Monthly Facility Inspection Form
Mark N/A for items not specific to your location
Date
*
-
Month
-
Day
Year
Date
Store Number
*
City
*
Inspected By
*
Record Keeping and Training
Rows
OK
Not OK
NA
Training records for each employee on file?
New Hire Training Completed?
Monthly Training Completed?
Comments
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House Keeping
Rows
Status
Housekeeping & Dust Control Policy Followed?
OK
NOT OK
N/A
Shop Area, Office, Breakrooms and Restrooms clean?
OK
NOT OK
N/A
All areas free of slip,trip and fall Hazards?
OK
NOT OK
N/A
Adequate lighting in work areas?
OK
NOT OK
N/A
Materials stored neat / organized?
OK
NOT OK
N/A
Comments
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Emergency, Fire, and First Aid
Rows
Status
Emergency Action Plan Posted?
OK
NOT OK
N/A
Stand Pipe and Sprinklers inspected / certified?
OK
NOT OK
N/A
Fire Extinguishers Annual and Monthly Inspections Current?
OK
NOT OK
N/A
Exits accessible / unobstructed?
OK
NOT OK
N/A
Emergency Lights working?
OK
NOT OK
N/A
First Aid Kits stocked and organized?
OK
NOT OK
N/A
BBPK stocked and readily available?
OK
NOT OK
N/A
Eye Wash bottles unexpired and accessible?
OK
NOT OK
N/A
Comments
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PPE
Rows
Status
Safety Glasses, gloves, hard toes, and Hearing Protection in use?
OK
NOT OK
N/A
Hard Hats used at Truss Press Station?
OK
NOT OK
N/A
Dust Masks available?
OK
NOT OK
N/A
Face Shield clean and available?
OK
NOT OK
N/A
Fall Protection used as required?
OK
NOT OK
N/A
Fall Protection inspected prior to each use?
OK
NOT OK
N/A
Comments
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Ladders
Rows
Status
Type I or II (No Type III)?
OK
NOT OK
N/A
Free of damage (no broken or bent rungs, etc.)?
OK
NOT OK
N/A
Label is Readable?
OK
NOT OK
N/A
Stored Secure when not in use?
OK
NOT OK
N/A
Comments
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Hand and Power Tools
Rows
Status
Power Breezers Serviced Monthly?
OK
NOT OK
N/A
Tools Inspected and OK for use (no cracks, frayed cords, etc.)?
OK
NOT OK
N/A
Guards in place and functional?
OK
NOT OK
N/A
Miter Saws / Grinders mounted and secured?
OK
NOT OK
N/A
Employees have been trained on tool use?
OK
NOT OK
N/A
Truss Press Safety Mechanisms working?
OK
NOT OK
N/A
No hydraulic leaks at Truss Press?
OK
NOT OK
N/A
Truss labeled with max load?
OK
NOT OK
N/A
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Chemicals and Materials
Rows
Status
Compresssed Gases and Propane Storage secured?
OK
NOT OK
N/A
Flammable / Combustable chemicals Stored in Fire Proof Cabinet?
OK
NOT OK
N/A
All Containers are labeled?
OK
NOT OK
N/A
SDS Book Current Inventory and SDS Sheets?
OK
NOT OK
N/A
No Smoking, Matches and Open Flame Signage?
OK
NOT OK
N/A
Designated Smoking Area?
OK
NOT OK
N/A
Comments
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Forklifts
Rows
Status
Pre-use inspection filled out daily?
OK
NOT OK
N/A
Operators have valid card?
OK
NOT OK
N/A
Horn, Lights, and backup alarm working?
OK
NOT OK
N/A
Tires not excessively worn or damaged?
OK
NOT OK
N/A
3rd Party regular maintenance?
OK
NOT OK
N/A
Comments
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Electrical
Rows
Status
3 prong or double insulated tools used?
OK
NOT OK
N/A
GFCI'S used for power hand tools?
OK
NOT OK
N/A
GFCI's used in outdoor outlets?
OK
NOT OK
N/A
GFCI's in Restrooms and Kitchen areas?
OK
NOT OK
N/A
All Panels have 36" clearance and accessible?
OK
NOT OK
N/A
Panels have warning sign?
OK
NOT OK
N/A
Cords free of frays and damage?
OK
NOT OK
N/A
Strain relief used?
OK
NOT OK
N/A
Comments
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Shelves and Racks
Rows
Status
Weight Capacity Labeled?
OK
NOT OK
N/A
Secured to wall or floor?
OK
NOT OK
N/A
Free from damage (bent girts, bent arms, etc.)?
OK
NOT OK
N/A
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Lockout/Tagout
Rows
Status
Employees Trained on LOTO?
OK
NOT OK
N/A
Logs, keys, and Tags Accounted for?
OK
NOT OK
N/A
LOTO Logs filled out?
OK
NOT OK
N/A
Comments
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General Safety
Rows
Status
Is the store Safety Committee Formed?
OK
NOT OK
N/A
Is the Safety Wall up and current?
OK
NOT OK
N/A
Are Policies, Safety Alerts, and Safety Rules Posted?
OK
NOT OK
N/A
Are Safety Guides and Manuals Available?
OK
NOT OK
N/A
Are all Monthly safety assignments current?
OK
NOT OK
N/A
Comments
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