BASIC LIFE SAFETY

Finding (circle one)

1.

Is the Fire Emergency Plan posted?

Yes

No

NA

2.

Are corridors and exits free from obstructions?

Yes

No

NA

3.

Are exit signs illuminated and visible?

Yes

No

NA

4.

Are emergency instructions and telephone numbers at telephone?

Yes

No

NA

SAFETY

5.

Are the moving parts of machines properly guarded?

Yes

No

NA

6.

Are lock out - tag out procedures followed?

Yes

No

NA

7.

Are motor driven instruments and machines grounded?

Yes

No

NA

8.

Are electrical cords and wires free of burns and fraying?

Yes

No

NA

9.

Are gas cylinders secured from falling?

Yes

No

NA

10.

Are oxygen cylinders separated from fuel gases or combustible material by 20 feet or more?

Yes

No

NA

11.

Is excavation and overhead work properly barricaded?

Yes

No

NA

HAZARDOUS CHEMICALS

12.

Are Material Safety Data Sheets (MSDS) available for hazardous chemicals used in the workplace?

Yes

No

NA

13.

Is there documentation that all employees have received hazard communication training?

Yes

No

NA

14.

Is eye wash/safety shower within 75 ft of hazards?

Yes

No

NA

15.

Are "EYE WASH" and "SAFETY SHOWER" signs posted?

Yes

No

NA

16.

Are chemical containers properly labeled?

Yes

No

NA

17.

Is protective clothing provided?

Yes

No

NA

18.

Are safety glasses and safety shoes provided and worn?

Yes

No

NA

19.

Have respirator users been trained?

Yes

No

NA

20.

Have asbestos containing materials been identified for each job site?

Yes

No

NA

HEARING CONSERVATION

21.

Is there documentation that employees exposed to sound levels above 85dBA receive annual training?

Yes

No

NA

 22.

Do employees wear hearing protectors?

Yes

No

NA

 23.

Have employees received annual audiometric testing?

Yes

No

NA