SAFETY AUDIT FORM
Description
FLOORS
 Wet, slip, fall hazard
 Trip hazard
 Cords across walkway
 Other:
STAIRS AND RAMPS:
 Adequate lighting
 Non-slip surfaces/good
condition
 Handrails available and
secure
 Other:
GENERAL SAFETY:
 aisles obstructed
 Free from falling hazards
 First aid kit available
 Good housekeeping
 Emergency numbers
posted
 Emergency procedures
posted and clear
 Eye wash stations clean
and clear of obstruction
 Other:
cellphones/earphones
PPE:
 Safety glasses and shields
 Earplugs/ muffs
 Steel toe shoes
 Gloves
PALLETS/RACKS/STORAGE
PRACTICES:
 Empty pallets properly
stored
 Storage containers in good
condition
 No more than 4 high
 Heavier material on lower
shelf
 Racks upright and shelving
properly secured
 Forklift trucks operators
wearing seatbelts
 Forklift charging area safe
YES
NO
COMMENTS
Pieces of pallet
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Above Madison
Dock/shipping
Bent legs
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SAFETY AUDIT FORM
FIRE EQUIPMENT/EXITS:
 Fire extinguishers
accessible
 Fire extinguishers tagged,
serviced
 Exits properly illuminated
 Exits clear
 No exposed wires or
frayed cords
 Other:
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* Others:
 Bumper on dock
 Pieces of pallet
 Norm not wearing seatbelt while on truck or safety glasses
 Lights over # 8
JClark /Ray Siebert 1/12/22
Inspector’s Signature
Date
Jessica Clark/ Ray Siebert
Print Name