Instructions: All topics are underlined and listed in ITALIC CAPS.




Satisfactory / Deficient / Not Applicable












Do you have a system in place for hazard identification and control?




Do you investigate all incidents and accidents?




Do you encourage employee involvement in health and safety matters?




Do you provide occupational safety and health training for your workers and supervisors?













Has an emergency medical plan been developed?




Are emergency phone numbers posted?




Are first-aid kits easily accessible to each work area, with necessary supplies available, periodically inspected and replenished as needed?




Are means provided for quick drenching or flushing of the eyes and body in areas where caustic or corrosive liquids or materials are handled?













Do you have a written fire-prevention plan?




Does your plan describe the type of fire protection equipment and / or systems (if any) that are available for use?




Have you established practices and procedures to control potential fire hazards and ignition sources?




Are employees aware of the fire hazards of the materials and processes to which they are exposed?




If you have a fire alarm system, is it tested at least annually?




Are sprinkler heads protected by metal guards when exposed to physical damage?




Is proper clearance maintained below sprinkler heads?  (18 inches of un-obstructed clearance below the sprinkler heads must be maintained!)




Are portable fire extinguishers provided in adequate numbers and types?




Are fire extinguishers mounted in readily assessable locations?




Are fire extinguishers checked monthly?  (Check to see if pull pin is secured by nylon tie, gauge is in the ‘green’, nozzle is clear of all obstructions, visual inspection for damage.) (Tag must be initialed monthly on the back by employee.)




Are fire extinguishers recharged regularly and then noted on the inspection tag?  (Charge must be inspected by vendor annually and new tag attached!)




If employees are expected to use fire extinguishers and fire protection procedures, are they trained?




If employees are not trained to use fire extinguishers, are they trained to immediately evacuate the building?












Has there been an assessment of the hazards that might require PPE, including a review of injuries?




Has the assessment been verified through written certification?




Has training been provided to each employee required to wear PPE?




Has the training been verified through written certification?




Are protective goggles or face shields provided and worn when there is any danger of flying material or caustic or corrosive materials?




Are ANSI-approved safety glasses worn at all times in areas where there is a risk of eye injury?




Are protective gloves, aprons, shields, or other protection provided against cuts, corrosive liquids, and chemicals?




Are hard hats provided and worn where danger of falling objects exists?




Are hard hats inspected periodically for damage to the shell and suspension system?




Are approved respirators provided for regular or emergency use where needed?




Is there a written respirator program?




Are the respirators inspected before and after each use?




Is a written record kept of all inspections dates and findings?




Have all employees been trained in adequate work procedures, use and maintenance of protective clothing, and proper use of equipment when cleaning up spilled toxic or other hazardous materials or liquids?




Is a spill kit available to clean up spilled toxic or hazardous materials?




Where employees are exposed to conditions that could cause foot injury, are safety shoes required to be worn?




Is all protective equipment maintained in a sanitary condition and ready for use?




Do you have eyewash facilities and a quick-drench shower within a work area where employees are exposed to caustic or corrosive materials?




When lunches are eaten on the premises, are they eaten in areas where there is no exposure to toxic materials or other health hazards?




Is protection against the effects of occupational noise exposure provided when sound levels exceed those of the OR-OSHA noise and hearing conservation standard?













Are aisles and passageways kept clear and are they at least 22 inches wide?




Are aisles and walkways appropriately marked?




Are wet surfaces covered with non-slip materials?




Are openings or holes in the floors or other treading surfaces repaired or otherwise made safe?




Is there safe clearance for walking in aisles where vehicles are operating?




Are materials or equipment stored so sharp objects can not obstruct the walkway?




Are changes of direction or elevations readily identifiable?




Are aisles or walkways that pass near moving or operating machinery, welding operations, or similar operations arranged so employees will not be subjected to hazards?




Is adequate headroom (of at least 6.5 fee) provided for the entire length of any walkway?




Are standard guardrails provided whenever aisle or walkway surfaces are elevated more than four fee above any adjacent floor or the ground?













Are all exits marked with an exit sign and illuminated by a reliable light source, if possibly used in the dark?




Are the directions to exits, if not immediately apparent, marked with visible signs?




Are doors, passageways, or stairways that are neither exits nor access to exits, and which could be mistaken for exits, appropriately marked “NOT AN EXIT,” or “TO BASEMENT,” “STOREROOM,” and the like?




Are exit signs provided with the work “EXIT” in lettering at least six inches high and the stroke of the lettering at least inches wide?




Are exit door side-hinged?




Are all exits kept free of obstructions and unlocked?




Are at least two means of egress provided form elevated platforms, pits, or rooms where the absence of a second exit would increase the risk of injury from hot , poisonous, corrosive, suffocating, flammable, or explosive substances?




Are there sufficient exits to permit prompt escape in case of emergency?




Are 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?




When workers must exit through glass doors, storm doors and such, are the doors fully tempered and meeting safety requirements for human impact?













Are doors required to serve as exits designed and constructed so that the way of exit travel is obvious and direct?




Are windows (which could be mistaken for exit doors) made inaccessible by barriers or railing?




Are exit doors able to open from the direction of exit travel without the use of a key or any special knowledge or effort?




Is a revolving, sliding, or overhead door prohibited from serving as a required exit door?




When panic hardware is installed on a required exit door, will it allow the door to open by applying a force of 15 pounds or less in the direction of the exit traffic?




Are doors on cold-storage rooms provided with an inside release mechanism that will release the latch and open the door even if it is padlocked or otherwise locked on the outside?




Where exit doors open directly onto a street, alley, or other area where vehicles may be operated, are adequate barriers and warnings provided to prevent employees from stepping directly into the path of traffic?




Are doors that swing in both directions between rooms in which where is frequent traffic, provided with viewing panels in each door?













Are all ladders in good condition, joints between steps and side rails tight, all hardware and fittings securely attached, and moveable parts operating freely without binding or undue play?




Are nonslip safety feet on all ladders except step ladders




Are ladder rungs and steps free of grease and oil?




Are employees prohibited from placing a ladder in front of doors openings toward the ladder except when the door is blocked open, locked, or guarded?




Are employees prohibited from placing ladders on boxes, barrels, or other unstable bases to obtain additional height?




Are employees instructed to face the ladder when ascending/descending?




Are employees prohibited from using ladders that are broken, missing steps, rungs or cleats, broken side rails, or other faulty equipment?




Are 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, roofs, and the like, does the ladder always extend at least three feet above the elevated surface?




Is it required that when portable rung or cleat-type ladders are used, the base is so placed that slipping will not occur, or it is lashed or otherwise held in place?




Are portable metal ladders legibly marked with signs reading “CAUTION – Do Not Use Around Electrical Equipment” or equivalent wording?




Are the rungs of ladders uniformly spaced at 12 inches, center to center?













Are all tools and equipment (both company- and employee-owned) in good working condition?




Are hand tools such as chisels or punches (that develop mushroomed heads) reconditioned or replaced as necessary?




Are broken or fractured handles on hammers, axes, or similar equipment replaced promptly?




Are appropriate handles used on files and similar tools?




Are appropriate safety glasses, face shields, and similar equipment used while using hand tools or equipment which might produce flying materials or be subject to breakage?




Are jacks checked periodically to assure that they are in good operating condition?




Are tool handles wedged tightly in the head of all tools?




Are tool-cutting edges kept sharp so the tool will move smoothly without binding or skipping?




Are eye and face protection used when driving hardened or tempered tools, bits, or nails?












Are grinders, saws, and similar equipment provided with appropriate safety guards?




Are power tools used with the shield or guard recommended by the manufacturer?




Are portable circular saws equipped with guards above and below the base shoe?




Are circular saw guards checked to ensure guarding or the lower blade portion?




Are rotating or moving parts of equipment guarded to prevent physical contact?




Are all cord-connected, electrically-operated tools and equipment effectively grounded or of the approved double-insulated type?




Are effective guards in place over belts, pulleys, chains, and sprockets on equipment such as concrete mixers, air compressors, and the like?




Are portable fans provided with full guards having openings of inch or less?




Is hoisting equipment available and used for lifting heavy objects, and are hoist ratings and characteristics appropriate for the task?




Are ground-fault circuit interrupters (provided on all temporary electrical 15, 20, and 30 ampere circuits) used during periods of construction?










Do you have an assured equipment-grounding conductor program in place in construction?




Are pneumatic and hydraulic hoses on power-operated tools checked regularly for deterioration or damage?













Is the work rest used and kept adjusted to within 1/8 inch of the wheel?




Is the adjustable tongue on the top side of the grinder used and kept adjusted to within inch of the wheel?




Do side guards cover the spindle, nut, flange and 75 percent of the wheel diameter?




Are bench and pedestal grinders permanently mounted?




Are ANSI-approved goggles or face shields always worn when grinding?




Is the maximum RPM rating of each abrasive wheel compatible with the RPM rating of the grinder motor?




Are fixed or permanently mounted grinders connected to heir electrical supply system with metallic conduit or by another permanent wiring method?




Does each grinder have an individual on/off switch?




Is each electrically-operated grinder effectively grounded?




Before mounting new abrasive wheels, are they visually inspected and ring tested?




Are dust collectors and powered exhausts provided on grinders used in operations that produce large amounts of dust?




To prevent coolant from splashing workers, are splashguards mounted on grinders that use coolant?




Is cleanliness maintained around grinders?













Is there an employee training program for safe methods of machine operation?




Is there adequate supervision to ensure that employees are following safe machine operation procedures?




Is there a regular program of safety inspection for machinery and equipment?




Is all machinery and equipment clean and properly maintained?




Is sufficient clearance provided around and between machines to allow for safe operations, set up and servicing, material handling, and waste removal?




Is equipment and machinery securely placed and anchored when necessary to prevent tipping or other movement and could result in personal injury?




Is there a power shut-off switch within reach of the operator’s position at each machine?




Are the noncurrent-carrying metal parts of electrically-operated machines bonded and grounded?




Are foot-operated switches guarded or arranged to prevent accidental actuation by personnel or falling objects?




Are manually operated valves and switches (controlling the operation of equipment and machines) clearly identified and readily accessible?




Are all emergency stop buttons colored red?




Are all pulleys and belts (that are located within seven feet of the floor or working level) properly guarded?




Are all moving chains and gears properly guarded?




Are methods provided to protect the operator and other employees in the machine area from hazards created at the point of operation, ingoing nip points, rotating parts, flying chips, and sparks?




Are machinery guards secured and arranged so they do not present a hazard in their use?




If special hand tools are used for placing and removing material, do they protect the operator’s hands?




Are revolving drums, barrels and containers (required to be guarded by an enclosure that is interlocked with the drive mechanism so that revolution cannot occur) guarded?




Do arbors and mandrels have firm and secure bearings, ad are they free from play?




Are provisions made to prevent machines from automatically starting when power is restored (following a power failure or shut-down)?




Are machines constructed so as to be free from excessive vibration (when the largest size tool is mounted and run at full speed)?




If machinery is cleaned with compressed air, is air pressure controlled and personal protective equipment or other safe guards used to protect operators and other workers from eye and body injury?




Are fan blades protected with a guard having openings no larger than inch when operating within seven feet of the floor?




Are saws used for ripping equipped with anti-kickback devices and spreaders?




Are radial arm saws guarded and so arranged that the cutting head will gently return to the back of the table when released?













Is all machinery or equipment (capable of movement) required to be de-energized or disengaged and locked out during cleaning, servicing, adjusting, or setting-up operations?




Is it prohibited to lock out control circuits in lieu of locking out main power disconnects?




Are all equipment control valve handles provided with a means of lockout?




Does the lockout / tagout procedure require that stored energy (i.e., mechanical, hydraulic ,air) be released or blocked before equipment is locked out for repairs?




Are appropriate employees provided with individually keyed personal safety locks?




Are employees required to keep personal control of their key(s) while they have safety locks in use?




Is it required that employees check the safety of the lockout by attempting to start up after making sure on one is exposed?

Where the power disconnecting means for equipment does not also disconnect the electrical control circuit:




Are the appropriate electrical enclosures identified?




Are means provided to assure the control circuit can also be disconnected and locked out?













Are only authorized and trained personnel permitted to use welding, cutting, or brazing equipment?




Are compressed gas cylinders regularly examined for signs of defect, deep rusting, or leakage?




Are cylinders kept away from sources of heat?




Are employees prohibited from using cylinders as rollers or supports?




Are empty cylinder appropriately marked, their valves closed, and valve-protection caps placed on them?




Are signs reading: “DANGER – NO SMOKING, MATCHES OR OPEN LIGHTS,” or the equivalent posted?




Are cylinders, cylinder valves, couplings, regulators, hoses, and apparatus kept free of oily or greasy substances?




Unless secured on special trucks, are regulators removed and valve-protection caps put in place before moving cylinders?




Do cylinders without fixed hand wheels have keys, handles, or nonadjustable wrenches on stem valves when services?




Are liquefied gases stored and shipped with the valve end up and with valve covers in place?




Before a regulator is removed, is the valve closed, and then gas released from the regulator?




Is open circuit (no load) voltage of arc welding and cutting machines as low as possible, and not in excess of the recommended limit?




Are electrodes removed from the holder when no in use?




Are employees required to shut off the electric power to the welder when no one is in attendance?




Is suitable fire-extinguishing equipment available for immediate use?




Are welders forbidden to coil or loop welding electrode cable around their bodies?




Are work and electrode lead cable frequently inspected for wear and damage and replaced when needed?




Do means for connecting cable lengths have adequate insulation?




When the object to be welded cannot be moved and fire hazards cannot be removed, are shields used to confine heat, sparks, and slag?




Are fire watchers assigned when welding or cutting is performed in locations where a serious fire might develop?




When welding is done on metal walls, are precautions taken to protect combustibles on the other side?




Before hot work begins, are drums, barrels, tanks, and other containers so thoroughly cleaned and tested that no substances remain that could explode, ignite, or produce toxic vapors?




Do eye-protection helmets, hand shields, and goggles meet appropriate standards?




Are employees exposed to the hazards created by welding, cutting, or brazing operations protected with personal protective equipment and clothing?




Is a check made for adequate ventilation where welding or cutting is performed?




When employees work in confined spaces, is the atmosphere monitored and are means provided for quick removal of welders in case of an emergency?













Are compressors equipped with pressure-relief valves and pressure gauges?




Are compressor air intakes installed and equipped to ensure that only clean, uncontaminated air enters the compressor?




Are air filters installed on the compressor intake?




Are compressors operated and lubricated according to the manufacturer’s recommendations?




Are safety devices on compressed-air systems checked frequently?




Before any repair work is done on the pressure systems of the compressor, is the pressure bled off and the system locked out?




Are signs posted to warn of the automatic starting feature o f the compressors?




Is the belt drive system totally enclosed to provide protection on the front, back, top and sides?




Is it strictly prohibited to direct compressed air toward a person?




Are employees prohibited from using compressed air at over 29 PSI for cleaning purposes unless they use an approved nozzle with pressure relief and clip guard?




Are employees prohibited from cleaning clothing with compressed air?




When using compressed air for cleaning, do employees use personal protective equipment?




Are high pressure hoses and connections in good repair?




Before compressed air is used to empty containers of liquid, is the safe working pressure of the container checked?




When compressed air is used with abrasive blast cleaning equipment, is the operating valve a type that must be held open manually?




Is it prohibited to use compressed air to move combustible dust if such action could cause the dust be suspended in the air and cause a fire or explosion?




If plastic piping is used, is the plastic approved for air line service?  (Some ABS is OK – PVC is not.)













Are cylinders with water-weight capacity over 30 pounds equipped (with means for connecting a valve protector or device, or with a collar or recess) to protect the valve?




Are cylinders legibly marked to clearly identify the gas contained?




Are compressed-gas cylinders stored in areas that are protected from external heat sources (such as flames, intense radiant heat, electric arcs or high temperature lines)?




Are cylinders located or stored in areas where they will not be damaged by passing or falling objects or be subject to tampering by unauthorized persons?




Are cylinders stored or transported in a manner to prevent them from creating a hazard by tipping, falling, or rolling?




Are cylinders containing liquefied fuel gas stored or transported in a position so that the safety relief device is always in direct contact with the vapor space in the cylinder?




Are valve protectors always placed on cylinders when the cylinders are not in use or connected for use?




Are all valves closed off before a cylinder is moved, when the cylinder is empty, and at the completion of each job?




Are low-pressure fuel-gas cylinders checked periodically for corrosion, general distortion, cracks, or any other defect that might indicate a weakness or render them unfit for service?




Does the periodic check of low-pressure fuel-gas cylinders include inspection of the bottom of each cylinder?




Is all portable electrical equipment used inside confined spaces either grounded and insulated or equipped with ground-fault protection?




Before gas welding or burning is begun in confined space, are hoses checked for leaks, compressed-gas bottles removed and torches lighted only outside the confined space area, to be returned to the confined space only after testing for explosive atmosphere?




When using oxygen-consuming equipment (such as salamanders, torches, furnaces) in a confined space, is air provided to ensure combustion without reducing the oxygen concentration of the atmosphere below 19.5 percent by volume?




Whenever combustion-type equipment is used in a confined space, are provisions made to ensure that the exhaust gases are vented outside the enclosure?




Is each confined space checked for decaying vegetation or animal matter that may produce methane?




Is the confined space checked for possible industrial waste that could contain toxic properties?




If the confined space is below the ground and near areas where motor vehicles are operating, is it possible for vehicle exhaust or carbon monoxide to enter the space?













Are combustible scrap, debris, and waste materials stored in covered metal receptacles and removed from the worksite promptly?




Are proper storage methods used to minimize the risk of fire and spontaneous combustion?




Are approved containers and tanks used for the storage and handling of flammable and combustible liquids?




Are all connections on drums and combustible liquid piping (vapor and liquid) tight?




Are all flammable liquids kept in closed containers when no in use?




Are bulk drums of flammable liquids grounded and bonded to containers during dispensing?




Do storage rooms for flammable and combustible liquids have explosion-proof lights?




Do storage rooms for flammables and combustible liquids have mechanical or gravity ventilation?




Are safe practices followed when liquid petroleum gas is stored, handled, and used?




Are liquefied petroleum storage tanks guarded to prevent damage from vehicles?




Are all solvent wastes and flammable liquids kept in fire-resistant, covered containers until they are removed from the worksite?




Is vacuuming used whenever possible, rather than blowing or sweeping combustible dust?




Are fire separators placed between stacked containers of combustibles or flammables to ensure their support and stability?




Are fuel-gas cylinders and oxygen cylinders separated by distance, fire-resistant barriers, or other means while in storage?




Are fire extinguishers provided for the type of materials they will extinguish, and placed in areas where they are to be used?

CLASS A: Ordinary combustible materials fires

CLASS B: Flammable liquid, gas, or grease fires

CLASS C: Energized-electrical equipment fires













If a Halon 1301 fire extinguisher is used, can employees evacuate within the specified time (for that extinguisher)?




Are appropriate fire extinguishers mounted within 75 feet of outside areas containing flammable liquids, and within 10 feet of any inside storage area for such materials?




Is the transfer/withdrawal of flammable or combustible liquids performed by trained personnel?




Are fire extinguishers mounted so that employees do not have to travel more than 75 feet for a Class A fire or 50 feet for a Class B fire?




Are employees trained in the use of fire extinguishers?




Are all extinguishers serviced, maintained, and tagged at intervals not to exceed one year?  Is a record maintained of required monthly checks of extinguishers?




Are all extinguishers fully charged and in their designated places?  Are extinguishers free from obstruction or blockage?




Where sprinkler systems are permanently installed, are the nozzle heads directed or arranged so that water will not be sprayed into operating electrical switchboards and equipment?




Are “NO SMOKING” signs posted in areas where flammable or combustible materials are used or stored?




Are “NO SMOKING” signs posted on liquefied petroleum gas tanks?




Are “NO SMOKING” rules enforced in areas involving storage and use of flammable materials?




Are safety cans used for dispensing flammable or combustible liquids?




Are all spills of flammable or combustible liquids cleaned up promptly?













Is employee exposure to chemicals kept within acceptable levels?




Are eyewash fountains and safety showers provided in areas where caustic corrosive chemicals are handled?




Are all employees required to use personal protective clothing and equipment (gloves, eye protection, respirators) when handling chemicals?




Are flammable or toxic chemicals kept in closed containers when not in use?




Where corrosive liquids are frequently handled in open containers or drawn from storage vessels or pipelines, are adequate means provided to neutralize or dispose of spills or overflows (properly and safety)?




Have standard operating procedures been established, and are they being followed when chemical spills are cleaned up?




Are respirators stored in a convenient and clean location?




Are emergency-use respirators adequate for the various conditions under which they may be used?




Are employees prohibited from eating in areas where hazardous chemicals are present?




Is personal protective equipment provided, used, and maintained whenever necessary?




Are there written standard operating procedures for selecting and using respirators where needed?




If you have a respirator protection program, are your employees instructed on the correct usage and limitations of the respirators?




Are the respirators NIOSH-approved for particular applications?




Are respirators inspected and cleaned, sanitized, and maintained regularly?




Are you familiar with the Threshold Limit Value (TLV) or Permissible Exposure Limit (PEL) of airborne contaminants and physical agents used in your workplace?




Have you considered having an industrial hygienist or environmental health specialist evaluate your work operations?




If internal combustion engines are used, is carbon monoxide kept within acceptable levels?




Is vacuuming used rather than blowing or sweeping dusts whenever possible for cleanups?













Are there areas in your workplace where continuous noise levels exceed 85 dBA?  (To determine maximum allowable levels for intermittent or impact noise see OR-OSHA’s noise and hearing conservation rules.)




Are noise levels measured using a sound-level meter or an octave band analyzer, and are you keeping records of these levels?




Have you tried isolating noisy machinery from the rest of your operation?  Have engineering controls been used to reduce excessive noise?




Where engineering controls are not feasible, are administrative controls (worker rotation) being used to minimize individual employee exposure to noise?




Is there a preventive health program that educates employees about safe levels of noise and exposure, effects of noise on their health, and use of personal protection?




Are employees who are exposed to continuous noise above 85 dBA retained annually?




Have work areas in which noise levels make voice communication difficult been identified and posted?




Is approved hearing protection equipment (noise attenuating devices) used by every employee working in areas where noise levels exceed 90 dBA?




Are employees properly fitted and instructed in the proper use and care of hearing protection?




Are employees who are exposed to continuous noise above 85 dBA given periodic audiometric testing to ensure that you have an effective hearing protection system?






Item needing improvement

Correction needed

Assigned to

Date completed






































































Corrective Action

Assigned To

Due Date