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2018 SGIA Safety Recognition Program - November/December

Administrative Areas

Company: *This question is required.

Date of Inspection: *This question is required.

calendar

Name of Inspector: *This question is required.

General *This question is required.

Space Cell	Yes	No	N/A
Safety personnel and emergency personnel identified and appointed	Safety personnel and emergency personnel identified and appointed : Yes	Safety personnel and emergency personnel identified and appointed : No	Safety personnel and emergency personnel identified and appointed : N/A
Applicable safety programs developed and maintained	Applicable safety programs developed and maintained: Yes	Applicable safety programs developed and maintained: No	Applicable safety programs developed and maintained: N/A
Applicable employee safety training records maintained	Applicable employee safety training records maintained : Yes	Applicable employee safety training records maintained : No	Applicable employee safety training records maintained : N/A
Appropriate safety notices conspicuously posted on bulletin board (For US companies, this includes a copy of the OSHA Workplace Poster)	Appropriate safety notices conspicuously posted on bulletin board (For US companies, this includes a copy of the OSHA Workplace Poster): Yes	Appropriate safety notices conspicuously posted on bulletin board (For US companies, this includes a copy of the OSHA Workplace Poster): No	Appropriate safety notices conspicuously posted on bulletin board (For US companies, this includes a copy of the OSHA Workplace Poster): N/A
Accident and close-call investigations conducted and recorded	Accident and close-call investigations conducted and recorded : Yes	Accident and close-call investigations conducted and recorded : No	Accident and close-call investigations conducted and recorded : N/A
OSHA logs properly maintained and recorded for all applicable injuries/illnesses	OSHA logs properly maintained and recorded for all applicable injuries/illnesses: Yes	OSHA logs properly maintained and recorded for all applicable injuries/illnesses: No	OSHA logs properly maintained and recorded for all applicable injuries/illnesses: N/A
OSHA 300 Summary Form Posted between February 1st and April 30th - US only	OSHA 300 Summary Form Posted between February 1st and April 30th - US only: Yes	OSHA 300 Summary Form Posted between February 1st and April 30th - US only: No	OSHA 300 Summary Form Posted between February 1st and April 30th - US only: N/A

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Offices *This question is required.

Space Cell	Yes	No	N/A
Aisles clear	Aisles clear: Yes	Aisles clear: No	Aisles clear: N/A
Rugs and runners lying flat	Rugs and runners lying flat: Yes	Rugs and runners lying flat: No	Rugs and runners lying flat: N/A
Electrical and extension cords properly used, secured, and in good repair	Electrical and extension cords properly used, secured, and in good repair: Yes	Electrical and extension cords properly used, secured, and in good repair: No	Electrical and extension cords properly used, secured, and in good repair: N/A
Lighting – kept at adequate safe level	Lighting – kept at adequate safe level: Yes	Lighting – kept at adequate safe level: No	Lighting – kept at adequate safe level: N/A
Desks, chairs in good repair and ergonomic design	Desks, chairs in good repair and ergonomic design: Yes	Desks, chairs in good repair and ergonomic design: No	Desks, chairs in good repair and ergonomic design: N/A
Computer screens adjusted to proper height and distance for user	Computer screens adjusted to proper height and distance for user: Yes	Computer screens adjusted to proper height and distance for user: No	Computer screens adjusted to proper height and distance for user: N/A

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Lunchroom/Breakroom *This question is required.

Space Cell	Yes	No	N/A
Kitchen appliances, tables, and chairs all in good working order	Kitchen appliances, tables, and chairs all in good working order: Yes	Kitchen appliances, tables, and chairs all in good working order: No	Kitchen appliances, tables, and chairs all in good working order: N/A
Floors clean and unobstructed, waste receptacles provided	Floors clean and unobstructed, waste receptacles provided: Yes	Floors clean and unobstructed, waste receptacles provided: No	Floors clean and unobstructed, waste receptacles provided: N/A
Refrigerator contents reviewed regularly	Refrigerator contents reviewed regularly: Yes	Refrigerator contents reviewed regularly: No	Refrigerator contents reviewed regularly: N/A
Dishes, cups, and utensils kept clean and sanitary	Dishes, cups, and utensils kept clean and sanitary: Yes	Dishes, cups, and utensils kept clean and sanitary: No	Dishes, cups, and utensils kept clean and sanitary: N/A
Lighting kept at adequate safe level	Lighting kept at adequate safe level: Yes	Lighting kept at adequate safe level: No	Lighting kept at adequate safe level: N/A

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Restrooms *This question is required.

Space Cell	Yes	No	N/A
Sinks, toilets, and soap dispensers clean and in good working order *This question is required	Sinks, toilets, and soap dispensers clean and in good working order: Yes	Sinks, toilets, and soap dispensers clean and in good working order: No	Sinks, toilets, and soap dispensers clean and in good working order: N/A
Separate facilities for men and women *This question is required	Separate facilities for men and women: Yes	Separate facilities for men and women: No	Separate facilities for men and women: N/A
Facial and toilet tissue supply adequate *This question is required	Facial and toilet tissue supply adequate: Yes	Facial and toilet tissue supply adequate: No	Facial and toilet tissue supply adequate: N/A
Floors clean and unobstructed, waste receptacles provided *This question is required	Floors clean and unobstructed, waste receptacles provided: Yes	Floors clean and unobstructed, waste receptacles provided: No	Floors clean and unobstructed, waste receptacles provided: N/A
Lighting kept at adequate safe level *This question is required	Lighting kept at adequate safe level: Yes	Lighting kept at adequate safe level: No	Lighting kept at adequate safe level: N/A

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