and working temperature controls. x
6 Toaster, toaster ovens, etc. used away from combustible materials. x
7 Coffeemakers, microwaves, etc. in good operating condition. x
8 Electrical plugs not overloaded. x
9 Drinking fountains are clean and operate properly. x
13 POSTERS AND SIGNAGE Yes No N/R Comments and or Action
1 Federal And State Law Posters are Current and Posted x
2 OSHA Poster is Current and Posted x

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