National Oceanic and Atmospheric Administration

**Office Safety Assessment Checklist for**

**Supervisors and Program Managers**

  ----------------------------------- -----------------------------------
  **Name:**                           **Division:**

  **Location:**                       **Date:**
  ----------------------------------- -----------------------------------

Questions with a "NO" answer require corrective action. Enter name of
person or department responsible for the Corrective Action

# Yes No N/A Emergency Exits Responsible Person/Dept.

0 0 0 Are exits kept free of obstructions or locking devices which could

impede immediate escape?

0 0 0 Are exits properly marked and illuminated?

0 0 0 Are doors, passageways or stairways that are neither exits nor
access

> to exits and which could be mistaken for exits, appropriately marked
>
> "NOT AN EXIT, " "TO BASEMENT," "STOREROOM," etc.?
>
> **Work Environment**

0 0 0 Are all work areas clean, sanitary, and orderly?

0 0 0 Are aisles and passages free of stored material that may present a

trip hazard?

0 0 0 Are tile floors in places like kitchens and bathrooms free of
water

and slippery substances?

0 0 0 Are carpet and throw rugs free of tears or trip hazards?

0 0 0 Are file drawers kept closed when not in use?

0 0 0 Are passenger and freight elevators inspected annually and are the

inspection certificates available for on-site review?

0 0 0 Are heating and air conditioning vents clear of obstructions?

0 0 0 Are doors locked/secured to labs that contain Radioactive
material?

**Ergonomics**

0 0 0 Are employees advised of proper lifting techniques?

0 0 0 Are workstations configured to prevent common ergonomic

concerns?

**Emergency Information**

0 0 0 Are established emergency phone numbers posted where they can be

readily found in case of emergency?

0 0 0 Are employees trained in emergency procedures?

0 0 0 Are fire evacuation procedures available and diagrams posted?

0 0 0 Is a copy of the facility fire prevention and emergency action
plan

readily available on site?

**Fire Prevention**

0 0 0 Are portable fire extinguishers visually inspected monthly and

serviced annually?

0 0 0 Are areas around portable fire extinguishers free of obstructions
and

properly labeled?

0 0 0 Are fire alarm pull stations clearly marked and unobstructed?

0 0 0 Are 18" clearances maintained below sprinkler heads, including all

storerooms, closets and mechanical rooms?

**Electrical Systems**

0 0 0 Are all cord and cable connections intact and secure?

0 0 0 Are power strips limited to one per outlet? (No daisy chaining?)

0 0 0 Are outlets free of overloading?

0 0 0 Has all temporary wiring been removed? (Through walls, doors,

under carpeting, etc.)

0 0 0 Are the areas around electrical panels and breakers free of
obstructions?

0 0 0 Is all equipment properly identified with voltage and purpose?

**Specific Notes for Deficiencies**

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  **Name of Supervisor:**

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Number range CHAPTER

### 

**SAFETY OBSERVATION FORM**

Instructions: Prior to making your observation, review checklist items
on this form. Upon entering the observation area, spend 20-30 seconds
closely observing behaviors, conditions, and procedures. Mentally note
them and return to fill out the observation form. Note at least one
corrective action for each observation. Review with employee, stressing
the employee's anonymity, and [commend]{.underline} or correct all
observed actions. End by thanking employee.

Manager/ Line Office
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Supervisor\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> Facility/Ship\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> Department
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Time \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Description of observation:**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Action(s) Taken:** (i.e. commended employee, corrected unsafe
condition, etc.)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Potential for Injury or Deficiencies
noted**:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

#### Personal Protective Equipment Position Tools 

\_\_\_\_\_Eyes & Face \_\_\_\_\_Struck by or Against \_\_\_\_\_Correct
tool for job?

\_\_\_\_\_Ears/Noise \_\_\_\_\_Caught between \_\_\_\_\_Proper Use

\_\_\_\_\_Hands \_\_\_\_\_Fall or Trip \_\_\_\_\_Condition of Tool

\_\_\_\_\_Feet \_\_\_\_\_Temperature

\_\_\_\_\_Respiratory \_\_\_\_\_Lifting

###### Facilities Procedures Behaviors 

**\_\_\_\_\_**Cleanliness/Housekeeping \_\_\_\_\_Written task
procedures? **\_\_\_\_\_**Communicates?

\_\_\_\_\_Work area design \_\_\_\_\_Were they followed? \_\_\_\_\_Eye
contact /hazard?

\_\_\_\_\_Floor Surfaces \_\_\_\_\_Are they adequate? \_\_\_\_\_Work
pace (behind)?