| Section I:
Exterior, exits and access |
Yes |
No |
Action taken to eliminate hazard |
| 1. Is there secured entry to prevent
unauthorized entry? |
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| 2. Are all exits and entrances marked and
lighted? Is there emergency lighting if power fails? |
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3. Are all exits and entrances free from obstruction and trip/slip/fall
hazards? |
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4. Are parking lots lighted with traffic control patterns to avoid
pedestrian injury? |
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5. Is the emergency evacuation plan available and communicated to all? |
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6. Are all telephone emergency contact numbers posted
(fire/police/paramedics)? |
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7. Are the designated employer representative telephone contact numbers
posted or available? |
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| Section
II: Walking and working surfaces |
Yes |
No |
Action taken to eliminate hazard |
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8. Are all aisles clean and free from trip/slip/fall hazards? |
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9. Are cots, supply pallets and furniture spaced for free access to exits in
case of fire? |
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10. Are stairways uncluttered and free from trip/slip/fall hazards? |
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| 11. Is there adequate lighting in all areas? |
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| 12. Are static (standing) mats provided in work areas? |
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| 13. Are all work areas clean, dry and free from
trip/slip/fall hazards? |
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| 14. Is there guarding for open-sided floors and handrails
for stairwells? |
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| 15. Is guarding in place on needed machines or equipment? |
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| Section
III: Kitchen and receiving area |
Yes |
No |
Action taken to eliminate hazard |
| 16. Are stoves and hoods cleaned of grease daily? |
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| 17. Is kitchen waste disposed of in appropriate, clean
receptacles that are emptied at least once a day? |
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| 18. Are there an adequate number of all types of fire
extinguishers? Are they charged and accessible? |
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| 19. Are floors clean, dry and without trip/slip/fall
hazards? |
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| 20. Is personal protective equipment (PPE) easily
accessible? (e.g., gloves/mittens/aprons) |
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| 21. Is the appropriate PPE being used for the tasks
performed? |
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| 22. Is there appropriate lifting equipment available? |
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| 23. Are powered lift trucks used at the site to unload
supplies? |
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- Are the operators certified in accordance to OSHA standard 29
CFR 1910.178?
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- Are lift truck regulations posted in the area of
operations?
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- Are the daily inspections documented?
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| 24. Are there emergency eyewash stations where corrosive
chemicals are located? (e.g. oven cleaner) |
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Section IV: Health Services – injury and illness
management |
Yes |
No |
Action taken to eliminate hazard |
| 25. Are new injuries, illnesses or communicable illness
cases reported? |
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| 26. Have there been referrals for medical or mental health
care? |
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| 27. Is personal protective equipment easily accessible? |
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| 28. Is the appropriate PPE being worn for the task? |
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| 29. Is injury/illness documentation completed to meet
organizational and regulatory requirements? |
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| 30. Are all incident reports made within 24 hours of
occurrence or knowledge? |
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| 31. Are injury/illness reports reviewed on site to eliminate
hazards and decrease contagious disease? |
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| Section V:
Environmental, fire, electrical, chemical and ventilation hazards |
Yes |
No |
Action taken to eliminate hazard |
| 32. Is the environment adequately
cooled/heated for the safety of employees? |
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| 33. Is the facility free of rodents,
insects, and other vermin? |
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| 34. Is there adequate potable water
available? |
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| 35. Are restrooms and washrooms clean,
functioning, and without trip/slip/fall hazards? |
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| 36. Are fire doors and shutters in good
operating condition? |
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| 37. Are fire doors and shutters unobstructed
and protected against obstructions? |
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| 38. Is proper clearance maintained below
sprinkler heads? |
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| 39. Are there working fire alarms or other communication
systems for evacuation? |
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| 40. Are portable fire extinguishers provided in adequate
number and type, and accessible? |
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| 41. Are fire extinguishers serviced and recharged regularly
with this noted on the inspection tag? |
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| 42. Are electrical extensions cords used safely? |
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- Environment free from dampness or combustible material
around extension cords?
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- Cords grounded and guarded to prevent trip/slip/fall
hazards?
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| 43. Are all hazardous materials identified, labeled and
stored safely? |
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| 44. If there are working generators, are they well vented
directly to the outside? |
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