Workplace Inspection Form - Environmental Health and Safety

Workplace InspectionWorkplace Inspection FormBuilding:Room Number:Department/Unit:Inspection Date:Inspector:Supervisor:Phone:Y N NAY=SatisfactoryN=Needs ImprovementNA=Not ApplicableGeneral1. Workplace clean and orderly2. Exits cleared of obstructions and accessible3. Stored materials secured and limited inheight to prevent collapse4. Suitable Warning signs and tags utilized5. A hazard assessment has been completedand the appropriate personal protectiveequipment has been identified for eachspecific jobTraining1. Safety training and inspections held for newemployees on a regular basis2. First Aid (and CPR) trained individualsavailable for medical emergencies3. Personnel familiar with the hazards ofchemicals and trade products and have readthe applicable Material Safety Data Sheets(MSDSs)4. All personnel familiar with documentedemergency evacuation plan5. Fire extinguisher familiarization providedComments Corrective ActionCompletion DateUW Environmental Health and Safety 11/00 1 of 5

Workplace InspectionY N NAY=SatisfactoryN=Needs ImprovementNA=Not Applicable6. Personnel are trained in the proper selection,use and maintenance of personal protectiveequipment.Safe Lifting1. Workers trained on and using safe liftingtechniquesa. Size up / test loadb. Avoid heavy loads - split into smallloads or ask for helpc. Bend knees to take pressure off of backwhen liftingd. Consciously firm up abdominals whenliftinge. Never twist while lifting or holding aloadFire1. Emergency exit signs identifiable andreadily visible2. Fire alarm pull stations and portable fireextinguishers visible and unobstructed3. Stairway doors are not kept open (unlessequipped with a self-closing device4. 18 inch vertical clearance maintained fromall sprinkler headsEarthquake1. Bookcases, filing cabinets, shelves, racks,cages, storage cabinets, and similar itemsover four feet tall are all secure2. Shelves have lips or other seismic restraints3. Portable machines or equipment securedagainst movement (unless actually beingmoved) by chains, lockable castors, straps,or other means where appropriateComments Corrective ActionCompletion DateUW Environmental Health and Safety 11/00 2 of 5

Workplace InspectionY N NAY=SatisfactoryN=Needs ImprovementNA=Not Applicable4. Top-heavy equipment of apparatus bolteddown or secured to withstand accelerationstypically expected in an earthquake5. Large and heavy objects stored on lowershelves or storage areas6. Valuable equipment sensitive to shockdamage, such as instruments, computers,and glassware are stored in latched cabinetsor otherwise secured to prevent falling.7. Storage areas uncluttered - providing clearevacuation routes in the event of anemergency8. Cabinets and lockers containing hazardousmaterials equipped with positive latching orsliding doors.Equipment1. Electrical Equipmenta. Clean and working properlyb. Properly groundedc. Proper clearances kept fromcombustibles (paper, cardboard, orcombustible liquids)d. Adequately ventilatede. Approved extension cords, extensioncords with breakers, and multipleconnectors used properly (e.g., not asfixed wiring)f. Frayed or damaged electric cordsreplaced2. Machinerya. Clean and working properlyb. Proper clearances kept fromcombustiblesc. Adequately ventilatedd. Emergency stop mechanisms identifiedand in working ordere. Mechanical safeguards in place and inworking orderComments Corrective ActionCompletion DateUW Environmental Health and Safety 11/00 3 of 5

Workplace InspectionY N NAY=SatisfactoryN=Needs ImprovementNA=Not ApplicablePersonal Protective Equipment1. Employees provided with and trained in theproper use and selection of respiratoryprotection2. Employees provided with and using hearingprotection for noise hazardous equipment(noise level above 85 dBA)3. Employees provided with and using safetygoggles/face shields when needed4. Employees provided with and usingprotective clothing (e.g., gloves, coats,aprons, coveralls)5. Steel-toed safety shoes worn when requiredHazardous MaterialsComments Corrective ActionCompletion Date1. Do you have any hazardous materials in your work area?2. If you have hazardous materials, are the MSDSs available?3. If you have hazardous materials, have they been inventoried within the last year?4. When transferring chemical materials from the original container to a secondary container are thesecondary containers labeled with the proper name and hazard warnings, including target organsaffected by an exposure?5. Please list any hazardous materials (by name and quantity) missing from any chemical inventoriesfor this work area.UW Environmental Health and Safety 11/00 4 of 5

Workplace InspectionY N NAY=SatisfactoryN=Needs ImprovementNA=Not ApplicableComments Corrective ActionCompletion DateUW Environmental Health and Safety 11/00 5 of 5