Date Of Auditing :
Name of Auditor Safety Representative
1
2 Manager Representative
3
A Personal Hygiene Yes No N/A Corrective Action
1 Tukang masak sehat untuk bekerja dan tidak menunjukkan gejala penyakit
2 Pakaian bersih atau celemek dipakai saat menyiapkan makanan dan menyajikan makanan
3 Pastikan tidak ada perhiasan yang dikenakan
4 Rambut dijaga tetap rapi dan ditutup dengan topi atau jaring rambut yang bersih jika diperlukan
5 Kuku pendek, bersih, tidak dipoles dan tanpa aksesoris kuku
6 Luka, luka atau sayatan di tangan, jika ada, ditutup dengan plester tahan air dan berwarna cerah
7 Tangan dicuci secara menyeluruh dengan sabun dan air secara berkala dan pada waktu yang tepat
18 Sampah dikemas dengan benar sebelum dibuang ke tempat pembuangan sampah/tempat sampah
F Hot Holding/ Cold Holding (if applicable) Yes No N/A Corrective Action
1 Makanan dibungkus/ditutup dengan benar dalam wadah yang tepat dan terlindung dari kontaminasi
3
A General Checklist Yes No N/A Corrective Action
1 Camp site and surrounding clean and tidy
2 Dustbins at strategic points around camp
3 Garbage collected and disposed of correctly
4 Dumping site demarcated and controlled
5 Fire extinguishers available and checked
6 Walkways satisfactory and obstruction free
7 Sufficient Lighting at night
8 Daily chlorination of camp’s water supply
9 Vehicles parked in demarcated parking area
10 Emergency Evacuation Route
11 Muster Point
12 Emergency Response Team, including contact number
13 Clearing area during Emergecny Case
B Washroom Yes No N/A Corrective Action
1 Showers available and in good condition
2 Showers cleaned daily
3 Hot and Cold water available
4 Latrines available and in good condition
5 Latrines cleaned daily and toilet paper replaced
6 Hand wash basin with liquid soap available
7 Facilities adequate for the number of personnel
C Sleeping Quarters Yes No N/A Corrective Action
1 Sleeping quarters cleaned daily
2 Sufficient ventilation and airing of rooms
3 Linen washed and changed weekly
4 Condition of beds in good standing
D Laundry Facility Yes No N/A Corrective Action
1 Laundry facility available
2 Availibility to dry wet clothing
3 Sorting of dirty and clean clothing seperately
4 Laundry schedule available and displayed
E Electrical Supply Yes No N/A Corrective Action
1 Generator set up safely and correctly
2 Generator grounded
3 Generator serviced and maintained regularly
4 Generator spillage control during refuelling
5 Access controlled and safety signage present
6 Electrical wiring installed safely and correctly
F Toilet Yes No N/A Corrective Action
1 Toilets are clean, dry and well ventilated
2 Basic amenities such as soap, toilet paper, hand dryer/ paper towel and waste bins are available
3 Toilet fittings facilities are in good working condition
Internal Audit of Warehouse
Date Of Auditing :
Name of Auditor Safety Representative
1
2 Manager Representative
3
A General Checklist Yes No N/A Corrective Action
1 Are floors in good condition?
2 Are walkways clean with no slip, trip, or fall hazards?
3 Are aisles properly marked?
4 Are aisle widths maintained for safe material retrieval?
5 Is housekeeping maintained?
6 Are idle pallets properly stored and separated with adequate stack heights?
7 Do work and storage areas have adequate lighting?
8 Are warehouse areas well ventilated?
9 Are loading bays clear and doors in good condition?
10 Are stairways in good condition and free of obstructions?
B Rack Storage Yes No N/A Corrective Action
1 Are racks in good condition with no damage, debris, rust, or distortion?
2 Are rack uprights and beams in good condition?
3 Are adequate transverse and longitudinal flue spaces maintained?
4 Are racks properly anchored to the floor and/or wall?
5 Are bolts and safety clips firmly attached and secured?
6 Are storage weight and height capacity limits posted and/or maintained?
7 Are pallets and loads correctly stowed?
8 All Bottle (Oxygen, Nitrogen, Act) put in proper rack/storage based on regulation
C Emergency Plan Yes No N/A Corrective Action
1 Are exits properly identified with illuminated signs?
2 Are egress paths and exit doors unobstructed?
3 Are there adequate numbers of emergency lights and working as designed?
4 Is there an emergency evacuation plan and map posted?
5 Are evacuation drills performed monthly and/or annually?
6 Are first aid kits identified, easily accessible and properly stocked?
7 Is backup generator and/or uninterruptible power supply tested weekly?
D Fire Protection Yes No N/A Corrective Action
1 Are portable fire extinguishers properly mounted and identified?
2 Are portable fire extinguishers inspected, recharged, and properly tagged?
3 Are there adequate numbers of smoke and/or heat detectors?
4 Is fire alarm system present and properly inspected, tested, and tagged?
5 Is the automatic fire sprinkler system properly inspected, tested, and tagged?
6 Is adequate clearance of at least 18 inches maintained below sprinkler heads?
7 Is adequate clearance of at least 36 inches maintained below ESFR sprinkler heads?
8 Are fire suppression systems installed where needed and properly inspected and tagged?
E Chemical Safety Storage Yes No N/A Corrective Action
Are hazardous material containers properly labeled with chemical identity and hazard
1
warnings?
Are chemicals stored according to manufacturer’s recommendations and local & national fire
2
codes?
3 Are Safety Data Sheets properly retained and easily accessible?
4 Are containers in good condition with no leaks and lids properly sealed?
5 Are flammable storage / transfer containers properly bonded and grounded?
6 Are eye wash stations and/or safety showers present with proper solution?
7 Are chemical spill kits available with use instructions?
8 Is proper PPE available and used for chemical handling?
F Exterior Safety & Security Yes No N/A Corrective Action
1 Is there adequate exterior lighting?
2 Is perimeter fencing adequate with access gate(s) secured?
3 Are there security cameras?
4 Are fire department connectors accessible and caps properly secured in place?
5 Are idle pallets properly stored and stacked at least 25 feet from building?
6 Is exterior housekeeping well maintained?
7 Are there any signs of exterior building / structure damage or deferred maintenance?
G Forklift Safety Yes No N/A Corrective Action
1 Do the forklifts meet design and requirements for the work environment?
2 Are designated operators properly trained and certified?
3 Are forklifts in good condition with no signs of damage or leaks?
4 Are overhead guards in good condition for protection from falling objects?
5 Do forklifts have required safety equipment? (i.e., seat belts, backup alarms, lights, and horns)
6 Are safety data information plates attached and legible?
7 Are battery charging stations located in designated area with proper ventilation?
H Toilet Yes No N/A Corrective Action
1 Toilets are clean, dry and well ventilated
2 Basic amenities such as soap, toilet paper, hand dryer/ paper towel and waste bins are available
3 Toilet fittings facilities are in good working condition