Department

California State Polytechnic University, Pomona

DEPARTMENT HEALTH AND SAFETY INSPECTION REPORT
Location(s)
Report prepared by

REVIEWED BY MANAGER, CHAIR, DIRECTOR OR DEAN.

SIGNATURE:
Safety Suggestions and Recommendations:

Date of this report

Date of last report

Date

SAFETY INSPECTION CHECKLIST

YES
NO
BUILDINGS AND GROUNDS
Protective equipment in good condition and
5
Lighting adequate in all areas.
used as required.
1
Electric lights, switches, etc, in good repair.
Proper clothing worn at all times.
2
6
Electric outlets not overloaded, multiple plug
Other
3
7
adapters are not used and have covers.
SHOP MACHINERY AND EQUIPMENT
D
Heating and ventilation adequate.
Moving parts of machinery properly guarded.
4
1
Floors in good repair with no tripping
Storage of tools adequate.
5
2
hazards.
Electrical equipment grounded.
3
Windows and doors in good repair, no sharp
Hoisting equipment has capacity and all
6
4
edges.
controls plainly marked as required
All plumbing fixtures in good repair.
Grinding wheels have hoods and tool rests.
7
5
Elevators operating properly.
Gas cylinders secured at all times.
8
6
Sidewalks free of holes or cracks
Air compressors have "Automatic startup"
9
7
Sprinklers are not a tripping hazard
warning signs.
10
Shrubbery and tree branches properly cut back
Guardrails provided for elevated work areas.
11
8
Other
Overhead storage areas have guardrails
12
9
OFFICE, CLASSROOM AND LAB EQUIPMENT
Operating procedures posted for each machine
B
10
Emergency procedures posted.
Equipment locked out when making repairs
1
11
Hand tools maintained in good condition.
Other
2
12
Ladders and stepstools in good condition.
HOUSEKEEPING
3
E
Laboratory fume hoods operating properly.
Hallways and aisles unobstructed
4
1
Lab equipment and glassware in good
Adequate space provided for storage
5
2
condition
All materials stored in a safe manner
Electrical equipment grounded with a 3-prong
Floors clean and free from slipping hazards.
6
3
plug and turned off when not in use.
Waste materials disposed of properly.
Electrical extension cords not damaged and
Access to electric panels unobstructed
7
4
being used properly.
Restrooms clean and well supplied.
5
Desks, chairs and tables in good repair
Other
8
6
Files and shelves anchored and not overloaded
SAFE PRACTICES
9
F
First aid equipment (include em. eye washes
Employees instructed in safe use of equipment.
10
1
/showers) available, adequate and complete.
Health and safety rules followed.
2
Chemicals and toxic materials kept in sealed,
Safe lifting techniques used.
11
3
labeled containers and separated from food.
Running, horseplay and unsafe shortcuts not
4
Chemical safety procedures posted and
permitted.
12
followed where chemicals used or stored
Other
5
MSDS available to all employees.
FIRE PROTECTION
13
G
Up to date Haz. Mat'l inventory list.
All flammables kept in labeled, closed containers
14
1
Other
Flammable materials stored in metal cabinets.
15
2
CLOTHING AND PROTECTIVE EQUIPMENT
Flammable wastes disposed of properly.
C
3
Eye protection provided in shops and labs
"No Smoking" signs posted where required.
1
4
Head/Hearing protection provided when
ABC fire extinguishers available and operable
2
5
necessary.
Fire ext. inspected monthly-tags initialed/dated.
6
Gloves, aprons & other clothing provided
All exits properly marked and accessible.
3
7
Proper respirators provided where necessary.
4
Briefly describe all accidents and injuries occurring since last report. If none, so indicate.
A

Send copy of this inspection to EH&S

Date Sent

YES

NO

EH&S F-305-00
10/28/2010

APPENDIX A continued

EXPLANATION OF UNSAFE CONDITIONS AND ACTS

Area

Comments

Date Completed/
Initials