Inspection Location and Date Inspection Performed By

## - ELECTRICAL -

+---+---+--------------------------------------------------------------+
| * | * | # Note: Document discrepancies/observatio                    |
| * | * | ns/suggestions in the spaces provided (below) and detail cor |
| Y | N | rective actions in the Kalman Monthly Safety Meeting report. |
| e | o |                                                              |
| s | * |                                                              |
| * | * |                                                              |
| * |   |                                                              |
+---+---+--------------------------------------------------------------+
|  |  | # Are electrical ap                                          |
|   |   | pliances (computers, fans, heaters, etc.) properly grounded? |
+---+---+--------------------------------------------------------------+
|  |  | Do extension cords have a grounding conductor?               |
+---+---+--------------------------------------------------------------+
|  |  | Are extension cords "daisy-chained" together.                |
+---+---+--------------------------------------------------------------+
|  |  | Is the number of built-in electrical outlets sufficient to   |
|   |   | meet the requirements of the employees?                      |
+---+---+--------------------------------------------------------------+
|  |  | Are flexible cords and cables free of splices, knots,        |
|   |   | fraying, cuts or taps?                                       |
+---+---+--------------------------------------------------------------+
|  |  | Are all disconnecting switches and circuit breakers labeled  |
|   |   | to indicate their use or equipment served?                   |
+---+---+--------------------------------------------------------------+
|  |  | Is sufficient access and working space provided and          |
|   |   | maintained around all electrical equipment to permit ready   |
|   |   | and safe operations and maintenance?                         |
+---+---+--------------------------------------------------------------+
|  |  | Are electrical enclosures (such as switches, receptacles,    |
|   |   | and junction boxes) provided with tight fitting covers or    |
|   |   | plates?                                                      |
+---+---+--------------------------------------------------------------+
|  |  | Are employees who regularly work on or around energized      |
|   |   | electrical equipment or lines instructed in the              |
|   |   | cardiopulmonary resuscitation (CPR) methods?                 |
+---+---+--------------------------------------------------------------+
|  |  | Are all workstations clean, sanitary, orderly and free of    |
|   |   | combustible materials?                                       |
+---+---+--------------------------------------------------------------+
|  |  | Are combustible scrap, debris and waste stored safely and    |
|   |   | removed from the work site properly?                         |
+---+---+--------------------------------------------------------------+
|  |  | Are accumulations of combustible dust routinely removed from |
|   |   | surfaces (in particular, areas near electrical outlets)?     |
+---+---+--------------------------------------------------------------+

### DISCREPANCIES/OBSERVATIONS/SUGGESTIONS

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***[- WALKWAYS -]{.underline}***

+---+---+--------------------------------------------------------------+
| * | * | # Note: Document discrepancies/observatio                    |
| * | * | ns/suggestions in the spaces provided (below) and detail cor |
| Y | N | rective actions in the Kalman Monthly Safety Meeting report. |
| e | o |                                                              |
| s | * |                                                              |
| * | * |                                                              |
| * |   |                                                              |
+---+---+--------------------------------------------------------------+
|  |  | Are aisles and passageways clear?                            |
+---+---+--------------------------------------------------------------+
|  |  | Are aisles and walkways marked, as appropriate?              |
+---+---+--------------------------------------------------------------+
|  |  | Are holes in the floor, sidewalk or other walking surface    |
|   |   | repaired properly, covered or otherwise made safe?           |
+---+---+--------------------------------------------------------------+
|  |  | Are materials or equipment stored in such a way that sharp   |
|   |   | objects will not interfere with the walkway?                 |
+---+---+--------------------------------------------------------------+
|  |  | Are changes in floor elevation readily identifiable?         |
+---+---+--------------------------------------------------------------+
|  |  | Are aisles or walkways that pass near industrial machinery,  |
|   |   | welding operations or similar hazardous operations arranged  |
|   |   | so employees will not be subjected to potential hazards?     |
+---+---+--------------------------------------------------------------+
|  |  | Is adequate headroom provided for the entire length of any   |
|   |   | aisle or walkway?                                            |
+---+---+--------------------------------------------------------------+
|  |  | Are standard guardrails provided wherever aisle or walkway   |
|   |   | surfaces are elevated more than 30 inches above any adjacent |
|   |   | floor or the ground?                                         |
+---+---+--------------------------------------------------------------+
|  |  | Is material on elevated surfaces piled, stacked or racked in |
|   |   | a manner to prevent it from tipping, falling, collapsing, or |
|   |   | rolling into walkways?                                       |
+---+---+--------------------------------------------------------------+

### 

### DISCREPANCIES/OBSERVATIONS/SUGGESTIONS

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***[- FLOOR & WALL OPENINGS -]{.underline}***

+---+---+--------------------------------------------------------------+
| * | * | # Note: Document discrepancies/observatio                    |
| * | * | ns/suggestions in the spaces provided (below) and detail cor |
| Y | N | rective actions in the Kalman Monthly Safety Meeting report. |
| e | o |                                                              |
| s | * |                                                              |
| * | * |                                                              |
| * |   |                                                              |
+---+---+--------------------------------------------------------------+
|  |  | Are toeboards installed around the edges of permanent floor  |
|   |   | openings (where persons may pass below the opening)?         |
+---+---+--------------------------------------------------------------+
|  |  | Is the glass in the windows, doors, glass walls, etc. (which |
|   |   | are subject to potential human impact) of sufficient         |
|   |   | thickness and type for the condition of use?                 |
+---+---+--------------------------------------------------------------+
|  |  | Are grates or similar type covers over floor openings (such  |
|   |   | as floor drains) of such design that foot traffic or rolling |
|   |   | equipment will not be affected by the grate spacing?         |
+---+---+--------------------------------------------------------------+
|  |  | Are floor or wall openings in fire resistive construction    |
|   |   | provided with doors or covers compatible with the fire       |
|   |   | rating of the structure and provided with a self-closing     |
|   |   | feature, when appropriate?                                   |
+---+---+--------------------------------------------------------------+

### 

### DISCREPANCIES/OBSERVATIONS/SUGGESTIONS

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***[- STAIRS & STAIRWAYS -]{.underline}***

+---+---+--------------------------------------------------------------+
| * | * | # Note: Document discrepancies/observatio                    |
| * | * | ns/suggestions in the spaces provided (below) and detail cor |
| Y | N | rective actions in the Kalman Monthly Safety Meeting report. |
| e | o |                                                              |
| s | * |                                                              |
| * | * |                                                              |
| * |   |                                                              |
+---+---+--------------------------------------------------------------+
|  |  | Are standard stair rails or handrails on all stairways       |
|   |   | having four or more risers?                                  |
+---+---+--------------------------------------------------------------+
|  |  | Are all stairways at least 22 inches wide?                   |
+---+---+--------------------------------------------------------------+
|  |  | Do stairs have landing platforms have not less than 30       |
|   |   | inches in the direction of travel and extend 22 inches in    |
|   |   | width at every 12 feet or less of vertical rise?             |
+---+---+--------------------------------------------------------------+
|  |  | Do stairs angle no more than 50 and no less than 30 degrees? |
+---+---+--------------------------------------------------------------+
|  |  | Are step risers on stairs uniform from top to bottom?        |
+---+---+--------------------------------------------------------------+
|  |  | Are steps on stairs and stairways designed or provided with  |
|   |   | a surface that renders them slip resistant?                  |
+---+---+--------------------------------------------------------------+
|  |  | Are stairway handrails located between 30 and 34 inches      |
|   |   | above the leading edge of stair treads?                      |
+---+---+--------------------------------------------------------------+
|  |  | Do stairway handrails have at least 3 inches of clearance    |
|   |   | between the handrails and the wall or surface they are       |
|   |   | mounted on?                                                  |
+---+---+--------------------------------------------------------------+
|  |  | Where doors or gates open directly on a stairway, is there a |
|   |   | platform provided so the swing of the door does not reduce   |
|   |   | the width of the platform to less than 21 inches?            |
+---+---+--------------------------------------------------------------+
|  |  | Where stairs or stairways exit directly into any area where  |
|   |   | vehicles may be operated, are adequate barriers and warnings |
|   |   | provided to prevent employees stepping into the path of      |
|   |   | traffic?                                                     |
+---+---+--------------------------------------------------------------+

### 

### DISCREPANCIES/OBSERVATIONS/SUGGESTIONS

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***[- GENERAL -]{.underline}***

+---+---+--------------------------------------------------------------+
| * | * | # Note: Document discrepancies/observatio                    |
| * | * | ns/suggestions in the spaces provided (below) and detail cor |
| Y | N | rective actions in the Kalman Monthly Safety Meeting report. |
| e | o |                                                              |
| s | * |                                                              |
| * | * |                                                              |
| * |   |                                                              |
+---+---+--------------------------------------------------------------+
|  |  | Is there a posted list of hazardous substances used in your  |
|   |   | workplace?                                                   |
+---+---+--------------------------------------------------------------+
|  |  | Is there a written Hazard Communication Program dealing with |
|   |   | Material Safety Data Sheets (MSDS), labeling and employee    |
|   |   | training?                                                    |
+---+---+--------------------------------------------------------------+
|  |  | Is there an employee training program for hazardous          |
|   |   | substances?                                                  |
+---+---+--------------------------------------------------------------+
|  |  | Are employees trained in how to recognize tasks that might   |
|   |   | result in occupational hazard exposure?                      |
+---+---+--------------------------------------------------------------+
|  |  | Is protection against the effects of occupational noise      |
|   |   | exposure provided when sound levels exceed those of the OSHA |
|   |   | noise standard?                                              |
+---+---+--------------------------------------------------------------+
|  |  | Are employees trained in whom to contact and what to do in   |
|   |   | an emergency?                                                |
+---+---+--------------------------------------------------------------+
|  |  | Is proper storage practiced to minimize the risk of fire     |
|   |   | including spontaneous combustion?                            |
+---+---+--------------------------------------------------------------+
|  |  | Are employees aware of the location and operation of fire    |
|   |   | extinguishers?                                               |
+---+---+--------------------------------------------------------------+
|  |  | Are extinguishers free from obstructions or blockage?        |
+---+---+--------------------------------------------------------------+
|  |  | Are all extinguishers serviced, maintained and tagged at     |
|   |   | intervals not to exceed 1 year?                              |
+---+---+--------------------------------------------------------------+
|  |  | Are employees aware that they shall [not]{.underline} expose |
|   |   | themselves to potential harm when determining whether to     |
|   |   | extinguish a small fire or to evacuate to a safe area?       |
+---+---+--------------------------------------------------------------+
|  |  | Are employees aware that they must report any and all        |
|   |   | instances of sexual harassment or workplace violence?        |
+---+---+--------------------------------------------------------------+
|  |  | In the event of emergency, do employees (or their immediate  |
|   |   | family) have the ability to contact the employee's           |
|   |   | supervisor 24 hours per day?                                 |
+---+---+--------------------------------------------------------------+
|  |  | Are employees trained in whom to contact and what to do in   |
|   |   | an emergency?                                                |
+---+---+--------------------------------------------------------------+

### 

### DISCREPANCIES/OBSERVATIONS/SUGGESTIONS

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