101 ARW Facility Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

All references are from AFI 91-203 unless otherwise noted.

Safety Color Coding, Labeling & Marking for Piping Systems (Ch. 20)

• Safety Color Coding, Labeling & Marking for Piping Systems

  Safe

  At Risk

  N/A

• Are piping systems labeled and color coded if they contain any of the following materials (20.3.4):<br>a. Flammable or readily ignitable materials<br>b. Toxic or poisonous gases or materials<br>c. Corrosive materials<br>d. Fire protection materials<br>e. Compressed air at or above 30 psig<br>f. Potable water above 75 psig<br>g. Radioactive substances<br>h. Oxidizing substances<br>i. Steam

  Yes

  No

  N/A

• Does the method of identification of piping systems conform to the requirements in para. 20.3.5?

  Yes

  No

  N/A

• Are letter legends clearly identified and visible from operating positions (20.3.5.2)?

  Yes

  No

  N/A

• Do supervisors ensure that all personnel working with piping systems are trained on their hazards and is the training documented IAW AFI 91-202 (20.4)?

  Yes

  No

  N/A

Electrical Safety (Ch. 8)

• Electrical Safety

  Safe

  At Risk

  N/A

Electrical Receptacles

• Electrical Receptacles

  Safe

  At Risk

  N/A

• Are electrical receptacles and cover plates free from dangerous cracks and securely mounted (8.2)?

  Yes

  No

  N/A

• Are receptacles located in damp or wet locations protected by GFCI (8.2)? See AFI 91-203, para. 8.9.7 for guidance on GFCIs

  Yes

  No

  N/A

• Are multiple plug adapters prohibited from being linked to provide additional or more convenient outlets? This could lead to overloading electrical circuits. At no time shall a multiple plug adapter or strip be plugged into another multiple plug adapter or strip (8.2.1).

  Yes

  No

  N/A

Electrical Cord/Wiring

• Electrical Cord/Wiring

  Safe

  At Risk

  N/A

• Are flexible cords and extension cords prohibited from being subjected to electrical currents or voltages greater than their rated capacities (8.4.1)?

  Yes

  No

  N/A

• Are worn, cracked, or frayed electrical extension cords, loose or broken electrical wires and worn or broken electrical plugs reported, replaced, removed from service and/or disposed of (8.4.1.2)?

  Yes

  No

  N/A

• Are electrical extension cords used as outlined in the NEC and not used as a substitute for fixed wiring (8.4.1.3)?

  Yes

  No

  N/A

• Are electrical extension cords not run through holes in walls, ceilings, floors, doorways and/or windows (8.4.1.4)?

  Yes

  No

  N/A

• Are electrical extension cords not taped, stapled, or tacked to building surfaces (8.4.1.6)?

  Yes

  No

  N/A

• Are cords not spliced, taped, pinched, coiled, or otherwise placed where they may be damaged or create a hazard (8.4.1.7)?

  Yes

  No

  N/A

• Are electrical extension cords protected by molded housings, bridges, or other approved covers and not placed where they will be walked on or where equipment will be allowed to run over them (8.4.1.8)?

  Yes

  No

  N/A

• Are extension cords and surge protectors not series connected/daisy chained/piggy backed (8.4.1.12)?

  Yes

  No

  N/A

• Are extension cords not placed under rugs, carpets or other combustible materials (8.4.1.16)?

  Yes

  No

  N/A

• Are electrical wiring/conduits not used as clothing hangers or supports of any nature (8.4.6)?

  Yes

  No

  N/A

Circuit Breaker Panels/Disconnect Switches/Fuses

• Circuit Breaker Panels/Disconnect Switches/Fuses

  Safe

  At Risk

  N/A

• Is electrical equipment, such as switchboards, switchgear, panelboards, industrial control panels, meter socket enclosures, and motor control centers, that are in other than dwelling units, and likely to require examination, adjustment, servicing, or maintenance while energized, field or factory marked warn qualified persons of potential electric arc flash hazards (IAW NFPA 70 National Electric Code, 2014 edition)?

  Yes

  No

  N/A

• Unless their purpose is evident, are circuit breakers and fuse boxes legibly marked to indicate their purpose (8.5)?

  Yes

  No

  N/A

• Are circuit breakers, disconnect switches and fuses readily accessible to workers and building management personnel? Is the work space in front clear and unimpeded and not located where exposed to physical damage or in the vicinity of easily ignitable material (8.5.2)?

  Yes

  No

  N/A

• Are unused openings (knock out plugs) in switch housings, junction boxes, etc., securely covered (8.6)?

  Yes

  No

  N/A

• Is rigid conduit securely attached to the box? Is flexible conduit firmly secured where the conduit enters the box (8.6)?

  Yes

  No

  N/A

Work Practices

• Work Practices

  Safe

  At Risk

  N/A

• Are electrical outlets, switches, junction boxes in good condition, do they have cover plates installed, and are they free from cracks or defect (8.6)?

  Yes

  No

  N/A

• Are machines safeguarded to protect workers during undervoltage situations in the event of a power interruption (8.16)?

  Yes

  No

  N/A

• Do workers remove jewelry, such as rings, earrings, bracelets and watches, and secure metal framed eyeglasses by a band or cord when they work on or near live electrical equipment (8.8)?

  Yes

  No

  N/A

• Are equipment interlocks working properly and not disconnected or bypassed by operators (8.17.2)?

  Yes

  No

  N/A

• Is the third and/or grounding prong cut off, or is an 3-to-2 prong adapter used?

  Yes

  No

  N/A

• Yes

  No

  N/A

Emergency Shower & Eyewash Units: IAW AFI 91-203 (Ch. 19)

• Emergency Shower & Eyewash Units

  Safe

  At Risk

  N/A

Inspection & Training

• Inspection & Training

  Safe

  At Risk

  N/A

• Do supervisors ensure emergency showers and eyewashes are provided, inspected, tested and maintained IAW AFI 91-203, ch. 19 (19.3)?

  Yes

  No

  N/A

• Do supervisors activate permanently installed shower and eyewash units weekly to verify proper operation (19.9.1)?

  Yes

  No

  N/A

• Do supervisors activate permanently installed units monthly IAW AFI 91-203, para. 19.12 (19.9.2)?

  Yes

  No

  N/A

• Are workers whose duties expose them to conditions that may warrant the use of emergency equipment properly trained (19.10)?

  Yes

  No

  N/A

Location

• Location

  Safe

  At Risk

  N/A

• Are emergency shower and eyewash units in conspicuously identified accessible locations that do not require more than 10 seconds to reach (19.5)?

  Yes

  No

  N/A

• Are emergency shower and eyewash units located so the water spray does not contact any electrical circuit (19.5)?

  Yes

  No

  N/A

• Are self-contained units and the water supply lines of permanently-installed units protected from freezing and from sunlight or other heat sources that could cause extremes in water temperature?

  Yes

  No

  N/A

• Are permanently-installed and self-contained units installed in a fixed location identified with a highly visible sign and well lighted (19.6.2)?

  Yes

  No

  N/A

• Where shutoff valves are installed on water supply lines to emergency shower and eyewash units, have signs or tags been installed to prevent accidental shutoff (19.6.3)?

  Yes

  No

  N/A

• Are emergency shower and eyewash actuating devices easy to locate and readily accessible to the user (19.12.2.1.3)?

  Yes

  No

  N/A

• Is the stored fluid in self-contained units protected against contaminants and temperature extremes, and are instructions permanently affixed to the unit (19.12.5)?

  Yes

  No

  N/A

Operation

• Operation

  Safe

  At Risk

  N/A

• Is the delivered water temperature in a comfortable range that would not discourage use of the unit (19.6.1)?

  Yes

  No

  N/A

• When actuated, does the water flow remain on without the use of the operator's hands (19.7.1)?

  Yes

  No

  N/A

• Is the control valve simple to operate (push-pull) and does it go from "off" to "on" in less then one second (19.7.1)?

  Yes

  No

  N/A

• If audible alarms or blinking lights are installed to show that the unit is in use, are they working properly (19.9.1)?

  Yes

  No

  N/A

Housekeeping, Walking Surfaces, & Office Safety (Ch. 5, 7, & 10)

Housekeeping

• Housekeeping

  Safe

  At Risk

  N/A

• Are floors and walking surfaces kept free of potential tripping hazards such as tools, electrical cords, air hoses, materials and liquids (5.1)?

  Yes

  No

  N/A

• Are protruding nails, brads and staples removed from packing materials to prevent injury to personnel (5.3)?

  Yes

  No

  N/A

• Are aisles and passageways kept clear of stacked materials (5.6)?

  Yes

  No

  N/A

• Are trash and garbage cans leakproof and adequate in number and size (5.8.2)?

  Yes

  No

  N/A

Walking Surfaces

• Walking Surfaces

  Safe

  At Risk

  N/A

• Are passageways, aisles and exit accesses provided to permit the free movement of employees and material (7.2.1.1.2)?

  Yes

  No

  N/A

• Are at least 18 inches provided for passageways through or between movable obstructions (7.2.1.1.4)?

  Yes

  No

  N/A

• Are floors kept in good condition and free of defects and obstructions that endanger workers, interfere with handling of materials or hinder people leaving the area during emergencies (7.2.1.2)?

  Yes

  No

  N/A

• Are floors of all shops, service rooms, halls and storerooms kept clean and free of slippery substances (7.2.1.2.2)?

  Yes

  No

  N/A

• Are drip or oil pans used whenever the possibility of spilling or dripping exists (7.2.1.2.2)?

  Yes

  No

  N/A

• When floors are being cleaned or finishing compounds are being applied, are signs posted to warn workers of a slipping hazard (7.2.1.2.5)?

  Yes

  No

  N/A

• Are passageways, aisles and exit accesses kept clear for easy access to emergency equipment and to enable firefighters to reach a fire, if necessary (7.2.1.2.7)?

  Yes

  No

  N/A

• Are areas adjacent to fire sprinkler control valves, fuse boxes and electrical switch panels clear and unobstructed (7.2.1.2.7)?

  Yes

  No

  N/A

• Are signs identifying the floor load capacity permanently installed in plain view of all workers (7.2.1.3)?

  Yes

  No

  N/A

• Are drains provided when floors are subject to water, moisture, flooding or when wet processes are used (7.2.1.4)?

  Yes

  No

  N/A

• Are all floor openings, such as hatchways, chutes, pits, trap doors, manholes and ladderways properly guarded (7.2.1.6)?

  Yes

  No

  N/A

• Are all open-sided floors, platforms and runways four (4) feet or more above the ground guarded on all open sides (7.2.1.7.3)?

  Yes

  No

  N/A

• Are the surfaces of docks smooth and even, and are their edges marked (7.2.2.1.1)?

  Yes

  No

  N/A

• Do parking lots have a smooth surface, good drainage and are they free of pedestrian tripping hazards (7.2.2.2)?

  Yes

  No

  N/A

• Are entrances and exits free of obstructions that block a driver‘s or pedestrian‘s view of traffic (7.2.2.2)?

  Yes

  No

  N/A

• Are exterior walkways kept clear of obstacles that block the right-of-way or present slipping and tripping hazards (7.2.2.3)?

  Yes

  No

  N/A

• Do workers ensure materials are not stored, left under or piled against buildings, doors, exits or stairways (7.2.2.4.1)?

  Yes

  No

  N/A

• Where there is less than seven (7) feet of headroom over stairs, are obstructions padded (7.3.2.7)?

  Yes

  No

  N/A

• Is every flight of fixed industrial stairs with four (4) or more risers equipped with standard guardrails or standard handrails (7.3.2.12.1)?

  Yes

  No

  N/A

• Do stairs less than 44 inches wide, having both sides enclosed, have at least one handrail, preferably on the right side going down (7.3.2.13.1.1)?

  Yes

  No

  N/A

• Are stairs and ramps kept clean, free of obstructions or slippery substances and in good repair (7.3.2.15)?

  Yes

  No

  N/A

• Are slippery surfaces replaced or made safe by coating them with nonslip surface materials (7.3.2.15.3)?

  Yes

  No

  N/A

• Are guardrails and handrails smooth, free of splinters or burrs and securely mounted (7.3.2.15.6)?

  Yes

  No

  N/A

Office Safety

• Office Safety

  Safe

  At Risk

  N/A

• Are all floors kept clean, dry and free of refuse (10.2.2.1)?

  Yes

  No

  N/A

• Are telephone and electrical cords located where they do not pose a tripping hazard (10.2.2.1)?

  Yes

  No

  N/A

• Are all defects, such as floor tiles, broken steps, torn carpet or curled mats identified until repaired or replaced (10.2.2.2)?

  Yes

  No

  N/A

• Are office ergonomics considered when attempting to fit the job to the person (10.3)?

  Yes

  No

  N/A

• Is access to fuses, circuit breakers and electrical controls clear and unobstructed (10.5.7.6)?

  Yes

  No

  N/A

Hoists: IAW AFI 91-203 (Ch. 4)

• Hoists

  Safe

  At Risk

  N/A

• Is the rated capacity on all lever operated hoists permanently and conspicuously marked and easily visible (4.9.3.1.1)?

  Yes

  No

  N/A

• Are hoists equipped with a device (ratchet and pawl or load brake) that prevents a suspended load from self-lowering and ensures loads are only lowered by operation of the hoist lever (4.9.3.1.2)?

  Yes

  No

  N/A

• Are hoists inspected daily or prior to each use of items such as loose or worn parts, cracked or broken welds, deformed hooks or chain, and bent or deformed pawls (4.9.3.2)?

  Yes

  No

  N/A

• Is an annual inspection accomplished on all MHE (4.9.3.3)?

  Yes

  No

  N/A

• Are identification tags attached to hoists indicating date of inspection, date of proof test, capacity of hoist and identification number of hoist (4.9.3.4)?

  Yes

  No

  N/A

• Do hoist users maintain records of all tests (4.9.3.5.1)?

  Yes

  No

  N/A

• Are only approved lifting devices like slings used to lift loads?

  Yes

  No

  N/A

Fire Safety: IAW AFI 91-203 (Ch. 5, 6, 10 & 22)

Commercial Cooking

• Commercial Cooking

  Safe

  At Risk

  N/A

• Are all commercial cooking facilities provided with a system to remove smoke and grease-laden vapors (6.2.2.1)?

  Yes

  No

  N/A

• Are grease ducts and grease removal systems protected by automatic fire suppression systems (6.2.2.1)?

  Yes

  No

  N/A

• Are grease filters installed in all hoods and extraction systems (6.2.2.2.1)?

  Yes

  No

  N/A

• Are hood and exhaust ducts thoroughly cleaned every six (6) months, or more frequently when determined by the installation FES Flight (6.2.2.2.3)?

  Yes

  No

  N/A

• Are deep fat fryer thermostats tested annually and after any repairs or as recommended by manufacturer (6.2.2.2.6)?

  Yes

  No

  N/A

General Fire Safety

• General Fire Safety

  Safe

  At Risk

  N/A

• Is the designated smoking area maintained IAW ARWI 32-2001?

  Yes

  No

  N/A

• Are noncombustible containers with vapor tight and spill proof lids provided for the disposal of combustible wastes, soiled rags and other flammable materials (5.2)?

  Yes

  No

  N/A

• Is an 18-inch clearance maintained below fire protection sprinkler heads, rafters, joists, beams and roof trusses when materials are stacked less than 15 feet high (5.6)?

  Yes

  No

  N/A

• Are fire extinguishers visually inspected at a minimum of 30-day intervals to detect and correct discrepancies (6.2.4.7)?

  Yes

  No

  N/A

• Is a functional test conducted and documented on every required battery-powered emergency lighting system at 30-day intervals to identify and correct discrepancies (NFPA 101: Life Safety Code, para. 7.9.3)?

  Yes

  No

  N/A

• Are caution signs posted both inside and outside rooms or enclosures protected by total flooding halon, CO2, or similar fire suppressing agents (6.2.5.2)?

  Yes

  No

  N/A

• Do hose cabinets of standpipe and hose systems contain only fire protection equipment (6.2.6.1)?

  Yes

  No

  N/A

• Are frayed electrical cords, broken electrical wires and outlet covers repaired or removed from service immediately (10.5.7.1)?

  Yes

  No

  N/A

• Are heating appliances, such as coffee makers, plugged directly into a facility outlet and unplugged at the end of the work shift (10.5.7.3)?

  Yes

  No

  N/A

• Are flammable and combustible liquids stored in office occupancies limited to that required for maintenance and operation of building and equipment (10.8.4.1)?

  Yes

  No

  N/A

• Are rags or cloth containing flammable or combustible liquid residue deposited in approved self-closing metal waste containers immediately after use (10.8.4.3)?

  Yes

  No

  N/A

Flammable & Combustible Liquids

• Flammable & Combustible Liquids

  Safe

  At Risk

  N/A

• Are flammable paints, oils, and varnishes in 1 to 5 gallon containers, used for building maintenance purposes, only stored temporarily in closed containers outside approved storage cabinets or rooms if kept at the job site for less than 10 calendar days (22.5.8.5)?

  Yes

  No

  N/A

• Is at least one portable fire extinguisher rated not less than 20-B located between 10 feet and 25 feet travel distance of any Class I or Class II liquid storage area outside of a storage room (22.5.9.4)?

  Yes

  No

  N/A

• Are containers having flammable or combustible liquids protected form heat sources (22.5.9.7)?

  Yes

  No

  N/A

• Are open flame devices and smoking prohibited within 50 feet of the flammable or combustible storage area (22.5.9.7)?

  Yes

  No

  N/A

• Are approved safety cans used for transporting and dispensing flammable liquids in quantities of five (5) gallons or less (22.5.10.1)?

  Yes

  No

  N/A

• Are flammable liquids kept in covered containers when not actually in use (22.5.10.2)?

  Yes

  No

  N/A

• Are plans made and means available to promptly clean up or remove spills (22.5.10.3)?

  Yes

  No

  N/A

• Are containers used to draw from an original container marked to identify their contents (22.6.1.3)?

  Yes

  No

  N/A

• Are refrigerators or cooling equipment labeled or stenciled "Approved fro Flammable Liquid Storage" (22.6.1.3)?<br>

  Yes

  No

  N/A

• Are flammables and combustibles kept away from open flames, hot surfaces, steam pipes or other heat sources (22.6.1.4)?<br>

  Yes

  No

  N/A

• Do laboratories have fire protection appropriate for their fire hazard classification (22.6.2)?

  Yes

  No

  N/A

• Do all containers bear clearly legible labels to identify contents and indicate hazards (22.7.12)?

  Yes

  No

  N/A

• Are fueling operations conducted in outside areas free from ignition sources (22.8.1)?

  Yes

  No

  N/A

• Are fuel tanks not filled or drained inside buildings or other facilities where vapors can accumulate (22.8.1)?

  Yes

  No

  N/A

• Are boiler rooms, equipment rooms and other utility rooms not utilized as storage areas for gasoline powered equipment (22.8.6)?

  Yes

  No

  N/A

• Are their restrictions on storing small gasoline powered equipment in hangars, nose docks, corrosion control, fuel cell repair, or missile assembly and repair facilities (22.8.7)?

  Yes

  No

  N/A

• When stored, is gasoline powered equipment isolated from potential ignition sources (22.8.7)?

  Yes

  No

  N/A

Ladders (Ch. 7)

• Ladder Safety

  Safe

  At Risk

  N/A

• Ladder Training & Inspections

  Safe

  At Risk

  N/A

• Is adequate illumination provided when using ladders (7.4.2.5)?

  Yes

  No

  N/A

• Are formal, fully documented inspections of all fixed ladders accomplished upon installation and at least every three (3) years thereafter (7.4.3.1)?

  Yes

  No

  N/A

• Do supervisors ensure personnel are properly trained on climbing and using ladders (7.4.6)?

  Yes

  No

  N/A

• Do workers abstain from using metal ladders and wood ladders with metal reinforced side rails in areas where they could contact energized electrical circuits (7.5.2.1.2.2)?

  Yes

  No

  N/A

• Do supervisors make thorough visual inspections of ladders when the ladder is initially received and before the ladder is placed in service (7.5.2.2)?

  Yes

  No

  N/A

• Do workers perform an inspection of ladders prior to use (7.5.2.2)?

  Yes

  No

  N/A

• Are ladders with defects which cannot be immediately repaired, removed from service and action taken to ensure they are scheduled for repair or destruction (7.5.2.4)?

  Yes

  No

  N/A

• Are personnel who use ladder adequately trained by the supervisor in the care and use of different type ladders when a worker is first assigned (7.5.2.4.1)?

  Yes

  No

  N/A

• Fixed Ladders

  Safe

  At Risk

  N/A

• Where unauthorized use of a fixed ladder is a problem, such as in a public area, is the bottom seven (7) feet guarded (7.4.2.6)?

  Yes

  No

  N/A

• Are electrical conductors not installed on or adjacent to fixed metal ladders, unless they are beyond reach and cannot be used as a handrail or grabbed in an emergency (7.4.2.8)?

  Yes

  No

  N/A

Personal Protective Equipment (PPE) (Ch. 14)

• PPE

  Safe

  At Risk

  N/A

• Do supervisors ensure PPE is provided, used and maintained in a sanitary, serviceable condition (14.3.2)?

  Yes

  No

  N/A

• Do supervisors ensure that required PPE job safety training is documented as required by AFI 91-202 (14.3.2)?

  Yes

  No

  N/A

• Is BE contacted for advice on the proper respirator protection to use prior to exposing personnel to a potentially hazardous atmosphere (14.4.5)?

  Yes

  No

  N/A

• Is contaminated PPE that cannot be decontaminated disposed of in a manner that protects employees from exposure to hazards (14.4.7.2.5)?

  Yes

  No

  N/A

• Do supervisors review SDS requirements, then verify proper selection of chemical protective clothing with BE before original issue (14.4.11.1)?

  Yes

  No

  N/A

• Do personnel exposed to vehicle or aircraft traffic during hours of darkness or periods of reduced visibility, or as part of construction or maintenance activities, use reflective vests/accessories (14.5.10.2)?

  Yes

  No

  N/A

Fall Protection (Ch. 13)

• Fall Protection

  Safe

  At Risk

  N/A

• Are workers provided fall protection when exposed to falls of four (4) feet or more (13.2.2)?

  Yes

  No

  N/A

• Are all PFAS components marked to indicate compliance with ANSI Z359.1 (13.4.6.2)?

  Yes

  No

  N/A

• Can anchorage connectors withstand a 5000 pound load for each PFAS connected (13.4.6.7)?

  Yes

  No

  N/A

• Do workers inspect their PFAS prior to each use for mildew, wear, damage and other deterioration (13.4.6.10.2)?

  Yes

  No

  N/A

• Does the supervisor ensure all PFAS components receive a thorough inspection at least quarterly and keep record of inspection for at least one year (13.4.6.10.3)?

  Yes

  No

  N/A

• Are PFAS components subjected to impact loading immediately removed from service and not to be used again until inspected and determined by a competent person to be undamaged and suitable for reuse (13.4.6.11.8)?

  Yes

  No

  N/A

• Are workers/competent persons trained and evaluated on the fall protection/fall arrest system prior to use (13.6)?

  Yes

  No

  N/A

• Is recurring fall protection training conducted annually, when work conditions change or when new fall protection/fall arrest systems are procured (13.6)?

  Yes

  No

  N/A

• Is a rescue plan included in each fall protection plan to assure prompt rescue of fallen workers (13.7)?

  Yes

  No

  N/A

Compressed Gases (Ch. 40)

• Compressed Gases

  Safe

  At Risk

  N/A

• Are only trained workers permitted to handle or use compressed gas cylinders (40.1.2.1)?

  Yes

  No

  N/A

• Are cylinders inspected for damage (i.e., dents, gouges, evidence of leakage or cracks) when received or before use (40.2.1)?

  Yes

  No

  N/A

• Have compressed gas cylinders been hydrostatically tested within the last five (5) years (40.2.1)?

  Yes

  No

  N/A

• Are compressed gas cylinders properly handled and secured (40.2.6)?

  Yes

  No

  N/A

• When cylinders are not in use, are they capped and secured to solid fixtures to prevent cylinders from falling over (40.3.1)?

  Yes

  No

  N/A

• When cylinders are attached to a manifold, are they also secured to a solid fixture to prevent cylinders from falling over (40.3.1.3)?

  Yes

  No

  N/A

• Are cylinders stored in areas where there is no danger of accidental damage (40.3.2.1)?

  Yes

  No

  N/A

• Have empty cylinders been plainly marked EMPTY and stored separately from full cylinders (40.3.2.2)?

  Yes

  No

  N/A

• Are oxygen cylinders stored at least 20 feet from combustible materials (i.e. oil, grease), or near any other substances likely to cause or accelerate fire (40.3.6)?

  Yes

  No

  N/A

• Are supply issued cylinders (government owned cylinders received through the supply chain) identified with two (2) DD Form 1574 tags? One tag will identify the contents of the cylinder and the other tag will identify the cylinder itself. Additionally, the cylinder will carry a DOT label and a hazard class label. (IAW T.O. 42B5-1-2, para. 2.2(1))

  Yes

  No

  N/A

Hazardous Energy Control (Lockout and Tagout) (Ch. 21)

• Hazardous Energy Control (LOTO)

  Safe

  At Risk

  N/A

• Are procedures developed and documented for safe and proper use of locks and tags (21.2.1.4)?

  Yes

  No

  N/A

• Has a training plan been developed for initial and recurring training on lockout and tagout procedures (21.2.1.6)?

  Yes

  No

  N/A

• Are LOTO devices (typically locks) used as a positive means of isolating energy sources and preventing unexpected start-up of machines and equipment (21.2.1.7)?

  Yes

  No

  N/A

• Is an inspection of the LOTO program conducted annually (21.2.1.10)?

  Yes

  No

  N/A

• Is an adequate supply of safety tags and locks available for use (21.3.3)?

  Yes

  No

  N/A

• Are all workers responsible for recognizing when LOTO is used, the general reasons for LOTO and the importance of not tampering with or removing LOTO devices (21.3.4.1)?

  Yes

  No

  N/A

• Have equipment-specific, written procedures been developed for use when equipment or machinery undergoes servicing, modification or maintenance (21.3.8)?

  Yes

  No

  N/A

• Are affected personnel in the area notified before and after lockout or tagout controls are used (21.4)?

  Yes

  No

  N/A

• Does the supervisor, authorized worker and operator responsible for the equipment or machinery know the type magnitude and hazards of the energy source(s) (21.4.2.1.1)?

  Yes

  No

  N/A

• Are lockout devices attached in a manner that will hold the energy isolating devices in a "safe" or "off" position (21.4.2.5.1)?

  Yes

  No

  N/A

• Are service/administrative locks and tags replaced when maintenance on equipment and machinery starts (21.4.9.1.3)?

  Yes

  No

  N/A

• Are specific, written procedures utilized during shift or personnel changes to ensure the continuity of lockout or tagout protection (21.4.10)?

  Yes

  No

  N/A

• Is initial and recurring lockout and tagout job training current and documented (21.5.5)?

  Yes

  No

  N/A

• Are periodic self-inspections conducted and documented by the unit (21.6.1)?

  Yes

  No

  N/A

Machinery (Ch. 18)

• Machinery

  Safe

  At Risk

  N/A

• Does the hood cover the part of the saw blade exposed above the material (18.4.2.1.1)?

  Yes

  No

  N/A

• Is a spreader provided at the table saw to prevent the wood from clamping down on the saw blade (18.4.2.1.2)?

  Yes

  No

  N/A

• Is the motor START switch on the machine protected against accidental or inadvertent operation (18.4.2.11.1)?

  Yes

  No

  N/A

• Are control switches available to workers a their operating positions so they do not need to reach over moving parts of machinery (18.4.2.11.3)?

  Yes

  No

  N/A

• Is the stop control switch identified by a printed word or color coded red (18.4.2.11.3)?

  Yes

  No

  N/A

• Are under-voltage protective devices installed on machines that are not safeguarded to protect the worker during under-voltage situations (18.4.2.11.4)?

  Yes

  No

  N/A

• Are foot treadle controls protected against unexpected or accidental tripping (18.4.2.11.5)?

  Yes

  No

  N/A

• Are all machine energy sources or energy isolating devices, such as disconnect switches or circuit breakers, locked out or tagged out before maintenance is performed or major adjustments are made with guards and panels removed (18.4.2.11.7)?

  Yes

  No

  N/A

• Are abrasive wheel machines only operated with safety guards installed (18.6.2.3.1)?

  Yes

  No

  N/A

• Are work rests used during all off-hand grinding operations (18.6.2.3.3)?

  Yes

  No

  N/A

• Are work rests adjusted closely to the wheel with a maximum opening of 1/8 inch to prevent work from being jammed between the wheel and the rest (18.6.2.3.3.1)?

  Yes

  No

  N/A

Mobile Elevating Work Platforms (Ch. 16)

• Mobile Elevating Work Platforms

  Safe

  At Risk

  N/A

• Are aerial ladders inspected and tested annually (16.4.5.1)?

  Yes

  No

  N/A

• Are aerial ladders inspected immediately following any repair of a structural or mechanical component of the ladder assembly (16.4.5.1)

  Yes

  No

  N/A

• Are articulating and extendible boom platforms inspected and tested annually (16.4.5.2)?

  Yes

  No

  N/A

• Is the aerial device manufacturer's operating manual available for operator use (16.4.6.1)?

  Yes

  No

  N/A

• Have operators of vehicle-mounted elevating and rotating work platforms been thoroughly trained and qualified in the use of the equipment (16.4.6.3)?

  Yes

  No

  N/A

• Are work platforms equipped with guardrails, midrails and toeboards on all four (4) sides of the platform, including the access opening to the platform (16.5.1)?

  Yes

  No

  N/A

• Are the steps of the all the ladder stands constructed of slip-resistant materials or covered with a slip-resistant coating (16.5.3.4)?

  Yes

  No

  N/A

• Are guardrails, midrails and toeboards installed on all scafffolding with work levels four (4) feet or more above ground or floor level (16.5.3.6)?

  Yes

  No

  N/A

• Do supervisors ensure personnel do not ride moving manually-propelled work platforms (16.5.3.8)?

  Yes

  No

  N/A

• Are at least two (2) of four (4) casters on ladder stands or work platforms equipped with positive swivel locks or wheel locks to prevent movement (16.5.5.2)?

  Yes

  No

  N/A

• Are screwjacks or other suitable means for adjusting height provided when leveling elevated work platform is required (16.5.5.3)?

  Yes

  No

  N/A

• Are at least two (2) brakes, wheel looks or permanently installed jacks operational on all work platforms (16.5.5.4)?

  Yes

  No

  N/A

• Are reflective materials for marking mobile work platforms used to the maximum extent authorized by TOs (16.5.11.5)?

  Yes

  No

  N/A

• Are work platforms secured against movement when not being transported (16.5.11.5)?

  Yes

  No

  N/A

• Are mobile work platform and/or ladder stands inspected daily before use (16.5.11.6)?

  Yes

  No

  N/A

• Are mobile platforms and ladders used for fuel cell repair or other hazardous areas equipped with bonding and (or) ground connections and static discharge plates for personnel to dissipate accumulated static electricity (16.5.11.8)?

  Yes

  No

  N/A

Conclusion

• Inspection Complete

• Inspection completed:

  Date

• Inspection conducted by:

  Sign