Facility Assessment
AlwaysPeople First, Safety
Assessor
First Name
Last Name
Assessor's Email
Confirmation Email
example@example.com
Facility
Name of Facility
Company
Name of JMAC Company
This checklist monitors the compliance activities at the facility. It also serves as a hazard assessment to current activities. The inspection shall be completed in all areas of the facility, including warehouse, shop and office areas as it is applicable. Issues shall be summarized. Corrections will be made and documented with the completion date in the comments section. All corrections are expected to be completed in a timely manner. ( YES - NO - CDI "Corrected During Inspection"- N/A "Not Applicable" )
SECTION 1: REVIEW OF PRIOR ITEMS
*
Rows
Yes
NO
CDI
N/A
1. Have all identified issues been corrected and noted on the previous facility inspection summary?
2. Are all corrections of previously identified issues still effective and not recurring?
Notes/ Comments:
REVIEW OF PRIOR ITEMS Notes/Comments
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SECTION 2: EMERGENCY PREPAREDNESS
Rows
Yes
No
CDI
N/A
1.Are all
exit signs illuminated and remain illuminated when battery tested?
2. Are all
exit signs free of damage?
3. Are all walkways and aisle ways free of obstructions?
4. Are all exits free of storage and clutter?
5. Are stairwells and corridors free of storage and clutter?
6. Are all employees aware of the proper meeting location in the event of an emergency?
7. Are all materials stored in racks wrapped and stable to prevent falling?
8. Are all the First Aid cabinets fully stocked?
9. Are the First Aid supplies in date
10. Is the fire alarm panel indicating an alarm condition?
11. Are all manual pull stations unobstructed and accessible?
12. Is there anything else relating to emergency preparedness that needs attention at this time?
Notes/ Comments:
EMERGENCY PREPAREDNESS Notes/Comments
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SECTION 3: FIRE EXTINGUISHERS
Rows
Yes
No
CDI
N/A
1. Are all extinguishers in their designated location?
2. Are all extinguishers clearly identified or have a wall mounted sign?
3. Are all extinguishers securely mounted off the ground?
4. Are all extinguishers easily accessible and free of obstructions?
5. Is the last annual inspection within the past 12 months?
6. Are inspection tags current with initial and date of inspection?
7. Are all seals and tamper pins in place?
8. Are all extinguishers free of damage, corrosion, leakage or clogged nozzles?
9. Do all pressure gauges indicate the extinguishers are ready for use?
10. Are all staff members trained on fire extinguisher use?
11. Do all staff members know where the extinguishers are located?
12. Are there additional hazards relating to fire extinguishers?
Notes/ Comments:
FIRE EXTINGUISHERS Notes/Comments
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SECTION 4: EYEWASH
Rows
Yes
No
CDI
N/A
1. Is there an eyewash stations in the areas where they are needed.
2. Is eye wash station accessible
3. Are there caps covering the emergency eyewash?
4. Is the emergency eyewash free of dust, dirt, and other debris?
5. Does the emergency eyewash function properly when turned on?
6. Are there additional hazards relating to eyewash stations?
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EYEWASH Notes/Comments
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SECTION 5: LADDERS
Rows
Yes
No
CDI
N/A
1. Are defective ladders removed from service and tagged out or rendered unusable?
2. Is the area where the ladder will be used inspected for a firm base (free of water, ice, grease, mud, etc.) and free of overhead hazards, such as power lines?
3. Are ladders secured from slipping?
4. Do ladder side rails extend 3 feet above the upper landing surface if a grab rail is not available?
5. Are portable rung and cleat ladders placed so that the horizontal distance from the top support to the feet is one quarter the working distance of the ladder (a ratio of 1 to 4)?
6. Are barricades placed to protect ladders from displacement when used in a walkway?
7. Have employees been trained on the proper selection and use of ladders?
8. Are employees allowed to carry materials as they ascend or descend ladders?
9. Are extension ladders left unattended?
10. Are employees prohibited from using the top step, top cap and rear braces when using step ladders?
11. Is there an established maintenance program to keep ladders in good repair and in usable condition?
12. Are ladders stored in dry areas away from heat, cold, and corrosives?
13. Are there additional hazards relating to ladders?
Notes/ Comments:
LADDERS Notes/Comments
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SECTION 6: STAIRWAYS
Rows
Yes
No
CDI
N/A
1. Is riser height and tread depth uniform?
2. Are landings installed every 12 feet of vertical rise?
3. Are landings a minimum 22 inches wide and minimum of 30 inches in the direction of travel?
4. Is a platform installed where doors or gates open directly onto stairs?
5. When a door is open, is the effective width of the platform a minimum of 20 inches?
6. Are all parts of a stairway free of hazardous projections, such as protruding nails?
7. Are slippery conditions (i.e. from snow or ice) eliminated prior to use?
8. Are stairways having four or more risers, or rising more than 30 inches, provided with at least one handrail?
9. Are unprotected sides and edges of stairways and landings provided with appropriate
guardrails?
10. Are there additional hazards relating to stairways?
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SECTION 7: FORKLIFTS
Rows
Yes
No
CDI
N/A
1. Are pre-use inspections completed on all Forklifts prior to each shift?
2. Are all designated forklift operators properly trained in each type of forklift in use?
3. Are the forklifts free of visible damage?
4. Are there additional hazards relating to forklifts?
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SECTION 8: HAZARDOUS MATERIALS
Rows
Yes
No
CDI
N/A
1. Are SDSs available on all hazardous materials in the facility?
2. Are all SDSs readily available for all employees?
3. Are all employees trained on how to locate, read and understand an SDS sheet? (HazCom)
4. Are all liquids stored in the appropriate containers?
5. Are all HW/UW containers labeled with the contents and an accumulation start date?
6. Are all personnel equipped with adequate PPE for these materials?
7. Are all spill kits located in the correct area?
8. Are all spill kits fully stocked with the needed equipment?
9. Are there additional hazards relating to hazardous materials?
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SECTION 9: ELECTRICAL
Rows
Yes
No
CDI
N/A
1. No circuit breakers regularly tripping?
2. No extension cords used for a permanent operation?
3. Are all plugs and cords in good condition?
4. Are all extension cords plugged into a grounded outlet when in use?
5. No electrical switches, switch plates or receptacles, cracked, broken or have exposed contacts?
6. Do all electrical panels have 3 feet clear space?
7. Are all electrical circuit breakers identified?
8. Are there extension cords run through walls?
9. Are there electrical cords "daisy chained"?
10. Are there additional hazards relating to electrical?
Notes/ Comments:
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SECTION 10: PERSONAL PROTECTIVE EQUIPMENT
Rows
Yes
No
CDI
N/A
1. Is there PPE available for visitors (Hardhat, safety glasses, gloves?
2. Is there adequate PPE for all job types on site?
3. Do all personnel requiring prescription safety glasses have them?
4. Are all personnel trained in the proper use of all PPE as required by their job(s)?
5. Is signage displayed in areas where PPE is required?
6. Are employees wearing proper footwear in accordance with PPE requirements?
7. Are employees wearing gloves wear required by the tasks?
8. Are there additional hazards relating to PPE?
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SECTION 11: RESPIRATORY PROTECTION
Rows
Yes
No
CDI
N/A
1. Are employees who use respirators, voluntarily, trained?
2. Are respirators stored in a sealed bag in sanitary condition?
3. Are respirators disposed of when soiled?
4. Are respirators used according to the NIOSH ratings?
5. Are there additional hazards relating to respiratory protection?
Notes/ Comments:
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SECTION 12: AIR COMPRESSOR
Rows
Yes
No
CDI
N/A
1. Was the air compressor drained of fluid?
2. Is fluid drain from the air compressor captured?
3. Are all belt and pulley guards in place?
4. Is the pressure gauge in working order?
5. Is the operating pressure within manufacturer’s specifications?
6. Is the safety valve in working order?
7. Are there any leaks in the lines?
8. Are air hoses in proper working order?
9. Are hose clamps used on air hoses?
10. Do employees understand the hazards of high pressure air?
11. Are there additional hazards relating to air compressor?
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SECTION 13: HOUSEKEEPING
Rows
Yes
No
CDI
N/A
1. Are all areas cleaned on a regular basis?
2. Are all walkways are at least 36 inches and free of other items that could cause a tripping hazard?
3. Are all floors free of liquids to avoid trips and falls?
4. Is equipment returned to their proper storage location when not in use to avoid a tripping hazard?
5. Check Office area. Is there NO signs of spills; Is there NO debris or garbage; Are areas neat/organized?
6. Check outside of warehouse & shop. Is there NO sign of spills; clear; NO debris or garbage?
7. NO containers leaking?
8. All containers clearly labeled?
9. Flammable materials such as cardboard and paper are stored away from fire hazards and not accumulated throughout the warehouse & shop?
10. Tools are safely secured and stored when not in use?
11. Are there additional hazards relating to air Housekeeping?
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