Your Company Name and Logo
Employee Work Area Inspection Form This form must be completed by each employee who is assigned to a specific work area at the beginning of each shift. REPORT ANY DEFECTS TO YOUR SUPERVISOR IMMEDIATELY! Unsat Sat 1. ARE ALL WALKING AREAS CLEAR OF OBSTRUCTIONS?
(HOSES, WIRES, DEBRIS, TRIP HAZARDS)
2. ARE WORKING AREAS FREE FROM OIL AND GREASE? 3. IS AREA LIGHTING ADEQUATE FOR SAFE WORK? 4. FIRE EXTINGUISHER SERVICABLE & HUNG ON BRACKETS AND ACCESS CLEAR ? 5. ARE THERE ANY LEAKING HOSES OR PIPES? (water,air,fuel lines
etc.)
6. ALL MOVING MACHINERY PROPERLY GUARDED? 7. ALL ELECTRICAL RECEPTICLES & SWITCH BOX COVERS CLOSED, SECURED, PROPERLY LABLED; WIREING SERVICABLE? 8. IS NECESSARY PPE AVAILABLE AND USED? (HEARING
PROTECTION, SAFETY GLASSES, WORK SHOES/GLOVES,HARD HAT)
9. ARE FLAMABLE MATERIALS PROPERLY LABLED & STORED? 10. ARE ALL GUARD RAILS / SAFETY BARRIERS IN PLACE? 11. ARE WARNING / DANGER SIGNS IN USE AND LEDGIBLE? 12. ARE COMMUNICATION SYSTEMS WORKING PROPERLY? 13. ARE SERVICABLE LIFE VESTS AVAILABLE AND USED? 14. DID YOU LEAVE YOUR WORK AREA IN GOOD CONDITION?
REMARKS/DEFECTS:
Date Employee Signature
Time
Area Foremans Signature