FIELD INSPECTION CHECKLIST FOR HEALTH, SAFETY, AND ENVIRONMENT
PLACE DATE AND TIME INSP No.
WORK AREA DEPARTMENT Number of workers
AREA SUPERVISOR SSOMA INSPECTOR SHEET No.
TOPIC ITEMS DESCRIPTION C N/C N/A QUANTITY
Are the basic and specific PPE being used correctly in the jobs?
EPP 1 completed? And in good condition?
2
ORDER AND CLEANLINESS Are the work areas in proper order and cleanliness?
3 Is there proper and well-placed signage to alert about dangers and risks?
SIGNAGE 4 Is the marking in good condition?
5 Is the area and the machines marked?
6 Do the leaders participate in security talks?
TALKS OF 7 Have safety talks been given to the staff in the area? And are they participating?
SECURITY 8 Are there safe work permits (PTS) for work in the area?
9 Have safety talks about the PTS been given to the staff involved?
ACTS AND CONDITIONS
10 Are unsafe acts detected among workers in the workplace?
INSECURE 11 Are there unsafe conditions in the work area?
12 Are there fire extinguishers in the work area? And are they in good condition?
FIRE EXTINGUISHERS
13 Are the fire extinguishers clear of any obstacles?
14 Are the electrical installations adequate and in good condition?
INSTALLATIONS The panels and electrical rooms are in good condition, marked and
ELECTRICAL 15 closed?
16 Are the teams in good overall condition?
Do the machines have an emergency stop system that is accessible to the point of
17 machine operation?
Do the machines have exposed parts that could cause harm to the worker in case
CONDITIONS OF 18 of accidental contact?
EQUIPMENT AND
MACHINERIES 19 Are the machines free of lubricant spills?
20 Are the machines free of noise outside of normal operating conditions?
21 Are the work tools in good condition to carry out the activity?
Are the chairs used in the workplace in good condition? (backrest,
22 height regulator, seat, wheels
JOB POSITION
23 Does the workspace allow for free movement?
GUARDS OF
24 Do the equipment have protective guards on all moving parts?
PROTECTION 25 Is there a risk of contact with exposed physical surfaces?
26 Are the walls in good condition of paint, without leaks or deterioration?
INFRASTRUCTURE
27
(FLOORS, DECKS AND
Are the floors clean, in good condition, and without gaps?
ROOFS 28 Are the roofs clean and in good condition without leaks?
29 Are the restrooms in adequate cleaning conditions?
Health Services
30 Are there water leaks and plumbing fixtures in poor condition?
DRINKING WATER 31 Do water filters have hygiene conditions?
HALLWAYS OF 32 Are the circulation corridors clear of any obstacles?
CIRCULATION
Are the escape routes properly identified and known to the
ESCAPE ROUTES 33 staff in the area?
34 Are the ventilation conditions in the work area good?
VENTILATION 35 Are there forced ventilation systems in the area?
36 Are the fans placed properly?
ILLUMINATION 37 Are the lighting conditions in the workstations good?
PIPES THAT
FLUIDS CONDUCT 38 Are the pipes that carry fluids properly labeled and identified?
39 Do you have a reverse alarm?
40 Do you have a lighting system in good condition?
THE VEHICLES
41 Are the operators properly certified?
42 Are the teams in good overall condition?
43 Are the storage conditions adequate?
STORAGE
44 Is the stacking height correct?
RESULTS
TOTAL DE NO CONFORMIDADES:
OBSERVACIONES: Anotar al reverso las no conformidades encontradas en cada items y las medidas preventvas a ser adoptadas
RESPONSIBLE NAME ID card SIGNATURE DATE HOUR
AREA SUPERVISOR
SSOMA SUPERVISOR
AREA MANAGER
GENERAL MANAGER
FIELD INSPECTION CHECKLIST FOR HEALTH, SAFETY, AND ENVIRONMENT
ITEM DESCRIPTION Preventive measures CORRECTIVE MEASURES
RESPONSIBLE PERSONS NAME ID card SIGNATURE DATE HOUR
AREA SUPERVISOR
SSOMA SUPERVISOR
AREA MANAGER
GENERAL MANAGER