Store #
LOSS PREVENTION SAFETY INSPECTION Date:
Audit Conducted by: Manager on Duty:
Box if this is a selfPrint Print
audit being conducted
by a member of store
managementSignatureSignature
Time of Day Audit was conducted: Follow-up Audit to be conducted? NO YES – By Date: / /
OK NOT N/A COMMENTSAREA OF INSPECTION PERSON COMPLETE BY: FIXED
OK A. Exterior of StoreRESPONSIBLE:
1. Parking lot well lit / /
2. Parking lot clear of stray carts / /
3. Parking lot free of pot holes / /
4. Sidewalks in front of store clear of debris / /
5. Sidewalk pavement level in front of store / /
6. Front entrance properly lit / /
7. Front doors opening and closing properly / /
8. Other: / /
9. Other: / /
Comments:
OK NOT N/A COMMENTSAREA OF INSPECTION PERSON COMPLETE BY: FIXED
OK B. Front EndRESPONSIBLE:
1. Properly working carts available to customers / /
2. Carts in need of repair located in rear of store / /
3. Front entrance has working lighted EXIT sign / /
4. Floor mats located at registers, entrances, ice machines / /
5. Floor area level and clean / /
6. Perishable items being put back immediately / /
7. Open cash wraps free of obstruction / /
8. Closed cash wraps properly blocked off / /
9. No wires exposed around cash wraps / /
10. Turn styles in proper working order, bars sturdy / /
11. Front end well lit / /
12. Fire extinguisher and First Aid Kit located in front of store / /
13. Other: / /
14. Other: / /
Comments:
OK NOT N/A COMMENTSAREA OF INSPECTION PERSON COMPLETE BY: FIXED
OK C. Sales FloorRESPONSIBLE:
1. Floors clean, dry, level / /
2. Floor stacks neat, sturdy / /
3. Shelves lined up properly, sturdy / /
4. Aisles well lit / /
5. Signage hanging properly / /
6. Items on top shelf easily accessible, lightweight / /
7. Crates, boxes, buckets, mops etc not left unattended / /
8. Stockers wearing backbelts properly / /
9. Stockers using proper safety cutters correctly / /
10. Doors on coolers open and close properly / /
11. Emergency Exits unobstructed, unlocked, lighted exit sign / /
12. Fire extinguishers located in this area / /
13. Other: / /
14. Other: / /
Comments:
OK NOT N/A COMMENTSAREA OF INSPECTION PERSON COMPLETE BY: FIXED
OK D. Produce DepartmentRESPONSIBLE:
1. Walkways cart accessible / /
2. Floors level, clean of produce, dry from sprinkler system / /
3. Mats around rice/bean bins and area by sprinkler system / /
4. Produce employees wearing backbelts properly / /
5. Employees using safety cutters/produce knives properly / /
6. First Aid Kit and Fire extinguishers located in area / /
7. Produce area well lit / /
8. Emergency exits unobstructed, unlocked, lighted exit sign / /
9. Produce back room floor level, clean, dry / /
10. Produce freezer/cooler doors open and close properly / /
11. Produce freezer/cooler well lit / /
12. No electrical panels blocked off / /
13. Produce knives stored safely when not in use / /
14. Other: / /
15. Other: / /
Comments:
OK NOT N/A COMMENTSAREA OF INSPECTION PERSON COMPLETE BY: FIXED
OK E. Bakery/Meat/Deli DepartmentRESPONSIBLE:
1. Employees are wearing hats/hair nets / /
2. Floors are level and clean / /
3. Employees are wearing backbelts properly / /
4. Employees are using cutters/knives properly (meat gloves) / /
5. Electrical wires are properly installed / /
6. First Aid Kits and Fire extinguishers located in area / /
7. Machines and ovens are operating and cleaned properly / /
8. Employees are familiar with Lock Out/Tag Out procedures / /
9. Employees are familiar with health standards for department / /
10. Freezer/cooler doors open and close properly / /
11. Work area and freezers/coolers well lit / /
12. No ice build-up in freezers / /
13. All knives safely put away, Machines secured when not in use / /
14. Other: / /
15. Other: / /
Comments:
OK NOT N/A COMMENTSAREA OF INSPECTION PERSON COMPLETE BY: FIXED
OK F. Receiving AreaRESPONSIBLE:
1. Floors level, clean, walkways free of obstruction / /
2. Eyewash station is clean, working, and accessible / /
3. Mops, buckets, floor cleaners stored in organized manner / /
4. Sprinkler Riser and water heater unobstructed / /
5. Electrical panels unobstructed / /
6. Emergency exits unobstructed, unlocked, lighted exit signs / /
7. Forklift/pallet jack works properly (forklift daily checklist done) / /
8. Receiver is using backbelt and safety cutter properly / /
9. Dairy, Grocery and Beer coolers are all properly lit / /
10. Dairy, Grocery and Beer cooler doors open and close properly / /
11. Beer Cooler is locked / /
12. Electrical service panels and conduit in good condition / /
13. Empty pallets, propane and helium tanks stored properly / /
14. First Aid Kits and Fire extinguishers located in area / /
15. Breakroom is clean / /
16. Dock area outside of receiving is unobstructed and organized / /
17. Fly fan above the receiving door operating properly / /
18. Other: / /
19. Other: / /
Comments:
OK NOT N/A COMMENTSAREA OF INSPECTION PERSON COMPLETE BY: FIXED
OK G. Miscellaneous IssuesRESPONSIBLE:
1. First Aid Kits Stocked – Last Inspected: / /
2. Eyewash Station – Last Inspected: / /
3. Fire Extinguishers – Last Monthly Inspection: / /
4. Sweep Cards – Last time punched: / /
5. Safety Meeting – Last Held: / /
6. Forklift Certificates Posted in Managers’ office / /
7. No Smoking in building, signs posted / /
8. No Weapons on premises, signs posted / /
9. Misc. OSHA posters posted by time clock / /
10. NetworkAwarenessCenter – Sexual Harassment poster / /
11. Drug – Free Workplace Posters / /
12. Workplace Violence Posters / /
13. Other: / /
14. Other: / /
Overall Comments:
Copies to be given to:
Store Manager District Manager
District Loss Prevention ManagerSr. VP Operations
THE INFORMATION PRESENTED IN THIS “SAMPLE” SAFETY PROGRAM HAS BEEN COMPILED FROM VARIOUS SOURCES BELIEVED TO BE RELIABLE. HOWEVER, IT CANNOT BE ASSUMED THAT ALL ACCEPTABLE MEASURES ARE CONTAINED IN THIS PROGRAM WITH REGARDS TO YOUR INDUSTRY STANDARDS AND REQUIREMENTS UNDER PARTICULAR FEDERAL, STATE, PROVINCIAL AND LOCAL LAW.
LOSS PREVENTION 11/16/18
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