Facility Safety Assessment Checklist by gN4R51

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									            Daily Inspection Schedule                                                   ASPDS3057 DAILY




Br - Ds - Location Number:                                                    Date Completed:
Location Name:
             PHYSICAL INSPECTION OF PARKING LOT/ GARAGE
           A = Acceptable
                                                                                                  CHECK (X) AS
           C = Corrections Required (provide target date)                                         APPLICABLE
           NA = Not Applicable

                                                                                                              Target
A. Parking Lot/ Garage                                                                        A           C    Date
1. All lot surfaces in good repair
2. Wheel Stops in good repair/properly placed
3. Lighting Fixtures in working order
4. Gate Arms working properly (protective padding installed)
5. All areas free of debris and obstructions
6. All parking stalls appear clean and free of "slip and fall" hazards
7. All pedestrian walkways appear clean and free of "slip and fall" hazards



Inspected By:
     (print name)




Signature:




           KEEP THIS FORM ON FILE IN YOUR OFFICE FOR 2 YEARS

            YOU MUST SUBMIT THIS FORM TO THE REGIONAL OFFICE

                       FOLLOWING A FACILITY ACCIDENT!
                                     Facility Safety Assessment Checklist                                                                  revised 2/15/12


Br - Ds - Location Number:                                                                           Date Completed:
Location Name:

         PART I: INJURY AND ACCIDENT PREVENTION DOCUMENTATION
                A = Acceptable
                C = Corrections Required (provide target date)                                             CHECK (X) AS APPLICABLE
                NA = Not Applicable
A. OSHA Documentation                                                                                     A             C    Target Date         NA
1. Injury & Illness Prevention Program in place
2. General Safety Rules identified
3. New Hire Safety Orientation Checklist
4. Postings In Place (Medical Clinic, CAL OSHA, Worker's Comp., Safety Rules, etc.)
5. MSDS site specific sheets in place
6. Emergency Evacuation Plan in Place
7. OSHA 300 Log available and up-to-date
8. Facility Safety Maintenance Schedules complete/up-to-date/target dates accomplished
B. Employee Safety Training                                                                               A             C    Target Date         NA
1. Documentation of training of new/reassigned employees
2. Documented monthly safety meeting agenda
3. Documented monthly safety communication attendance rosters
4. Documentation of safety training for specialized job classifications
5. Documentation of Ergonomics Training
6. Documentation of Violence Prevention Training
C. Health and Safety Programs                                                                             A             C    Target Date         NA
1. Hazard Communication Program (MSDS)
2. IRAP Program (Inspect-Report-Analyze-Prevent)
3. Daily Facility Inspection Program
4. Barricade Program
5. Slip/ Trip and Fall Protection Program
6. Safety Communication and Accident Review Program In Place
D. Emergency Procedures                                                                                   A             C    Target Date         NA
1. First aid - personnel/procedures/supplies
2. Formal Emergency Evacuation/Response Plan
3. Workplace Violence Protocol In Place
4. Emergency Contact List up-to-date and documented
E. Driver/Fleet Safety                                                                                    A             C    Target Date         NA
1. Driver's have working knowledge of emergency procedures/documentation in place
2. Vehicle Inspections preformed according company policy/documentation in place)
3. Company Driver Permits required and MVR program in place/documentation
4. Drivers instructed/use vehicle seat belts (documentation/corrective action in place)
5. CDL Driver's documentation (License & Medical Card)
6. Periodic drivers evaluation program/documentation
7. Vehicle Preventive Maintenance conducted and properly documented
8. Vehicle accident reporting procedure implemented and documented
9. Smartdrive" program in place/up-to-date downloaded events/documented census/reporting
10. Driver Training in place and documented census
11. CDL/(PUC/CA) Drivers enrolled in Random Drug and Alcohol Program/documentation census
12. CDL/PUC Drivers enrolled in Pull Notice Program (CA)/documentation census
13. Shuttle Driver Back Safety Program in place and documented

                                     PART II: PHYSICAL INSPECTION
A. Parking Lot/ Garage                                                                                    A             C    Target Date         NA
1. All EXITS clearly marked
2. Presence of Liability Disclaimer Signs (must match ticket)
3. All lot surfaces in good repair
4. Wheel Stops in good repair/properly placed
5. Striping clear and defined
6. Traffic directional arrows present
7. Convex mirrors installed at "blind intersections"
8. Pedestrian walkways well defined/non-skid surface
9. Presence of traffic flow indicators and signs
10. Posted Speed Limit/Caution Signs present
11. Sufficient lighting and lighting fixtures in working order.
12. Vents and ductwork in the rear of parking stalls painted/ protected.
13. Gate Arms working properly (protective padding and "Not A Walkway" decal installed)
14. Curbing painted in contrasting color/signs "watch your step" if appropriate
15. All areas free of debris and obstructions
16. Stalls and walkways appear clean and free of "slip and fall" hazards
17. Ticket dispenser and Gate Arm Control Box closed and locked
18. Clearance checked throughout the garage checked and corresponds to clearance signs.
19. All key boxes locked and secure
20. Ventilation system in good working order (garages-underground parking)
B. Cashiers Booths                                                                                        A             C    Target Date         NA
1. Security cameras in place
2. Doors and windows operational and lockable
3. Money drop procedures in place and documented
4. Security procedures and training documented (emergency numbers in place)
5. Heating, ventilation and air conditioning (HVAC) system operational
6. Electrical cords in good condition
7. Workstation ergonomics addressed and adjustments made
8. Cashier's chair stable and in good condition
9. Sufficient lighting, visibility / camera or convex mirrors
10. Fire extinguisher in booth
11. NO SMOKING POLICY is observed and documented
12. Area around booth well lit, free of obstructions and secure
13. Chemical-containing products and supplies inside booth stored properly
MANAGERS NAME (PRINT):                                                      SIGNATURE:

COMPLETED BY NAME (PRINT):                                                  SIGNATURE:
Complted this form monthly or after any accident.
A copy must be kept on file at the location and forwarded to: Branch Operations Manager / Regional Safety Coordinator




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                                     PART II: PHYSICAL INSPECTION (Cont.)
                 A = Acceptable
                 C = Corrections Required (provide target date)                                            CHECK (X) AS APPLICABLE
                 NA = Not Applicable
C. Stairwells                                                                                             A             C    Target Date    NA
1. Stairwell signs in place "Please Use Handrail"
2. Exit signs in place per local code
3. Doors to stairwells open and in good operating condition
4. Doors locked/closed from the exterior
5. Steps clean and clear of obstacles
6. Non-slip strips on stairs and in good condition
7. Sufficient Lighting and in working order
8. Appropriate sign posting according to city fire codes
9. Signs in stairwell landings "Please Use Handrail"
D. Elevators                                                                                              A             C    Target Date    NA
1. Elevator(s) operating properly
2. Door safety open operational
3. Elevator leveling on all floors
4. Sufficient lighting inside elevator
5. Alarm and telephone operational
6. Layout map (directions) to nearest stairwell present
7. Liability signs present/posted near elevators
8. Permits and appropriate licensing displayed in elevators
E. Employee Lavatory and Break room                                                                       A             C    Target Date    NA
1. Supplies in stock (paper, soap, etc.)
2. Lavatory conveniently available to employees
3. Drinking and washing water available
4. All Appliances operating properly
5. Employee postings in place
6. No Smoking Signs in place
F. Office Area                                                                                            A             C    Target Date    NA
1. Workstation's ergonomically correct
2. Office is neat (free from electrical and "trip and fall" hazards)
3. Exit Signs clearly posted
4. Emergency Evacuation Diagrams Posted
5. Fire extinguishers in place
6. Emergency Contact Numbers On File and Current For All Employees
7. All Chairs and Furniture in good working order
8. Lighting Is Good Interior and Exterior
G. Emergency Equipment                                                                                    A             C    Target Date    NA
1. Emergency Evacuation Plan In Place All Workstations
2. Three (3) day food supply, flashlights, batteries, blankets and drinking water in place
3. Fire Extinguishers In Place and Inspection Dates Current
4. First Aid Supplies Available and in good condition
5. Condition/ Use of Personal Protective Equipment for appropriate job classifications
      a) Footwear
      b) Gloves
      c) Back Belts
      d) Safety Glasses
      e) Footwear
       f) Masks or Respirators
      g) Absorbent Materials to prevent slip and fall injuries
H. Shuttle Vehicles                                                                                       A             C    Target Date    NA
1. ASP Corporate Pre-Trip Inspection Form Used Each Shift (Form 804 9/98)
2. Drivers Alert Decals on vehicles (How Am I Driving?)
3. Insurance and Registration in vehicle and up-to-date
4. Fire Extinguisher in vehicle and properly charged
5. Three (3) Emergency Triangles in vehicle
6. Radio Equipment In Vehicle and in good working order
7. Emergency Procedures Instructions Located In Vehicle
8. Luggage Weight Limit 35lb. Decal Displayed At Entrance To Shuttle Vehicle
9. Driver's Seat Belt in good working order
10. All Emergency Exit Windows Clearly Marked and In good working order
11. Tires In Good Condition (no excessive ware 1/42nd) or uneven ware
12. DriveCam Installed In Vehicle/ In Good Working Order
13. Fleet Maintenance Records up-to-date for current month
J. Valet Operations                                                                                       A             C    Target Date    NA
1. ASP Parking Tickets In Place (diagram of automobile for marking pre-existing damage)
2. Attendants trained to check for pre-existing damage/documentation in place
3. Entrances Clearly Marked With "Caution Slow Pedestrian Traffic" Signs
4. Chain of custody protocol for customer keys/documentation for "lost ticket".
5. All keys locked in secure area
6. Column and Wall Padding In Place/Good Condition
7. Sign Posted "Do Not Leave Valuables In Vehicle"
8. Non-skid surface in carriage area
J. Company Accident Forms (All Forms May Be Ordered By Fax: 213 623-4298)                                 A             C    Target Date    NA
1. Safety Box In Place contains camera (use checklist below)
2. Employee Injury / Workers' Compensation
      a) Supervisor's Report of Employee Injury and Investigation (Form: ABM242-1)
      b) Medical Service Order Form (Form: ABM462-C)
      C) Manager's Injury Investigation (Form: ASP3058)
2. Customer Injury / Public Liability
      a) Personal Injury Accident Report (Form: ASP 3387)
      b) Standard Insurance Claim Information Form
      C) Manager's Injury Investigation (Form: ASP3058)
3. Vehicle Collision / Property Damage
      a) Facility Loss Report (Form: ASP 3082)
      b) Standard Insurance Claim Information Form
4. Facility Safety Maintenance Schedule (Form: ASP-DS902)
                          COMMENTS PHYSICAL EVALUATION NEEDS ASSESSMENT



MANAGERS NAME (PRINT):                                                       SIGNATURE:

COMPLETED BY NAME (PRINT):                                                    SIGNATURE:
Complted this form monthly or after any accident.
A copy must be kept on file at the location and forwarded to: Branch Operations Manager / Regional Safety Coordinator

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