Carefully check all of these items and note and correct any deficiencies. Please provide additional details regarding any problems
noted in the blank space below or on the reverse side. Give the completed form to the Safety and Health Program Manager for filing.
All required posters are displayed where they can be read
by all employees. The phone number to call in a medical emergency is posted. Additional
information on posting requirements is available at http://www.nclabor.com/posters
Employees can open emergency exit doors from inside without tools,
keys or special knowledge (except in mental, penal, or correctional facilities where there
is an evacuation plan). Capacity of exit routes is adequate. Exit discharge leads directly
outside or to a street, walkway, refuge area, public way, or open space with access to the
outside. Exit access is adequate, at least 28 inches wide and ceiling height is at least seven
feet six inches. Exit path is constructed using fire resistant materials.
Work areas are clean and orderly. Floors are free of unnecessary clutter
and trip hazards. Floors are dry.
The first aid kit is readily accessible and fully stocked with gloves, CPR barrier,
and all necessary items (http://www.benmeadows.com/refinfo/ezfacts/ezpdf/tech208.pdf
#search=%22ansi%20Z308%22). A clinic, hospital or infirmary is available nearby, or a
person with a valid first aid certificate is available on site.
Cool drinking water is available. Employees do not use a common cup
Shade or cooling areas are available for employees who experience
Toilet facilities are available and clean. Convenient hand washing facilities
with tepid water, soap, and clean drying facilities are available.
There is enough light for employees to perform their assigned duties.
All employees are wearing the PPE required for the
task they are performing. The PPE is all clean and in good working order.
All fall protection equipment is in good condition. Appropriate
anchor points are available in all locations where employees must use personal fall
arrest systems. A plan is in place to quickly rescue an employee who falls.
Fire extinguishers are present at all locations marked by signs.
All fire extinguishers are inspected to verify they are still full monthly. All fire extinguishers
have been serviced (usually by a specialist) within the last year. Note: Fire extinguishers
are not required in most workplaces. However, if present, these requirements apply.
All employees have set up their computer
comfortably. All employees can use their computer without twisting. All keyboards are
just below elbow height when employees sit with their shoulders and arms relaxed at their
sides. The top of all monitor screens are not above eye level. All employees that need a
footrest or telephone headset have one.
All floor openings (size over one inch) are covered, protected by standard
railings (a top rail 42 inches high, an intermediate rail, and posts) or constantly attended
by a person. Bridge plates are strong enough to support the intended load and secured
All hand tools (company and employee owned) are in
good condition. No mushroomed shafts or loose hammer heads or shafts. Tools are reasonably
free from grease. Cutting tools are sharp.
All electrical cords and equipment are in good condition. Nothing
is stored within the clearance zone of all electrical panels (36" deep and 30" wide). All
electrical cords and wiring are dry. Ground Fault Interrupters (GFI) are installed on all
electrical circuits or equipment used in wet areas.
All portable ladders are in good condition (check all rungs, uprights,
bases, hinges, and spreaders).
No other hazards were noted during this walk-through.