WORKPLACE INSPECTION RECORDING FORM Store No.: Inspected By: Date of Inspection: Time of Inspection:

Similar documents
SAFETY SELF-INSPECTION PROGRAM

Safety Inspection Checklist

SAMPLE using TEMPLATE 1

Walking and Working Surface Checklist:

Dining Services OSHA Safety Training Program TRAINING RECORD

Walking/Work Surfaces Fall Protection Program

Monthly Inspection Checklists

Kidd Mine Barricade Standards

Name Of Occupancy Date. Yes No Describe

Safety Inspections and Sample Safety Inspection Checklists

Safety in Offices and other General Areas

WEEKLY SAFETY MEETING All Euramax Subsidiaries HOUSEKEEPING. Safety Meeting Contents. Meeting Notice. Leaders Guide. Employee Handout.

Waste Management Log Book

Town of Bellingham Fire Department

Farmers Restaurant Loss Prevention Program

Injury & Illness Prevention Program (IIPP)

OSHA & Restaurants: Top 10 Frequently Cited Violations from October 2008 September 2009 for SIC Code 5812 Eating and Drinking Places

HEALTH AND SAFETY REDUCING ACCIDENTS IN KITCHENS

Preventing Slips, Trips, & Falls

Preventing Accidents in the Kitchen

Master Workplace Inspection Checklist for General Shop Safety. MASTER WORKPLACE INSPECTION CHECKLIST General Shop Safety

Safety Checklist. Apartment buildings and condominiums. AvivaCanada.com/risks

How To Check If A Building Is Safe For A Disabled Person

Company Name Company Address Company Phone Number Company Fax Number

Dennis Fire Department Fire Prevention Mark Dellner Fire Chief

Slips, Trips, & Falls. Supervisors Notes

Safety Rules. Miscellaneous Retail Stores

Items in red were complete Items in green were complete on Lined out items are Life Safety Codes.

RECOGNIZING SLIP, TRIP AND FALL HAZARDS

FACILITY SAFETY SIGNAGE GUIDE: 10 SIGNS TO SPOT DURING A PLANT WALKTHROUGH

E3902 Seeing Accidents Before They Happen Leader s Guide

Housekeeping and Material Storage

How To Protect Your Shop From Tripping Hazards

OCCUPIERS LIABILITY SLIPS, TRIPS +FALLS

CANTON FIRE DEPARTMENT

APPENDIX 2-3 PCAPP EDS INSPECTION LOG SHEETS

Preventing Falls, Slips and Trips

OSHA Compliance Checklist ASC

North Carolina State University Emergency Facilities Closure Checklist- Part I

Department: Manager: Safety Coordinator: Date:

c. As mandated by law, facilities must obtain and maintain valid zoning permits as well as permits for intended use.

SCHOOL SELF-INSPECTION FORM

Level I Inspection Guidance Document 2014

Working Safely In Restaurants

FIRE AND LIFE SAFETY REQUIREMENTS FOR CONVENTIONS, TRADE SHOWS AND EXHIBITS

Quality Assurance Calendar Laundry and Housekeeping Responsible Party Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

LABORATORY SAFETY INSPECTION CHECKLIST

CAL FIRE/San Luis Obispo County Fire Fire Prevention Bureau

Guidance on preventing Slips, Trips and Falls

SLIPS, TRIPS AND FALLS SLIPS, TRIPS AND FALLS (STF) Slips, Trips and Falls: Agenda

SELF-INSPECTION PROGRAM FOR FIRE PROTECTION EQUIPMENT

Louisiana State University Information Technology Services (ITS) Frey Computing Services Center Data Center Policy

ENVIRONMENTAL, HEALTH, AND SAFETY (EHS) AUDIT CHECKLIST (permission to use/modify checklist from NIAR-ASTEC )

Supermarket / Retail Safety Solutions

Slips, Trips and Falls

Discussion Leaders Guide Session Slips, Trips and Falls

BUILDING DEPARTMENT 8748 W. 82 nd Place - Justice, IL Phone: (708) Fax: (708)

PPG SUPPLIER DEVELOPMENT ASSESSMENT

Laboratory Safety and Environmental Health Assessment Program

FIRE AND LIFE SAFETY REQUIREMENTS FOR CONVENTIONS, TRADE SHOWS AND EXHIBITS November 2011

Introduction to PC Repair By

HOUSING QUALITY STANDARDS (HQS)

FIRE SAFETY ONLINE TRAINING

FACILITY FIRE PREVENTION AND EMERGENCY PREPAREDNESS INSPECTION CHECKLIST

Portable Ladder Safety

Slip, Trip and Fall Prevention Manual

Safety Inspection Guidelines for Department Safety Coordinators

Injury Prevention in Restaurants and Kitchens

ELECTRICAL SAFETY. The standard unit for measuring electrical current.

TOWN OF DAVIE BUSINESS TAX RECEIPT 6591 ORANGE DRIVE DAVIE, FLORIDA PHONE: FAX:

ESTABLISHMENT OF A NEW BUSINESS

FIRE SAFETY SELF-INSPECTION FORM FOR CULTURAL INSTITUTIONS. 1. All Floors (inspect from top floor to basement): Yes No

Universiti Tunku Abdul Rahman Manual Title : HAZARD IDENTIFICATION, RISK ASSESSMENT AND RISK CONTROL (HIRARC)

FIRE SAFETY SELF-INSPECTION FORM FOR CULTURAL INSTITUTIONS

COMPREHENSIVE PROPERTY INSPECTIONS

Beth Israel Deaconess Medical Center Environment of Care Manual

The Commonwealth of Massachusetts Executive Office of Public Safety Department of Fire Services

Safety and Health Office WORKPLACE SAFETY CHECKLIST

Depending on your facility and the equipment contained within, all or part of the checklists/logs can be printed for use.

How To Check For A Deficiency

Monthly Warehouse Inspection Checklist

AUTOMATIC SLIDING DOOR

Preventing Burns from Hot Stuff

[Type text] What is the probability of an accident happening? Task, activity or environment being assessed

Warehouse Handbook. White Settlement ISD

Standard Operating Procedure Title: Housekeeping Audit Procedure

North Dakota State University Slips, Trips, & Falls Program

De Beers Canada Inc. OP 050 SLIPS, TRIPS, FALLS AND PEDESTRIAN SAFETY - SURFACE

NATEF On-Site Evaluation Photo Album

Safety Manual For Overhead Crane Operators

General Fire Code Requirements Within Commercial Tenant Spaces

Laboratory Safety Inspection Checklist (Biology and Biochemistry)

Laboratory Audit Sheet Auditor s Name: Date of Inspection: / / Building Name: Room# Principal Investigator:

Safety, Health & Environment Contractor Induction

An inventory of hazardous materials used in your workplace will prove useful.

SAMPLE using TEMPLATE 2

Final Walk-Through Checklist

Job Description. Custodian

Risk and its Impact to(insert company name here) Risk AFTER Mitigation. Objective (A-D)

Reducing Slips, Trips and Falls

Transcription:

WKPLACE RECDING FM Store No.: Inspected : of Inspection: Time of Inspection: Hazards Observed If NOT EXTERI / PARKING LOT FOLLOW-UP F HAZARDS OBSERVED Are parking areas well lit? Are parking areas free of snow, ice, debris or other obstructions? Are sidewalks and pavements clear of potholes, snow, ice, debris or other obstructions? ENTRANCES Are all entrances well lit? Are the door closure devices working properly? Are the threshold plates on all doors secured? No protruding screws? Are there solid glass door markers to alert the customers? Class C Hazard: Hazard requiring attention.

If NOT CUSTOMER AREA FOLLOW-UP F HAZARDS OBSERVED Are customer areas well lit? Are floors free of slip hazards? Are changes in the floor elevation clearly identified? Are signs used to indicate that floors are wet and slippery while mopping? Is the front counter well lit? FRONT COUNTER Is the dishwasher door closed when unattended? Is the floor free of tripping hazards, debris, or obstructions? (i.e. Waxies, boxes, etc.) Are oven mitts being worn where required? Are oven mitts in good condition? (i.e. No holes, split seams, etc.) Are oven doors closed when unattended? Are bagel cutters being used properly? Are knives being used and stored properly? Class C Hazard: Hazard requiring attention

Is kitchen well lit? Is the floor clear of wet spots and/or debris? (i.e. Paper, food, etc.) Are wet floor signs available? Are they in useable condition? Are they being used? Is the area free of tripping hazards, debris and obstructions? Are all mixers guarded? Are oven mitts available and in good condition? (i.e. No holes, split seams, etc.)? Are knives being used and properly stored in designated area(s)? Are lids being used on pots or pans when hot food is carried to and from the stove/kitchen? Are all handles on cooking pots/pans well secured? Are all storage areas well lit, including the fridge and freezer? Is the interior door latch of the fridge and freezer working properly to allow for exit from within? (i.e. Door does not stick; components are not loose, etc.) Are ladders/step stools available? Are they in good condition? (i.e. Non-slip feet, broken or loose rungs, etc.) Are heavier items and bulkier items stored on bottom or lower shelves? If NOT KITCHEN AREA STAGE AREAS FOLLOW-UP F HAZARDS OBSERVED

If NOT STAGE AREAS FOLLOW-UP F HAZARDS OBSERVED Are racks/shelves suitable for load? Are the tall or heavy shelves firmly secured? Are stored items kept at least 18 inches below the sprinkler heads and overhead heaters? Are there any boxes or other flammable materials near the overhead heaters? Are aisles free of tripping hazards? STAFF ROOM Housekeeping being done? OFFICE Housekeeping being done? Electrical are all cords and wires in good condition and out of the way? WASHROOMS Cleanliness and housekeeping? Class C Hazard: Hazard requiring attention

Hazards Observed If NOT FOLLOW OW-UP F HAZARDS OBSERVED Is the area (at least 1 meter) in front of the electrical panel clean and clear of any objects? Does the entrance to the room or similar enclosure containing exposed, live electrical parts; have any warning sign of danger? Are there any chemicals being stored in the room? ELECTRICAL ROOM Is there an emergency phone numbers list next to the phone(s)? Is it current and legible? Are all emergency exits clearly identified and well lit? Are all exit doors completely free of debris or obstruction? Are all fire extinguishers being inspected monthly? Is the tag initialled and dated? EMERGENCY AND FIRE Do electrical outlets, which are not in use, have covers? Is the emergency evacuation plan posted? Class C Hazard: Hazard requiring attention

Are all controlled products identified by either a Supplier label or Workplace label? Is there an inventory list that identifies what WHMIS materials are stored, used and handled in the store? If NOT WHMIS FOLLOW-UP F HAZARDS OBSERVED Are chemicals stored properly? Are there Material Safety Data Sheets (MSDS) for each product on the inventory sheet? Are all MSDS sheets current? Are the MSDS sheets available in a location accessible to all employees, and where controlled products are used? Is PPE available? Stored properly? Accessible? Is PPE in good condition? PERSONAL PROTECTIVE EQUIPMENT Is there an eyewash station in the area? Is the eye wash station clean and free of obstructions? Class C Hazard: Hazard requiring attention

Is there an appropriate provincial poster at the First Aid Station? Is there an appropriate First Aid Kit available and easily accessible? Is the First Aid Kit fully stocked? Is the First Aid Kit inspected at least quarterly? Is there documentation of the inspection available? Is there someone certified in First Aid on each shift? Is the certificate of the First Aid Attendants current and posted? If NOT FIRST AID FOLLOW-UP F HAZARDS OBSERVED Is the Health and Safety Policy posted in a conspicuous place? Are all the names of the Joint Health and Safety Committee members or the Health and Safety Rep posted? Are the three (3) most recent JHSC meeting minutes posted? Is the Act and Regulations posted/easily available to all employees? Are employees following safe work practices? GENERAL

CONTACTS MADE WITH WKERS DURING OUR Workers Name Work Location Concerns: SUPERVISS / MANAGERS THAT PARTICIPATED IN THIS Supervisors Name Work Location Action items taken during our inspection Copies To (For Action): Copies To (For Information): Forwarded: Forwarded: Signature of Inspector : Reviewed by worker Co-Chair (Signature and ): Reviewed by Management Co-Chair (Signature and ): Reviewed by Management (Signature and ) T im H o rto n s - O tta w a S to re # 2 8 T im H o rto n s - O tta w a S to re # 2 8