Department:	PI/Manager/Supervisor:
Location:
Inspector:	Date:
INSPECTION ITEMS	Y	N	N/A	Corrective Action	Corrected at time of inspection	Date Complete
Emergency and Fires
1. Are emergency phone numbers posted?	☐	☐	☐	☐
2. Do employees know where to gather in case of an evacuation?	☐	☐	☐	☐
3. Do employees know where and how to receive care for an injury?	☐	☐	☐	☐
4. Are signs present for emergency safety equipment (eyewash, exits etc.)?	☐	☐	☐	☐
5. Are emergency evacuation drills conducted at least quarterly?	☐	☐	☐	☐
6. Are all exits and paths free of obstruction?	☐	☐	☐	☐
7. Are first aid kits fully stocked and inspected monthly?	☐	☐	☐	☐
8. Are fire extinguishers present and inspected within the past year?	☐	☐	☐	☐
9. Are oily rags kept in a metal bin and removed from the shop daily?	☐	☐	☐	☐
10. Are flammable materials in excess of 10 gallons stored in appropriate containers and storage cabinets?	☐	☐	☐	☐
Pressure Systems
1. Is the compressor pop-off valve operational and routinely inspected?	☐	☐	☐	☐
2. Is the water heater pressure relief valve operational and discharged properly?	☐	☐	☐	☐
3. Are 30 lb. pressure reducing values installed on compressed air hoses?	☐	☐	☐	☐

INSPECTION ITEMS	Y	N	N/A	Corrective Action	Corrected at time of inspection	Date Complete
Safety Administration
1. Have all employees received general safety training: SDS, personal protective equipment (PPE), fire and back safety, etc.?	☐	☐	☐	☐
2. Have all employees been trained on the equipment that they operate?	☐	☐	☐	☐
3. Are all employees current on specialized training:	☐	☐	☐	☐
 Ladders	☐	☐	☐	☐
 Fall Protection	☐	☐	☐	☐
 First Aid	☐	☐	☐	☐
 Lockout/Tagout	☐	☐	☐	☐
 Skid-Steer Loader	☐	☐	☐	☐
 Forklift	☐	☐	☐	☐
 Materials Handling	☐	☐	☐	☐
 Respirators	☐	☐	☐	☐
 Injury and Illness Prevention	☐	☐	☐	☐
4. Are all safety trainings documented and filed?	☐	☐	☐	☐
5. Are regularly scheduled safety meetings conducted in the shop?	☐	☐	☐	☐
6. Are safety meeting minutes posted and implemented?	☐	☐	☐	☐
7. Do all employees have access to the shop safety guide?	☐	☐	☐	☐
8. Is PPE provided and used whenever necessary?	☐	☐	☐	☐

INSPECTION ITEMS	Y	N	N/A	Corrective Action	Corrected at time of inspection	Date Complete
Housekeeping and Ventilation
1. Are all worksites clean and orderly?	☐	☐	☐	☐
2. Are waste containers kept clean and emptied daily?	☐	☐	☐	☐
3. Is food kept in the designated area at all times?	☐	☐	☐	☐
4. Are all cabinets and shelves secured or anchored?	☐	☐	☐	☐
5. Are all machines secured or anchored?	☐	☐	☐	☐
6. Are floors in good condition and kept dry?	☐	☐	☐	☐
7. Are all light fixtures adequate and functioning properly?	☐	☐	☐	☐
8. Is the ventilation system adequate for the work being performed?	☐	☐	☐	☐
9. Are filters changed routinely?	☐	☐	☐	☐
Electrical Safety
1. Are all plugs, cords, and panels enclosed, free from splices with insulation in good condition?	☐	☐	☐	☐
2. Do all extension cords have grounding conductors?	☐	☐	☐	☐
3. Are extension cords used only temporarily? Never link cords together!	☐	☐	☐	☐
4. Are cords secured so they do not run across pathways, under doors or the walls?	☐	☐	☐	☐
5. Is the breaker panel accessible with labels identifying the function of each switch?	☐	☐	☐	☐
6. Are ground fault circuit interrupters available for use in wet areas?	☐	☐	☐	☐
7. Are hand-tools effectively grounded or an approved double insulated type?	☐	☐	☐	☐

INSPECTION ITEMS	Y	N	N/A	Corrective Action	Corrected at time of inspection	Date Complete
Mechanical Safety
1. Is defective equipment promptly reported, labeled, and repaired?	☐	☐	☐	☐
2. Do all machines have guards to protect against points of operation, nip points, rotating parts, moving parts, flying chips, sparks, etc.?	☐	☐	☐	☐
3. Are start, stop, emergency and other operating controls within the operator’s reach?	☐	☐	☐	☐
4. Are written standard operating procedures (SOPs and checklists) for each machine available and executed by all employees?	☐	☐	☐	☐
5. Are machines regularly cleaned, repaired, and maintained by authorized employees?	☐	☐	☐	☐
6. Are maintenance records, calibrations, certifications of each machine kept on file?	☐	☐	☐	☐
Portable Tools
1. Are all electrical hand tools in good operating condition?	☐	☐	☐	☐
2. Are tools free from cracks and broken parts?	☐	☐	☐	☐
3. Are ladders free from dents, splinters, grease, and dirt?	☐	☐	☐	☐
4. Do the spreaders lock in place?	☐	☐	☐	☐
5. Are all safety feet on the ladder in good condition?	☐	☐	☐	☐
6. Are only approved welding equipment used?	☐	☐	☐	☐
7. Are all welding equipment properly insulated?	☐	☐	☐	☐
8. Are fuel gas hoses red, oxygen green, and inert gas black?	☐	☐	☐	☐
9. Are cylinders legibly marked?	☐	☐	☐	☐
10. Are cylinders and hoses free from cracks or dents?	☐	☐	☐	☐
11. Are cylinders secured upright with a double chain and value protector caps?	☐	☐	☐	☐

INSPECTION ITEMS	Y	N	N/A	Corrective Action	Corrected at time of inspection	Date Complete
Storage, Hazardous Materials and Waste
1. Are materials stored to prevent falls and spills?	☐	☐	☐	☐
2. Do signs designate storage areas	☐	☐	☐	☐
3. Are all storage containers labeled with their contents (no abbreviations)?	☐	☐	☐	☐
4. Are storage racks free from sagging?	☐	☐	☐	☐
5. Are employees taught how to stock and unstock shelves safely?	☐	☐	☐	☐
6. Are combustibles and chemicals kept in closed containers when not in use?	☐	☐	☐	☐
7. Do workers use the appropriate PPE when handling materials?	☐	☐	☐	☐
8. Has a current chemical inventory list been provided to EH&S?	☐	☐	☐	☐
9. Are chemicals separated by hazard class (acids, bases, etc.)?	☐	☐	☐	☐
10. Is chemical waste properly separated and stored with EH&S?	☐	☐	☐	☐
11. Are hazardous waste containers properly labelled?	☐	☐	☐	☐
12. Is the hazardous waste properly stored and disposed of through EH&S?	☐	☐	☐	☐
13. Are spill kits/supplies readily available and clearly labelled?	☐	☐	☐	☐
Notes