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Safety Gemba Walk Checklist Template

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Safety Gemba Walk Checklist Template


PPE & Safe Work Practices

Correct PPE worn and is it in good condition?

Metatarsal safety shoes worn and are they in good condition

Hearing protection worn

Gloves (if required)

Other required PPE?

Lifting Devices

Material lifting devices used and are they in good condition

Can operator explain daily inspection performed on lifting devices

Inspect lifting devices for worn or damaged devices

Are suspended loads attended

Suspended loads must never be lifted over employees

Safety Shower / Eye Wash Station

Is their a shower of eye station located where acids / bases (corrosives) used. " Sodium Aluminate"

Are they inspected monthly and access not blocked

Are eye wash stations available in high dust areas

Emergency Exits

Aisles and emergency exits not blocked


Is voltage indicated on electrical control enclosures, power cabinets,, junction boxes etc.

Arc Flash label present on electrical control enclosures, power cabinets, junction boxes etc.

Clearance in front of electrical enclosures 36" (0-150v) and 42" (151-600v)

Chords are free from frays and damage

Extension cords only allowed for temporary situations

GFCI's required on portable electric tools and in areas where wetness or damage to cord is possible

Are knockout plugs present on all electrical enclosures

Mobile Equipment

Are inspections being completed on equipment, prior to being used before each shift

Mobile equipment license and training current within 3 years

Seatbelt used whenever forklift operated

Material Storage Area

Material organized and rotated by date

Material not triple stacked, only two high

Flammable Cabinets

Only flammable liquids in cabinet (no paper, wood or plastic stored in cabinet)

Cabinets undamaged

No more than 3 cabinets within 100 square feet


Are all areas free from spills?

Machine Guarding

Is point of operation (grinding wheel, etc.) protected such that inadvertent contact is prevented?

Flywheels, gears, shafts, pulleys, belts, gears, sprockets, chains and couplings guarded to protect employees

E-stop button present

Walking / Working surfaces

Are the walkways clear and free of debris

Are all holes or floor openings guarded?

Fire Extinguishers

Monthly Inspection completed / Verify completely charged

Confined space

Marked with proper signage (permit required sign or non permit required sign


All containers labeled. (Original container with Manufacturers Label or secondary container with HMIS label)

Do employees know how to access an MSDS for a chemicals used?

Lockout / Tagout

Is machine specific energy control procedure present?

Are LOTO labels present

Compressed Air Nozzles

Are nozzles labeled as OSHA compliant. (regulate air pressure to 30psi or less)

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?

Cylinders secured with chain, lab strap or hard stock device located on the upper one third of the cylinder

Nesting methods for storage are prohibited. Acceptable means of storage include individual chains or straps, holding racks, cylinder carts etc.

Flammable gasses shall be stored at least 20 feet from oxidizers and any other source of ignition or separated by an approved firewall

OE and Standard Work

Material consumption be tracked PP/T?

Are 5S audits and Safety audits posted and current

Observe if standard work is being followed

Area clean & organized (less than 1 day of dirt)?

Aisles and emergency exits not blocked?

Do the employees know: (Interview a few people)

How to report suggestions

Who to report incident or injuries to and how long they have to do it in "as soon as it happens"

How to do and R3 and what it is

What is standard work and where is it located

What do they do if they find a problem

What a STOP card is and do they have them available

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