Safety Gemba Walk Checklist Template Download as PDF Digitalize this paper form now
Register for free on lumiformapp.com and conduct inspections via our mobile app
Cut inspection time by 50% Uncover more issues and solve them 4x faster Select from over 4000 expert-proofed templates Safety Gemba Walk Checklist Template PPE & Safe Work Practices Correct PPE worn and is it in good condition? Yes No N/A Metatarsal safety shoes worn and are they in good condition Yes No N/A Hearing protection worn Yes No N/A Gloves (if required) Yes No N/A Other required PPE? Yes No N/A Lifting Devices Material lifting devices used and are they in good condition Yes No N/A Can operator explain daily inspection performed on lifting devices Yes No N/A Inspect lifting devices for worn or damaged devices Yes No N/A Are suspended loads attended Yes No N/A Suspended loads must never be lifted over employees Yes No N/A Safety Shower / Eye Wash Station Is their a shower of eye station located where acids / bases (corrosives) used. " Sodium Aluminate" Yes No N/A Are they inspected monthly and access not blocked Yes No N/A Are eye wash stations available in high dust areas Yes No N/A Emergency Exits Aisles and emergency exits not blocked Yes No N/A Electrical Is voltage indicated on electrical control enclosures, power cabinets,, junction boxes etc. Yes No N/A Arc Flash label present on electrical control enclosures, power cabinets, junction boxes etc. Yes No N/A Clearance in front of electrical enclosures 36" (0-150v) and 42" (151-600v) Yes No N/A Chords are free from frays and damage Yes No N/A Extension cords only allowed for temporary situations Yes No N/A GFCI's required on portable electric tools and in areas where wetness or damage to cord is possible Yes No N/A Are knockout plugs present on all electrical enclosures Yes No N/A Mobile Equipment Are inspections being completed on equipment, prior to being used before each shift Yes No N/A Mobile equipment license and training current within 3 years Yes No N/A Seatbelt used whenever forklift operated Yes No N/A Material Storage Area Material organized and rotated by date Yes No N/A Material not triple stacked, only two high Yes No N/A Flammable Cabinets Only flammable liquids in cabinet (no paper, wood or plastic stored in cabinet) Yes No N/A Cabinets undamaged Yes No N/A No more than 3 cabinets within 100 square feet Yes No N/A Environmental Are all areas free from spills? Yes No N/A Machine Guarding Is point of operation (grinding wheel, etc.) protected such that inadvertent contact is prevented? Yes No N/A Flywheels, gears, shafts, pulleys, belts, gears, sprockets, chains and couplings guarded to protect employees Yes No N/A E-stop button present Yes No N/A Walking / Working surfaces Are the walkways clear and free of debris Yes No N/A Are all holes or floor openings guarded? Yes No N/A Fire Extinguishers Monthly Inspection completed / Verify completely charged Yes No N/A Confined space Marked with proper signage (permit required sign or non permit required sign Yes No N/A HAZCOM All containers labeled. (Original container with Manufacturers Label or secondary container with HMIS label) Yes No N/A Do employees know how to access an MSDS for a chemicals used? Yes No N/A Lockout / Tagout Is machine specific energy control procedure present? Yes No N/A Are LOTO labels present Yes No N/A Compressed Air Nozzles Are nozzles labeled as OSHA compliant. (regulate air pressure to 30psi or less) Yes No N/A Compressed Gas Cylinder Storage Are cylinders identified with a durable label that clearly identifies the cylinder contents and gives a brief description of the potential hazard? Yes No N/A Cylinders secured with chain, lab strap or hard stock device located on the upper one third of the cylinder Yes No N/A Nesting methods for storage are prohibited. Acceptable means of storage include individual chains or straps, holding racks, cylinder carts etc. Yes No N/A Flammable gasses shall be stored at least 20 feet from oxidizers and any other source of ignition or separated by an approved firewall Yes No N/A OE and Standard Work Material consumption be tracked PP/T? Yes No N/A Are 5S audits and Safety audits posted and current Yes No N/A Observe if standard work is being followed Yes No N/A Area clean & organized (less than 1 day of dirt)? Yes No N/A Aisles and emergency exits not blocked? Yes No N/A Do the employees know: (Interview a few people) How to report suggestions Yes No N/A Who to report incident or injuries to and how long they have to do it in "as soon as it happens" Yes No N/A How to do and R3 and what it is Yes No N/A What is standard work and where is it located Yes No N/A What do they do if they find a problem Yes No N/A What a STOP card is and do they have them available Yes No N/A This template is also available in:
Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.