An essential part of loss prevention is the recognition and removal or correction of hazards before a loss occurs. This checklist should serve as a tool, indicating those areas needing attention. This survey form should be completed monthly and reviewed by management to monitor the Corporate Safety & Health Program and Loss Prevention. Date Location Inspected by General Environment Yes No N/A 1. Is the property owned by Fisher Auto Parts? 2. Is the roof in good condition? 3. Are exterior doors equipped with dead bolt locks? 4. Is painting/siding in good condition? 5. Are windows/doors in good condition? 6. Are signs in good condition and adequately secured? 7. Are car stops provided around the building? 8. Are the restrooms cleaned and regularly maintained? Are they free of clogs and leaks? 9. Is smoking permitted only in designated areas? Are there proper and sufficient receptacles provided for discarded cigarettes? General Safety and Housekeeping Yes No N/A 10. Are the required OSHA Job Safety and Health Protection Posters displayed in a prominent location where all employees can see it? 11. Is information concerning employee access to Safety Data Sheets (SDSs) posted and available to employees? 12. Are emergency telephone numbers posted where they can be readily found in case of emergency? (FAP Form S003) 13. Are One Point Safety Lessons posted in the facility for all employees to see? 14. Is there a safety committee that meets regularly? 15. Is there an employee on each shift that is currently certified to render first aid? 16. Are first aid kits easily accessible to each work area and replenished as used? 17. Is the building protected by a security alarm? Is it maintained in good operating condition? 18. Are all worksites clean, sanitary, orderly and adequately illuminated? 19. Is trash and debris stored safely and removed from the worksite promptly? 20. All spent fluorescent light tubes recycled according to Company policy? Page 1 of 5....................... Fisher Auto Parts.......................... Revised: 6/2018 Form: S002
Fire Protection Yes No N/A 21. Are emergency evacuation procedures and duties pre-planned, periodically reviewed with employees and posted? 22. Is the local fire department familiar with the facility, its location and specific hazards? 23. Is the building is protected by a fire alarm system? Is it certified as required and tested annually? 24. If there are fire alarm pull boxes, are they all visible and clear of all obstructions? 25. If there are fire doors and shutters, are they in good operating condition? Are fusible links in place; are they unobstructed and protected against obstructions, including their counterweights? 26. Is there is a sprinkler system in the building? Is it certified as required and tested annually? Are sprinkler control valves secured in the open position and not subject to tampering or mechanical damage? Is there a minimum of 18 clearance between stock storage and sprinkler heads? Are sprinkler system water control valves checked periodically as required? Are sprinkler heads protected by metal guards if exposed to potential physical damage? 27. If no sprinklers, is there a minimum of 24 maintained between top of rack storage and ceiling or roof joists if building? 28. Are there the proper number, size and type of fire extinguishers? Are they clearly marked, mounted, and serviced annually? Are extinguishers free from obstructions or blockage? Are employees instructed in the use of fire extinguishers annually? 29. Is there an emergency lighting system which will automatically activate in the event of a power failure? 30. Are there adequate emergency exits? Are they properly marked with illuminated signage? Is the emergency exit able to be opened in one motion? Are they kept clear (3 clearance) and accessible at all times? Are they always unlocked during business hours? Are the directions to exits, when not immediately apparent, marked with visible signs? 31. Are doors, passageways or stairways that are neither exits nor access to exits, but could be mistaken for exits, appropriately marked "NOT AN EXIT? 32. Are combustible and/or flammable materials kept at least 2 feet from heating or electrical equipment? Page 2 of 5....................... Fisher Auto Parts.......................... Revised: 6/2018 Form: S002
Electrical Hazards Yes No N/A 33. Are circuit breaker control panels labeled? Are they free of obstructions (3 clearance)? 34. Are there adequate outlets with covers provided? Is the use of gang plugs prohibited? Are GFCI outlets provided when an outlet is within 5 feet of water? 35. Is the use of extension cords as permanent wiring prohibited? 36. Are all electrical cords in good condition: ground plugs in place, no frayed insulation, pinched wiring, no exposed wiring, no splices/electrical tape? 37. Are all electrical enclosures (switches, receptacles, junction boxes) provided with tight-fitting covers? 38. Are all unused openings in electrical enclosures and fittings closed with appropriate covers, plugs, or plates (including conduit knockouts)? 39. Are all light fixtures and light switches secured and operable? Are all ballasts covered? 40. Are coffee pots and hot plates located away from combustibles and unplugged when not in use? Flammable and Combustible Materials Yes No N/A 41. Is liquefied petroleum gas (LPG) stored outside of the building, handled and used in accordance with safe practices and standards? Are LPG storage tanks guarded to prevent damage? Are "NO SMOKING" signs posted on liquefied petroleum gas tanks? 42. Are standard operating procedures established and are they being followed when cleaning up chemical spills? Personal Protective Equipment Yes No N/A 43. Is all PPE maintained in a sanitary condition and ready for use? 44. Are eye-wash fountains and safety showers provided in areas where corrosive chemicals are handled? 45. Is approved eye protection required to be worn at all times in areas where there is a risk of eye injuries such as punctures, abrasions, contusions, or burns? 46. Is appropriate foot protection required where there is the risk of foot injuries from hot, corrosive, falling objects, crushing, or penetrating actions? Portable Ladders Yes No N/A 47. Are ladders/step stools OSHA approved and adequate height for anticipated needs? Are all ladders maintained in good condition? Are non-slip safety feet provided on each metal or rung ladder? Page 3 of 5....................... Fisher Auto Parts.......................... Revised: 6/2018 Form: S002
Compressors and Compressed Air Yes No N/A 48. Are compressors equipped with pressure relief valves and pressure gauges? 49. Are air filters installed on the compressor intake? 50. Are compressors operated and lubricated in accordance with the manufacturer's recommendations? 51. Are signs posted to warn of the automatic starting feature of the compressors? Materials Handling Yes No N/A 52. Are employees trained in safe lifting techniques, including team lifting? 53. When possible, are manual lifting devices used? (dollies, hand trucks, etc.) Are hand trucks and carts maintained in safe operating condition? 54. Are heavy materials that must be lifted stored off the ground, no lower than knee height, to reduce pressure on the spine? Is enough space to lift them safely, without reaching or twisting? 55. Are shelves/racks well designed and firmly secured with orderly stock storage? 56. Are aisles and passageways marked and kept clear? 57. Are holes in the floor, sidewalk, or other walking surface repaired properly, covered, or otherwise made safe? 58. Is there safe clearance for walking in aisles where motorized or mechanical handling equipment is operating? 59. Are aisles or walkways that pass near moving or operating machinery arranged so employees will not be subjected to potential hazards? Is adequate headroom provided for the entire length of any aisle or walkway? 60. Are bridges provided over conveyors? 61. Are surfaces that are elevated more than 48 inches provided with standard guardrails or approved fall protection? Provided with standard 4-inch toeboards? 62. Is material on elevated surfaces piled, stacked, or racked in a manner to prevent it from tipping, falling, collapsing, rolling, or spreading? 63. Are load bearings posted on mezzanines? 64. Is a permanent means of access and egress provided to elevated storage and work surfaces? 65. Is there safe clearance for equipment through aisles and doorways? 66. Are dock doors closed when no loading or unloading is taking place or when the edge is unguarded? 67. Are dock boards (bridge plates) used when loading or unloading operations are taking place between vehicles and docks? 68. Are trucks and trailers secured from movement during loading and unloading operations? (chocks and stabilizers) Page 4 of 5....................... Fisher Auto Parts.......................... Revised: 6/2018 Form: S002
69. Are chutes equipped with sideboards to prevent the materials being handled from falling off? 70. Are chutes and gravity roller sections firmly placed or secured to prevent displacement? 71. Are pallets properly stacked, not over 4 feet high, and exterior storage pallets at a safe distance from the building? Industrial Trucks - Forklifts Yes No N/A 72. Are employees properly trained in the use of the industrial truck they operate? Recertification every three (3) years or when there has been an incident or near miss? 73. Are motorized vehicles inspected daily or prior to use? 74. Are trucks in need of repair removed from service immediately? Transporting Employees and Materials Yes No N/A 75. Are vehicles kept in good repair? 76. Are all vehicles backed in upon return to the facility? 77. Are keys removed from all vehicles? 78. Are pre-trip vehicle inspections conducted and followed up? 79. Is cell phone use prohibited according to Company Policy? 80. Is there any damage to any vehicle? Has it been reported to Donlen so that it can get repaired? Tools and Equipment Yes No N/A 81. Are all tools and equipment (both company and employee-owned) used at the workplace in good condition? Notes: 82. Are power tools used with proper shields, guards, or attachments, as recommended by the manufacturer? 83. Are effective guards in place over belts, pulleys, chains and sprockets on equipment? 84. Are portable fans provided with full guards or screens having openings 1/2 inch or less? Page 5 of 5....................... Fisher Auto Parts.......................... Revised: 6/2018 Form: S002