Monthly Slip, Trip, and Fall Self-Inspection

Location Name/Number: _______________________________ Date: _____________

This audit is designed to be performed by members of the management team in conjunction with the monthly safety meeting. When completing this self-inspection, conditions that are found to be satisfactory should be marked with an "S" to the left of the question. Unsatisfactory conditions should be marked with a "U" to the left of the question. Questions that do not apply should be marked N/A, indicating "not applicable." Any conditions found to be "unsatisfactory" require a correction action comment on the deficiencies page and follow up by management to insure the unsatisfactory condition is corrected as soon as possible. Completed audits should be filed monthly for review by district or regional management and retained for a period of two years.

S = Satisfactory U = Unsatisfactory N/A-Not Applicable

SECTION I - PARKING AREA/SIDEWALKS

Date: _________________ Completed By: ____________________________________

S/U______ A) Surface Condition - pavement unbroken and free of potholes. Areas clear of trash and debris.______ B) Handicapped parking stalls properly marked/signed.______ C) Sidewalks in good repair and do not present a tripping hazard.______ D) All external lighting functioning properly/as designed.______ E) Leased properties. Landlord or property management notified when unsafe conditions are noted.

(Inadequate snow removal, salting, roof leaking, debris in parking lot or employee parking area, etc.)

SECTION II - ENTRANCES/EXITS

Date: _________________ Completed By: ____________________________________

S/U

______ A) Doorway threshold plates tightly fastened, beveled to prevent trip exposures.______ B) Emergency evacuation lighting works when tested.______ C) Exit signs properly illuminated without obstruction of visibility.______ D) Stairwells are clear of any merchandise, fixtures and trash.______ E) Approved decals are installed at a level of 4' 6" on all glass doors and partitions to prevent customers from

striking into glass and falling.

SECTION III FLOORS

Date: _________________ Completed By: ____________________________________

S/U

______ A) Platforms/bases that are used for special displays do not represent a tripping hazard.______ B) Empty platforms/bases are removed from the area.______ C) Platforms, bases, displays or stack-outs do not block access to handrails, stairways, etc.

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______ D) Rolling equipment is safety striped or painted with bright paint as required.______ E) Material handling equipment is limited to one unit per associate working to protect customers or the public

from tripping or striking into the equipment.______ F) Ladders are directly attended and removed from the floor immediately after use.______ G) Aisles are free of unattended cartons that represent potential tripping

hazards.______ H) Handrails are installed and secure for all steps with more than two risers.______ I) Floors free of tripping/slipping hazards. (i.e., trash, debris, fixturing components, extension cords,

unattended ladders or other material handling equipment, etc).______ J) Entrance mats are used and maintained in a clean and dry condition to prevent slipping hazards. Mats are

placed tight against the door threshold and tight against each other to provide maximum coverage for customers and employees to rid their shoes of moisture. Entrance mats are of good quality and do not present a trip hazard.

______ K) Carpeting free of any tears, waves or other defects which are significant and create a tripping hazard.______ L) Carpet edge molding is securely attached throughout the building and does not present a hazard.______ M) Spill Kit Requirements - Pop-up paper towels are maintained at designated areas for "quick" pick-ups of

minor spills.______ N) Complete spill kits are available in designated areas as follows:

Wet Floor Sign

Whisk Broom

Dust Pan Window Cleaner

Paper Towels

Absorbent Materials/Bucket

Designated Area # 1Designated Area # 2Designated Area # 3Designated Area # 4Designated Area # 5

______ O) One dedicated mop, bucket and two wet floor signs are available for response to larger spills.______ P) Three associates are questioned about the use of spill kits and can confirm their location, contents and use.

S/U Associate Name Title

______ _______________________ ____________________________________

______ _______________________ ____________________________________

______ _______________________ ____________________________________

SECTION IV – STOCKROOMS/WAREHOUSE

Date: _________________ Completed By: ____________________________________

S/U

______ A) Ladders, portable stairs and lift equipment available and in good condition. All are safety striped.

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______ B) "Do not climb fixture!" signs are posted in each stockroom and in the warehouse.______ C) Aisles clear with adequate lighting and free of tripping hazards.

SECTION V -WASHROOMS

Date: _________________ Completed By: ____________________________________

S/U

______ A) Plumbing fixtures in good condition, free of leaks.______ B) Floors clean and free of slipping/tripping hazards.

SECTION VI – Escalator/Elevator Safety

Date: _________________ Completed By: ____________________________________

S/U

______ A) Escalator landing plates are secure and screws anchoring plates are flush with the walking surface.______ B) The speed of the handrail matches the speed of the escalator steps.______ C) Warning signs are installed on both sides of the Up/Down escalators. Signs communicate- No Strollers, Face

Forward, Use Handrail and Hold Child's Hand while riding.______ D) Glass paneled escalators are equipped with exterior- side child restraints to prevent children from fitting or

falling between the escalator and the railing.______E) The escalator start-key is readily accessible.______F) Elevator functions properly when tested. Carriage is level with the floor when doors open.______G) Valid Certificates of Inspection are on file or posted as required for escalators and elevators

Corrective Action Comments

Deficiency: Person Responsible Date Corrected(Specify item or task to be completed)

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Manager Signature: ___________________________________ Date:____________________________

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