Millard Refrigerated Services Monthly Health and Safety Observations Completed by: Date: Facility: Page 1 of 6 Y/N State Substandard Conditions and Location Responsibility Dock Area: 1. The overhead dock doors are in good operating condition and well maintained? Dock plate good operating condition and and the pits clear of debris 2. Are exits and aisles kept clear and free of obstruction? 3. Are the floor areas and travel paths clear of any debris 4. Floors clear of excessive water and ice accumulation? 5. Are fire extinguishers accessible and not blocked? 6. Are trailer dock lights in good repair? 7. Are overhead doors kept latched closed when not in use? 8. Is the concrete floor in satisfactory condition. 9. Are floor drains in good repair? 10. Pallets are stored properly under 10 feet, stored flat and not stored on their sides? 11. Product staging well arranged and not subject to tipping?
Page 2 of 6 Freezer/Cooler Area: 1. Freezer doors in good operating condition? 2. Freezer doors kept closed? Y/N State Substandard Conditions and Location Responsibility 3. Door areas free of ice accumulation? 4. Door curtains in good repair? 5. Exits, doors and aisles kept clear and free of obstructions? 6. Are the floor areas and travel paths clear of any debris 7. Floors clear of excessive ice and water accumulation? 8. Are fire extinguishers accessible and not blocked? 9. Is the concrete floor in satisfactory condition. 10. Product staging well arranged and not subject to falling? Restrooms/Showers/locker rooms 1. Toilets and washing facilities are in good operating condition? 2. Restrooms are clean - soap, paper products and waste cans provided? 3. GFCI outlets provided by sinks and trip tested monthly.
Page 3 of 6 Battery Changing Room 1. Racks in good repair? Y/N State Substandard Conditions and Location Responsibility 2. Rack's flip locks in place and used to prevent battery movement? 3. Batteries clean and fill caps in place? 4. Battery cables in good repair? 5. Chargers properly mounted and in good repair? 6. Eye wash station clean and inspected monthly? 7. Face shield, rubber gloves and apron provided and is clean and in good repair? 8. Battery changing equipment in good repair? 9. Housekeeping is good? Stairways & Steps 1. Stairways are clean and free of water accumulation? 2. Stair steps are in good repair and provided with slip-resistant surface? 3. Hand railings provided and are in good repair? 4. Standard railings system on open side of stairway?
Page 4 of 6 Office Areas 1. Offices and storage areas are clean, well arranged and sanitary? 2. Carpeting and tile is clean and in good repair? 3. Adequately illuminated throughout? Y/N State Substandard Conditions and Location Responsibility 4. Extension cords are controlled and electrical outlets are not overloaded? 5. Office furniture, partitions and equipment are in good repair? Break rooms 1. Kept clean and sanitary, plus trash cans provided? 2. Furniture and equipment in good repair? 3. GFCI outlets provided by sinks and trip tested monthly. 4. Electrical cords from vending machines coffee pots and microwaves in good repair? Outside Buildings 1. The parking lot, sidewalks, steps, wheel chair ramps are in good repair and clean? 2. General grounds, break areas & storage areas are clean and well arranged? 3. Adequately illumination throughout?
Page 5 of 6 Y/N State Substandard Conditions and Location Responsibility Personal Protective Equipment (PPE) 1. Hard hats and safety shoes worn by all warehouse personnel? 2. Proper freezer gear provided and is in good repair? 3. Proper eye/face protection provided when grinding, welding, drilling, pouring, etc? 4. Hearing protectors are located on the out side entrance to the engine room? Forklifts/Pallet Jacks 1. Equipment is parked properly? Not blocking doors, walkways and travel routes, etc. 2. Parked forklifts with forks flush on floor? 3. Equipment is inspected before operating at the being of each shift? 4. Operators are operating safely? Sounding horns, controlling speed, traveling backwards 5. Operators are keeping their body within safety zone of the equipment's frame? Electrical Rooms 1. Rooms kept clean and free of storage? 2. Are all electrical panel boxes accessible? Sprinkler rooms 1. Sprinkler rooms kept clean and free of storage? 2. Is the sprinkler log available in room and are water/air pressures recorded daily?
Page 6 of 6 Additional Comments: State Substandard Conditions and Location Responsibility Location