Safety Inspection

Daily Commercial PIV Pre-Operational Checklist: Inspector: Required

Inspection Date: Required
Americas/Denver

PIV Name & Number: Required

Check as inspected: Required
Pubs/Hour Meter

Eng. Fluid Levels

Lift Fluid

Cooling System

Eng. Hoses

Fuel System (Leaks)

Missing/Loose Parts

Physical Damage

Tires/Lugs/Rims

Batteries

Lift System

Gauges/Instruments

Nameplate/Dataplate

Lift Controls

Clutch (if installed)

Steering Play

Lights

Parking Brake

Service Brake

Horn/Back-up Alarm

Fire Exit/Seatbelt

Cleanliness of Vehicle

Comments / Notes:
Administrative Area Safety Checklist [Monthly Inspection]: Inspector: Required

01. Are aisles, doorways, and corners free from obstructions to permit visibility and movement? Required
Yes

No

02. Are file cabinets and storage closets arranged so that drawers and doors do not open in walkways? Required
Yes

No

03. Do chairs have any loose casters? Required
Yes

No

04. Are all chair rungs and legs sturdy? Required
Yes

No

05. Are there any sharp edges, points, burrs, or splinters on furniture? Required
Yes

No

06. Is office overly furnished? Required
Yes

No

07. Are all electrical appliances and equipment properly grounded or double insulated? Required
Yes

No

08. Is all electrical equipment in good working condition? Required
Yes

No

09. Are phone lines, electric cords, and extension wires secured under desks or alongside baseboards? Required
Yes

No

10. When cords do run into walkways, are they covered by runners? Required
Yes

No

11. Can building’s electrical circuit system handle items such as coffee makers, space heaters, radios, or other items used? Ensure no cords are “Daisy Chained”. Required
Yes

No

12. Do sharp tools such as scissors and razor blades have safe storage covers or adequate storage place to insure safe removal? Required
Yes

No

13. Are desk cluttered by extra books, file boxes, or dividers? Required
Yes

No

14. Is there a storage place within desk for materials such as cleaning fluids, correcting fluids and glue if used at desk? Required
Yes

No

15. Are cleaning materials stored in plastic or metal containers, when possible, with tight fitting lids? Required
Yes

No

16. Are Safety Data Sheets available for all chemicals utilized in the facility? These should be located both where the chemicals are stored and where they are used. Required
Yes

No

17. Within storage cabinets, are heavy items stored in lower and middle shelves? Required
Yes

No

18. Are bottled materials within easy reach? Required
Yes

No

19. Are small, loose items boxed and labeled? Required
Yes

No

20. Are floor surfaces clean, dry, level and free of debris? Required
Yes

No

21. Are carpets well secured to the floor? Required
Yes

No

22. Are carpets free of worn or frayed seams? Required
Yes

No

23. Are all emergency exits clearly marked and visible? Required
Yes

No

24. Are emergency exits adequately lighted and free of debris? Required
Yes

No

25. Is there adequate walking space approaching exits? Required
Yes

No

26. Does everyone know where emergency exits are and how to reach them? Required
Yes

No

27. Are stairways in good condition and covered with skid resistant materials? Required
Yes

No

28. Where stairs are carpeted, is the carpeting well secured? Required
Yes

No

29. If one or two steps adjoin different levels, are they easy to see? Required
Yes

No

30. Is office equipped with a step stool or ladder so that high objects can be reached safely? Are all ladders marked for limitations in weight, height, etc.? Required
Yes

No

31. Are personnel familiar with the correct way to use ladders? Required
Yes

No

32. Do personnel know where fire extinguishers are and have personnel been trained on using the equipment in the last 12 months? Required
Yes

No

33. Are fire extinguishers inspected monthly and the tags initialed showing this inspection? Required
Yes

No

34. Do personnel know where fire alarms are and whether or not they call the fire department? Required
Yes

No

35. Are personnel familiar with fire evacuation procedures for the building and what to do in case of fire in their work area? Required
Yes

No

36. Do personnel know how to call for ambulance service? Required
Yes

No

37. Are computer monitors and keyboards aligned to prevent neck strain? Required
Yes

No

38. Are personnel provided adjustable keyboard tray and chairs? Required
Yes

No

39. Are flammable items stored in flammable lockers that are secured? Required
Yes

No

40. Are eye wash stations available where chemicals requiring them are in use? Required
Yes

No

41. Are eye wash stations inspected to ensure they are not out of date? Required
Yes

No

Comments:
Standard Army Safety & Occupational Health [Quarterly Inspection]: Inspector: Required

Date: Required
Americas/Denver

Office / Location / Facility: Required

Safety Board

OSHA poster "It’s the law", DD Form 2272, policy letters, safety grams/messages Required
Satisfactory

Unsatisfactory / Action Required

N/A

Safety Administration

CDSO/ADSO on orders, required training (initial training, annual refresher) [TAB B] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Pre-accident plan developed for the facility (fire, first aid, weather, accident reporting etc) / Bomb threat procedures (phone call, evacuation, drills) [TAB D] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Job Hazard Analysis (conducted for specific activities within the facility & all other duties, PPE) [TAB F] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Licenses, documented training (equipment specific, medical, motor vehicles, lifts, hoists, machines) [TAB G] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Medical Surveillance (BPP, RPP, hearing, radiation) [TAB O, P, Q] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Employee/Supervisor required safety training (risk management, SOHAC, injury prevention, accident reporting); CRC online. [TAB G] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Quarterly facility safety inspections (STF hazards, stairs, exists, doors, windows, electrical, etc.) [TAB H] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Hazard reporting/record keeping (work orders, RACs, safety notified, etc.) [TAB I, N] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Building

Floors, stairways, aisles, ramps, ingress, egress clear and unobstructed? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Building access points lighted to prevent STFs, show hazards, etc.? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are handrails, handholds, guardrails in place and the proper height? (loading docks/pits) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are swinging doors marked? (kitchen areas, in and out) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are floor and ceiling openings/access points marked and secured? (confined space, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Elevators inspected annually? (on file with building manager) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are customer waiting areas void of sharp corners, objects, choking hazards for children, and toxic plants? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is basic housekeeping/office cleaning being conducted to prevent a cluttered work site? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are the floors slippery, oily or wet? (marked with STF signage) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Break Room/Lunch Room

Fire Suppression Systems installed on cook stoves and annually inspected? [TAB I] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Have the electrical appliances been approved by DPW and the fire department? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are break rooms clean and void of all out dated food? Is there an effective means of preventing disease? (cleanliness, sanitation) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Preventative Medical Inspections for food services areas? (retail services, DFAC, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Emergency Management (CFR 1910. Subpart E&L)

Are Fire Extinguishers posted, visible, unobstructed and inspected? [TAB H] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is violence in the work place training being conducted? (active shooter, etc.) [TAB G] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are First Aid Kits available and location known to employees? (inventories, serviceable, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are emergency responders trained and current in CPR, First Aid and AEDs? (documented training, professional certs, etc.) [TAB G] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is there a blood borne pathogens response kit and plan in place? (CFR 1910.1030 1200 1020) [TAB G] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Illumination

Are lamp reflectors Clean? (fire prevention) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are bulbs missing, burnt out? (monthly building safety inspections, work orders) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Does a light survey need to be conducted? (dimly lit offices, dark spaces, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Ergonomics

Have employees filled out an ergonomic check list? (do’s & don’ts of proper workstations) [TAB M] Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are filing cabinets loaded with heavy on bottom and lighter on top? (to aid in proper lifting) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Hazardous Materials (CFR 1926.1100-1148 &1910.1201) [TAB N]

Are hazardous materials stored properly? (splash hazards below waist level, containers sealed, eye wash available/PPE if needed) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are they labeled properly? (SDS correct, GHS pictograms, mixed agents) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is the SDS located at the work site? (master list and inventory, local SDS with items) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is there a hazardous communication program in place? (employee knowledgeable) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are all employees aware of the HAZMAT hazards associated with their jobs and work sites? (JHA, HAZCOM, training, PPE, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are there SOPs governing the use of products? (proper use, ventilation, do not mix, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are spill kits and containment kits on hand? (applicable to hazard) Required
Satisfactory

Unsatisfactory / Action Required

N/A

PPE, deluge and eye wash stations available? (applicable to hazard, or location) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are further evaluation of hazards to health required? (exposure assessment by IH) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Electrical Safety (CFR 1926.400-433 & 1910.335 Subpart I and S)

Excessive power cords/power strips being used? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Does all electrical equipment meet the CE rating requirements? (high amperage draws on low voltage circuits) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are all electrical control boxes marked the extra ports closed? (ARC flash, clear of moisture, water, metallic items, machines, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is all new equipment request being reviewed by safety/IH/Occ Health & electrical shops for approval? (proper grounding, use, ergonomics, noise, guarding, location, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are buildings grounded? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are raised floors/ ceilings being checked for damage to power cords? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Indoor Air Quality

Windows/doors are opened on a daily bases, and serviceable? (monthly/daily inspections, hazard reporting) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Lock Out/Tag Out Procedures (1910.147, AR 385-10 ch 18)

Are lock out/tag out procedures being conducted? (machines, confined space) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are all employees aware of the Lock out Tag out procedures? (any reason to have LOTO?) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is all equipment/machinery known that requires lock out tag out? (identified, JHA) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Has lock out tag out training program been established for employees? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Machine Guarding (CFR1910.242, 1926/302)

Are machines properly guarded using manufactures specifications? (table saws, grinders, machine presses, circular saws, laths, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Forklifts, Hand jacks and Hoists (CFR 1926.600, 1926.602, ANSI B56.1 1910.66-68)

Has equipment been certified by TUV and load tested? (documented on hand) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are diesel forklifts being used indoors? (propane authorized with proper muffler) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are forklift operators licensed? (per load capacity, rough terrain, center steering) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are maintenance logs up to date and maintained? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Respiratory Protection Program

Are respirators required? (airborne hazards, chemical or particulate, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are respirators stored correctly? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are personnel fit tested? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are personnel medically cleared? (Occ Health) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are the right filters being used for job? (supply of replacement filters on hand) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are employees trained on use of respirator? (listed on JHA, training documented) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Vision Conservation (DA PAM 40-506)

Are there eye hazards in the area? (grinding, shredding, ARC, laser, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Face shields, safety glasses being used for eye hazard operations, and are they available? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are face shields and safety goggles being used during operations involving liquids? (SDS hazard based) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are eye wash stations present with 10 seconds of eye hazards and visibly marked and unobstructed? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are eye wash stations inspected weekly and documented? (rust, calcium buildup, blocked holes, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Do eye wash station meet ANSI standard? (height, flow, protection, operation) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Hearing Conservation (DA PAM 40-501)

Is the area considered noise hazardous? (does it need a TWA conducted, speakers, rifle fire, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Have employees been trained on the wear and use of hearing protection? (proper fitment by Occ Health, selection by IH) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Are signs posted designating the area as a noise hazard? (clearly visible prior to entering area, at machine, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is hearing protection available, and correct for the db level? (pulse v.s. duration) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Confined Space (CFR 1919.146)

Has a permit been issued? (permit confined space v.s confined space) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is required equipment available? (2 personnel on site, hoist, air monitors, respirators) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Has air monitoring been conducted before entry? (O2 levels documented, three level survey, UEL/LEL, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Fall Protection (CFR 1926.451)

Harness? (fall protection) Required
Satisfactory

Unsatisfactory / Action Required

N/A

PPCE (CFR 1926.95-107, 1910.132-139 Subpart I)

Chemical aprons, gloves, overshoes for caustic hazards? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Hand protection? (leather gloves, meat cutters, concertina gloves, sharps protection, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Coveralls? (explosive handlers coveralls, non-flammable, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Safety shoes? (foot crush hazards, tarsal protection, steel v.s composite) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Ventilation (CFR 1910.94)

Do maintenance pits have ventilation? (do not perform O2 depleting operations, hot work, etc. while in a pit) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Does exhaust ventilation meet requirements? (see IH) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Hazardous Waste (CFR 1926.65)

Are all oily rags kept in fire resistant containers? (cleaning rags, etc.) Required
Satisfactory

Unsatisfactory / Action Required

N/A

Is there an emergency response plan in place and posted? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Hazardous waste containers available? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Hazardous waste site control plan in place? Required
Satisfactory

Unsatisfactory / Action Required

N/A

Army Services

WIC Walk-in's

Toddler Time

Recreation

Safety Inspection

Safety Board

Safety Administration

Building

Break Room/Lunch Room

Emergency Management (CFR 1910. Subpart E&L)

Illumination

Ergonomics

Hazardous Materials (CFR 1926.1100-1148 &1910.1201) [TAB N]

Electrical Safety (CFR 1926.400-433 & 1910.335 Subpart I and S)

Indoor Air Quality

Lock Out/Tag Out Procedures (1910.147, AR 385-10 ch 18)

Machine Guarding (CFR1910.242, 1926/302)

Forklifts, Hand jacks and Hoists (CFR 1926.600, 1926.602, ANSI B56.1 1910.66-68)

Respiratory Protection Program

Vision Conservation (DA PAM 40-506)

Hearing Conservation (DA PAM 40-501)

Confined Space (CFR 1919.146)

Fall Protection (CFR 1926.451)

PPCE (CFR 1926.95-107, 1910.132-139 Subpart I)

Ventilation (CFR 1910.94)

Hazardous Waste (CFR 1926.65)

WIC Walk-in's

Toddler Time

Safety Inspection

Safety Board

Safety Administration

Building

Break Room/Lunch Room

Emergency Management (CFR 1910. Subpart E&L)

Illumination

Ergonomics

Hazardous Materials (CFR 1926.1100-1148 &1910.1201) [TAB N]

Electrical Safety (CFR 1926.400-433 & 1910.335 Subpart I and S)

Indoor Air Quality

Lock Out/Tag Out Procedures (1910.147, AR 385-10 ch 18)

Machine Guarding (CFR1910.242, 1926/302)

Forklifts, Hand jacks and Hoists (CFR 1926.600, 1926.602, ANSI B56.1 1910.66-68)

Respiratory Protection Program

Vision Conservation (DA PAM 40-506)

Hearing Conservation (DA PAM 40-501)

Confined Space (CFR 1919.146)

Fall Protection (CFR 1926.451)

PPCE (CFR 1926.95-107, 1910.132-139 Subpart I)

Ventilation (CFR 1910.94)

Hazardous Waste (CFR 1926.65)

Leaving U.S. Army Family and MWR