Facility Risk Assessment Questionnaire
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1 Facility Risk Assessment Questionnaire ServiceMaster anytime provides this safety information free of charge. These materials are provided as a service to our clients and 866 Recover enrollees and is for information purposes only. This information is not a substitute for a thorough analysis by one of your safety management specialists. Business Name: City: State: Phone #1: Back Up Phone #: Janitorial Service Provider: Address: Zip: Key Contact: Janitorial Contact Phone Administrative Corrective Team Member Written safety rules/safe job procedures in place OSHA log updated/safety posters displayed Management Safety Policy in place All planned safety activities preformed (meetings, inspections, training) Effective new employee safety orientation Exits, Walkways and Stairwells Corrective Team Member All fire exits clearly marked Walkways maintained, aisles defined, uncluttered All exit doors in working order, free of any hindrance, debris or obstructions All fire doors open outward? The stairwell side of the exit door marked with LARGE bright floor numbers All fire escapes inspected and serviced at least quarterly Fire doors have panic hardware Unapproved doors clearly marked NOT AN EXIT Sufficient emergency lighting heads The emergency lighting system checked often
2 Emergency Medical Corrective Team Member Emergency contact information posted First aid responders available for each shift Blood borne pathogens exposure potential adequately addressed First aid supplies adequate and available Transportation available for injured workers/plan in place Trip/Slip and Fall Hazards Corrective Team Member Portable ladders equipped with non slip feet. Metal ladders marked Do Not Use Around Electrical Equipment Stairways in good repair with handrails, treads and risers in proper proportion and non slip Elevated areas have guardrails and toe boards Work areas, aisle ways, storage areas are orderly Illumination adequate for normal conditions, emergency lighting in place External walking, parking, break areas free of hazards, well maintained Warning signs posted for wet floors or spills Anti slip mats and flooring used where appropriate Hand Tools Corrective Team Member Power tools properly grounded/have safety power switch Defective tools are removed from service Proper guards are provided, tools electrically grounded or double insulated Preventive maintenance/inspection program inplace Employees are trained in the safe use of hand tools Machinery Corrective Team Member Lockout/tagout program in place, locks available, employees trained Hazardous areas painted bright colors Guards are provided for point of operation of machinery.
3 Clothing and hair restrictions in place to prevent entanglement in machinery Power transmission guards are in place Noise exposures adequately addressed Warnings displayed in obvious locations Compressed air systems have pressure reduced to 30 PSI and are not used for cleaning clothing Air hoses provided with safety latch to prevent accidental disconnect Welding equipment in good condition Compressed gas cylinders are and secured to prevent falling Overhead hazards from equipment, conveyors, and process pipes, are guarded below 7 ft from floor Mechanical & Manual Materials Handling & Storage Corrective Team Member Hoist chains, cables, and slings are inspected regularly and documented Storage piles are stable and secured from falling or collapse Load limits are posted for all floors above ground level Load limits are displayed on all hoists Manual handling aids available and used Weight limits set for manual lifting, carrying, pushing, pulling Workers trained in proper lifting techniques/ergonomics Chemicals Corrective Team Member Hazardous materials containers labeled MSDS available Hazard Communication Training program in place Smoking and eating prohibited in work areas where chemicals are used Eyewash/emergency shower available and functional Personal Protective Equipment Corrective Team Member PPE assessment performed PPE requirements in place Employees trained in the use and maintenance of
4 PPE training documented Hard hat areas designated and enforced Hearing protecting utilized in required areas Face/eye protection in place where needed Safety foot protection required where appropriate Protective clothing, gloves, aprons, boots, face shields, and goggles are used when handling hazardous materials Approved respiratory protection equipment available and fit tested Fire Protection Corrective Team Member Is there an automatic fire detection system? If Yes, What Type? Direct to Fire and Police Local within the building Central System Monitor Automatic sprinklers or standpipes and hoses are inspected annually Fire detection system or smoke alarm system in the building Fire detection system serviced and inspected regularly Fire extinguishers inspected and recharged annually Approved safety containers are used for flammable liquids Bonding and grounding used with storage of flammable materials Combustible debris disposed of regularly No Smoking areas designated Sprinkler system functional/inspected/documented Smoke/heat detectors functional and inspected Minimum 18 clearance below sprinkler heads Sprinkler valves locked open Electrical Corrective Team Member Panel boards, switches and fuses enclosed in metal cabinets that securely close Circuits easily assessable & identifiable Are all fuses or breakers properly sized for equipment and lighting
5 Recurring problems with fuses or circuit breakers that are continually tripped Ground fault interrupters utilized in potentially wet or damp areas Machinery and equipment are grounded Electrical panels clearly marked Permanent wiring in place no extension cords Exposure of overhead electrical lines controlled Outlets, switches and boxes have covers Emergency stops and critical electrical controls are identified Appropriate electrical systems designed for hazardous locations have been installed in spray booths and flammable liquid storage rooms HVAC Corrective Team Member HVAC system been inspected and serviced within the past year Is an outside service contractor Boiler s low water cutoff/water supply flushed out every month during the heating season Boiler room meet fire code requirements concerning non combustible materials and proper fire related doors and closers Boiler room properly ventilated No combustible materials are stored in the Boiler room Vents and chimney flutes inspected for clear passage annually Do you have a program for cleaning ductwork and diffusers Risk Assessment conducted by: (Business staff) Date: It is recommended that you update or review this questionnaire periodically. When you have this document competed, please fax it to ServiceMaster Anytime at We will retain your facility information in our Emergency Services Data base. This information is for internal use only and will never be sold or shared. Make a copy of this document and return to your Emergency Procedures Manual
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