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Safe Working Environment Shift Inspection

Facility Inspected :

Shift:

Date:

Indicate if a subsequent notification exists for all items requiring attention?

D/S
Yes

N/S
No

Hazard Removed, Area Cleaned:

Comments of Action
Taken

Notifications Numbers and description including equipment numbers

Comments of action
required

Inspected By:

Supervisor:

Date:

Date:

Signature:

Signature:

Good Condition



Attention Required



Notification Numbers

Stored Correctly

Secured Correctly

No Product Build up spillage

Clear of Obstruction

Tagged in date

Condition

--Indicate equipment inspected--

Comments

General Environment
Lighting General
Personal Access Walkways
Process Pads
Handrails
Grid mesh
Stairways

Deployed
Revalidate

05.09.2016
05.09.2019

Author

Greg Kimber

Owner
Materials Execution Superintendent
WAPL Plant Inspection UNCONTROLLED ONCE PRINTED

Version 3.0
01021225
Page 2 of 5