Company: Work Area:
Inspected by: Date of Inspection:



General Work Environment Yes No
     Worksites clean and orderly? ___ __
     Work surfaces kept dry or appropriate means taken to assure the surfaces are slip-resistant? ___ __
     All spilled materials or liquids cleaned up immediately? ___ __
     Combustible scrap, debris and waste stored safely and removed from the worksite promptly? ___ __
     Accumulations of combustible dust routinely removed from elevated surfaces including the overhead structure of the buildings? ___ __
     Combustible dust cleaned up with a vacuum system to prevent the dust going into suspension? ___ __
     Metallic or conductive dust prevented from entering or accumulating on or around electrical enclosures or equipment? ___ __
     Covered metal waste cans used for oily and paint soaked waste? ___ __
     Oil and gas fired devices equipped with flame failure controls that will prevent flow of fuel if pilots or main burners are not working? ___ __
     At least minimum number of toilets and washing facilities provided? ___ __
     Toilets and washing facilities clean and sanitary? ___ __
     Work areas adequately illuminated? ___ __
     Pits and floor openings covered or otherwise guarded? ___ __


Exiting or Egress Yes No
     All exits marked with an exit sign and illuminated by a reliable light source? ___ __
     Are the directions to exits, when not immediately apparent, marked with visible signs? ___ __
     Doors, passageways or stairways, that are neither exits nor access to exits and which could be mistaken for exits, appropriately       marked "NOT AN EXIT", etc.  ___ __
     Exit signs provided with the word "EXIT" in lettering at least 5 inches high and the stroke of the lettering at least 1/2 inch wide? ___ __
     Exit doors side-hinged? ___ __
     All exits kept free of obstructions? ___ __
     At least two means of egress provided from elevated platforms, pits or rooms where the absence of a second exit would increase the risk of injury? ___ __
     Sufficient exits to permit prompt escape in case of an emergency? ___ __
     Special precautions taken to protect employees during construction and repair operations? ___ __
     Is the number of exits from each floor of a building and the number of exits from the building itself appropriate for the building occupancy load? ___ __
     Exits stairways that are required to be separated from other parts of a building enclosed by at least two-hour, fire-resistive construction in buildings more than four stories high, and not less than one-hour fire resistive construction elsewhere? ___ __
     When ramps are used as part of required exiting from a building, is the ramp slope limited to 1 foot vertical to 12 feet horizontal? ___ __
     When an exit must be made through an unframed glass door, glass exit door, etc.  are the doors fully tempered and do they meet the safety requirements for human impact? ___ __


Exit Doors Yes No
     Doors that are required to serve as exits designed and constructed so that the way of exit travel is obvious and direct? ___ __
     Windows that could be mistaken for exit doors made inaccessible by means of barriers or railing? ___ __
     Exit doors able to open from the direction of exit travel without the use of a key or any special knowledge or effort when the building is occupied? ___ __
     Are revolving, sliding, or overhead doors prohibited from serving as a require exit door? ___ __
     Where hardware installed on a required exit door allow the door to open by applying a force of 15 pounds or less in the direction of the exit traffic? ___ __
     Doors on cold storage rooms provided with an inside release mechanism that will release the latch and open the door even if it's padlocked or otherwise locked on the outside? ___ __
     When exits doors open directly onto any street, alley, or other area where vehicles may be operated, are barriers and warning provided to prevent employees from stepping into the path of traffic? ___ __
     Are there viewing panels in doors that swing in both directions and are located between rooms where there is frequent traffic? ___ __


Portable Ladders Yes No
     Ladders maintained in good condition, joints between steps and side rails tight, all hardware and fittings securely attached and movable parts operating freely without binding or undue play? ___ __
     Non slip safety feet provided on each metal or rung ladder? ___ __
     Ladder rungs and steps free of grease and oil? ___ __
     Is it prohibited to place a ladder in front of door openings towards the ladder except when the door is blocked open, locked or other wise guarded? ___ __
     Is it prohibited to place ladders on boxes, barrels or other unstable bases to obtain additional height? ___ __
     Are employees instructed to face the ladder when ascending or descending? ___ __
     Employees prohibited from using ladders that are broken, missing steps, rungs, or cleats, have broken side rails, or from using other faulty equipment? ___ __
     Employees instructed not to use the top step of ordinary stepladders as a step? ___ __
     When portable rung ladders are used to gain access to elevated platforms, roof, etc., does the ladder always extend at least 3 feet above the elevated surface? ___ __
     When portable rung or cleat ladders are used, is it required the base places so that slipping will not occur or it is lashed or other wise held in place? ___ __
     Portable metal ladders legibly marked with signs reading "CAUTION: Do not use around electrical equipment" or equivalent wording? ___ __
     Employees prohibited from using ladders as guys, braces, skids, gin poles, or for other than their intended purposes? ___ __
     Employees instructed to adjust extension ladders only while standing at the base, not while standing on the ladder or any position above the ladder? ___ __


Walkways Yes No
     Aisles and passageways kept clear? ___ __
     Aisles and walkways marked as appropriate? ___ __
     Wet surfaces covered with non-slip materials? ___ __
     Holes in the floor, sidewalk or other walking surfaces repaired properly, covered or other wise made safe? ___ __
     Are there safe clearance for walking in aisles where motorized or mechanical handling equipment is operating? ___ __
     Materials or equipment stored in such a way that sharp projectiles will not interfere with the walkway? ___ __
     Spilled materials cleaned up immediately? ___ __
     Changes of direction or elevations readily identifiable? ___ __
     Aisles or walkways that pass near moving or operating machinery, welding operations or similar operations arranged so employees will not be subjected to potential hazards? ___ __
     Adequate headroom provided for the entire length of any aisle or walkway? ___ __
     Standard guardrails provided wherever aisle or walkway surfaces are elevated more than 30 inches above any adjacent floor or the ground? ___ __
     Bridges provided over conveyers and similar hazards equipped with proper railing? ___ __


Floor and Wall Openings Yes No
     Floor openings guarded by a cover, guardrail or equivalent on all sides (except entrance to stairways or ladders)? ___ __
     Toe boards installed around the edges of permanent floor openings? ___ __
     Skylight screens of such construction and mounting that they will with stand a load of at least 200 lbs. ___ __
     Glass in windows, doors, glass walls, etc.  which are subject to human impact of sufficient thickness and type for the condition of use? ___ __
     Grates or similar type covers over floor openings, such as floor drains, of such design that foot traffic or rolling equipment will not be affected by the grate spacing? ___ __
     Unused portions of service pits and pits not actually in use either covered or protected by guardrails or equivalent? ___ __
     Manhole covers, trench covers and similar covers, plus their supports, designed to carry a truck rear axle load of at least 20,000 pounds when located in roadways and subject to vehicle traffic. ___ __
     Floor or wall openings in fire resistive construction provided with doors or covers compatible with the fire rating of the structure and provided with a self closing feature when appropriate? ___ __


Stairs and Stairways Yes No
     Standard stair rails or handrails on all stairways having four or more risers? ___ __
     Stairways at least 22 inches wide? ___ __
     Stairs have at least 6'6" clearance? ___ __
     Stairs angle no more than 50 and no less than 30 degrees? ___ __
     Stairs of hollow pan type treads and landing filled with solid material? ___ __
     Steps on stairs and stairways designed or provided with a surface that renders them slip resistant? ___ __
     Stairway handrails located between 30 and 34 inches above the leading edge of stair treads? ___ __
     Stairway handrails have at least 1 and 1/2 inches of clearance between the handrails and the wall or surface they are mounted on? ___ __
     Stairway handrails capable of withstanding a load of 200 pounds, applied in any direction? ___ __
     Where stairs or stairways exit directly into any area where vehicles may be operated, are adequate barriers and warnings provided to prevent employees from steeping into the path of traffic? ___ __
     Stairway landings have a dimension measured in the direction of travel, at least equal to the width of the stairway? ___ __
     Vertical distance between stairway landings limited to 12 feet or less? ___ __
     Stairway provided to the roof or each building 4 or more stories in height, provided the roof slope has a 4 inch drop in 12 inches or less? ___ __


Elevated Surfaces Yes No
     Signs posted, when appropriate, showing the elevated surface load capacity? ___ __
     Surfaces elevated more than 30 inches above the floor or ground provided with standard guardrails? ___ __
     Elevated surfaces (beneath which people or machinery could be exposed to falling objects) provided with standard four inch toe boards? ___ __
     Permanent means of access and egress provided to elevated storage and work surfaces? ___ __
     Required headroom provided where necessary? ___ __
     Material on elevated surfaces piled, stacked or racked in a manner to prevent it from tipping, falling, collapsing, rolling or spreading? ___ __
     Dock boards or bridge plates used when transferring materials between docks and trucks or rail cars? ___ __