EXECUTIVE SUMMARY

EXECUTIVE SUMMARY

Summary

** This annual safety program assessment and facilities inspection meets and satisfies the mandatory safety requirements of AFI91-202. **

1. Upon completion of the inspection, 128th ARW Safety has 15 days to complete the inspection report for Commander coordination.

2. All noted program and facility (if applicable) findings from this report require corrective actions. Once the report is received by the unit, corrective actions must be sent to the safety office within 30 days.

3. Upon receipt of the report, the Unit Safety Representative (USR) will ensure all appropriate functional/facility managers receive a copy of the safety inspection report. Each noted finding requires a reply.

4. Observations do not require reply, but should be addressed in a timely manner. The USR will consolidate responses and forward corrective actions taken or planned, along with an estimated completion date (ECD), to the safety office. If a work order request was submitted, enter the work order number, and the date the work request was submitted to base CE. Submission of a work request is NOT considered a closing action; only when the item is actually corrected.

5. Each open finding requires follow-up and a status sent to Wing Safety by the workcenter supervisor every 30 days until all actions are completed. Once finding is corrected this will be verified by Wing Safety and officially closed in the report.

Overall Unit Score
Commander's Support of Safety
Unit Supervisor's Support of Safety
Weapons Safety Program Score
Squadron Flight Safety Officer's Score

Best Practices

Inspection Report Sent to Unit
Inspection Follow-up Due to Wing Safety

IN-BRIEF

IN-BRIEF RECAP
In-Brief Date/ Time

In-Brief Attendees (Rank, Name, Unit)

Total Number Attended
FY Mishap Trends (Past Year - Current Year)

Mishap Trend Comments

Open Discrepancies

Open Discrepancy Comments

Open Hazards (Hazard Abatement)

Hazard Abatement Comments

PROGRAM ASSESSMENT

Program Assessment?
OCCUPATIONAL SAFETY

COMMANDER SAFETY POLICY LETTER

POLICY

Has the Unit Commander published their safety policy and goals?

UNIT SAFETY REPRESENTATIVE (USR)

USR

Has the Unit Commander appointed a primary and alternate Unit Safety Representative (USR)?

Has USR been trained within 60 days of appointment?

Is the USR appointment letter accurate and up-to-date?

USR SPOT INSP: USRs shall conduct and document monthly spot inspections in conjunction with facility managers when possible and IAW paragraph 3.5 of this instruction. This will encompass 100% of the workplaces annually. AFI 91-202 para 2.2.2.2.
- The activity or work are inspected.
- The date and time of the inspection.
- The name of the person conducting the spot inspection.
- Brief description of the area or hazard.
- Applicable RAC, if assigned by Bio, Safety, Fire.
- Corrective actions taken or planned.
- Follow-up actions every 30 days until closed.

ADVISE CC: USRs shall advise the commander on safety related matters at least on a quarterly basis or more frequently as necessary and document key elements briefed. AFI 91-202 para 8.5.1.

SAFETY BRIEFING: USRs shall conduct safety briefings and provide unit personnel with educational safety materials. AFI 91-202 para 2.2.2.5.

MOTORCYCLE SAFETY REPRESENTATIVE (MSR)

MSR

Has the Unit Commander appointed at least one Motorcycle Safety Representative (MSR) in writing coordinate the Motorcycle Safety Program?

Has the MSR been trained within 30 days of appointment?

Is the MSR appointment letter accurate and up-to-date?

Is the commander completing annual safety brief for all motorcycle riders?

Are all motorcycle riders tracked in AFSAS/MUSTT?

HIGH RISK ACTIVITIES PROGRAM

HRAP

Has the Unit Commander provided a Risk Activity Briefing to all unit personnel whether they chose to participate in high risk activities or not?

MICT

Has squadron accomplished the following MICT checklists: 1. Unit Safety Representative (USR) Responsibilities/ 2. Supervisor Occupational Safety Responsibilities (within the squadron)/ 3. Commander below Installation Level Responsibilities Communicator

DISCREPANCY

Discrepancy

Discrepancy

Recommendation

Reference

Database Reference # (For Internal Use Only)

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WEAPONS SAFETY
WEAPONS SAFETY: APPLICABLE/NON-APPLICABLE

ADDITIONAL DUTY WEAPONS SAFETY REPRESENTATIVE (ADWSR)

ADWSR

Has the Unit Commander appointed at least one Additional Duty Weapons Safety Representative (ADWSR) in writing coordinate the Weapons Safety Program?

Has the ADWSR been trained within 30 days of appointment?

Is the ADWSR appointment letter accurate and up-to-date?

ADWSR SPOT INSP: ADWSR's shall conduct and document monthly spot inspections in conjunction with facility managers when possible and IAW paragraph 3.5 of this instruction. This will encompass 100% of the workplaces annually. AFI 91-202 para 2.2.2.2.
- The activity or work are inspected.
- The date and time of the inspection.
- The name of the person conducting the spot inspection.
- Brief description of the area or hazard.
- Applicable RAC, if assigned by Bio, Safety, Fire.
- Corrective actions taken or planned.
- Follow-up actions every 30 days until closed.

SAFETY BRIEFING: USRs shall conduct safety briefings and provide unit personnel with educational safety materials. AFI 91-202 para 2.2.2.5.

ADVISE CC: ADWSR's shall advise the commander on safety related matters at least on a quarterly basis or more frequently as necessary and document key elements briefed. AFI 91-202 para 8.5.1.

MICT

Has squadron accomplished the following MICT checklists: 1. SEW-3 Weapons Safety program Management - AFI90-201, Para. 5.4.

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

Database Reference # (For Internal Use Only)

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FLIGHT SAFETY
FLIGHT SAFETY: APPLICABLE/NON-APPLICABLE

SQUADRON FLIGHT SAFETY OFFICER (SFSO)

SFSO

Has the Unit Commander appointed at least one Squadron Flight Safety Officer (SFSO) in writing coordinate the Flight Safety Program?

Has the SFSO been trained within 30 days of appointment?

Is the SFSO appointment letter accurate and up-to-date?

MICT

Has squadron accomplished the following MICT checklists: 1. SE F01 - Aviation Safety/ 2. AMC SEF Sup - Aviation Safety - AMC Sup - AFI90-201, Para. 5.4.

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

Database Reference # (For Internal Use Only)

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JOB SAFETY TRAINING OUTLINE (JSTO)

Method of documenting safety training:

JSTO

Does the JSTO COVER THE 16 mandatory items from AFI 91-202, Attachment 4?

Does the JSTO cover specific hazards to include both task specific and work environment hazards?

Are all workcenter specific items cover in second section of JSTO?

Supervisor annual review:

When was the review last accomplished?

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

Database Reference # (For Internal Use Only)

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HAZARDOUS ENERGY CONTROL PROGRAM
OCCUPATIONAL SAFETY: APPLICABLE/NON-APPLICABLE

HAZARDOUS ENERGY CONTROL PROGRAM

LOTO

Is an adequate supply of safety tags and locks available for use? Reference 21.3.3

Are procedures developed and documented for safe and proper use of locks and tags? Reference 21.2.1.4

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

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

Is an inspection of the lockout and tagout program conducted annually? Reference 21.2.1.10

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? Reference 21.3.4.1

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

Has squadron accomplished the following MICT checklists: 1. SE F01 - Aviation Safety/ 2. AMC SEF Sup - Aviation Safety - AMC Sup - AFI90-201, Para. 5.4.

Was a management above supervisor review accomplished?

Management above supervisor review:

Date of management review

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

Database Reference # (For Internal Use Only)

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CONFINED SPACE PROGRAM
OCCUPATIONAL SAFETY: APPLICABLE/NON-APPLICABLE

CONFINED SPACE

Confined Space

Has the commander and/or functional manager developed and implemented a written confined space program? Reference 23.2.7

Does the commander and/or functional manager ensure personnel who support the permit-required confined space program are properly trained, equipped and qualified? Reference 23.2.7.2
-Does the organization have an effective training program that incorporates safe work practices and techniques? Reference 23.7.1
-Does the organization ensure all individuals authorized and assigned permit-required confined space entry duties complete site-specific training? Reference 23.7.2
-Is confined space training documented on an AF IMT 55, Employee Safety and Health Record, or an authorized computerized information management system? Reference 23.7.5

Does the commander and/or functional manager ensure required equipment is available and properly maintained? Reference 23.2.7.3

Does the commander and/or functional manager maintain a current list of all confined spaces, both permit-required and non-permit, under the control of their organization? Reference 23.2.7.4.

Does the entry supervisor have a copy of the MEP? Reference 23.2.8.1

Are entry permits, including those canceled or revoked, retained on file for one year? Reference 23.5.1.2

Does the organization have a MEP, as appropriate? Reference 23.5.4.10

Does the entry supervisor ensure the inspection, testing, maintenance and documentation of safety and rescue equipment are accomplished prior to an operation being performed? Reference 23.6.2

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

Database Reference # (For Internal Use Only)

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FALL PROTECTION PROGRAM
OCCUPATIONAL SAFETY: APPLICABLE/NON-APPLICABLE

FALL PROTECTION

Fall Protection

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

Are all PFAS components marked to indicate compliance with ANSI Z359.1.? Reference 13.4.6.2

Can anchorage connectors withstand a 5000 pound load for each PFAS connected? Reference 13.4.6.7

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

Does the competent person thoroughly inspect all PFAS components at least quarterly and keep the record of inspection for at least one year? Reference 13.4.6.10.3

Are competent persons trained and appointed in writing by the commander?

Is recurring fall protection training conducted annually, when work conditions change or when new fall protection/fall arrest systems are procured and does it contain a rescue plan developed to assure prompt rescue of fallen workers? Reference 13.6, 13.7

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

Database Reference # (For Internal Use Only)

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GOVERNMENT-VEHICLE OPERATOR TRAINING
GOVERNMENT-VEHICLE OPERATOR TRAINING: APPLICABLE/NON-APPLICABLE

GOVERNMENT-VEHICLE OPERATOR TRAINING

Vehicle

Do workers who operate vehicle-mounted elevating and rotating work platforms receive thorough training to include hands-on-training prior to actual on-the-job training tasks? is training documented in individuals training records? (623's, 797's, ARCNET)

Does training meet minimum mandatory requirements for Aerial Lift Training and Training Plans in AFI 91-203, Attachment 2?

Is training/certification documented on AF Form 483

Is the instructor for forklift trucks/MHE qualified as an instructor?

Does the qualified instructor evaluate each operator at least every 3 years and provide refresher training if needed? Is there a written record of each operations evaluation on file for review? Is recertification annotated in operators training record or in TBA?

Does Materials handling and lifting equipment training include:
Reference AFI 91-203 Para. 35.3.3.4

Is training/certification documented on AF Form 2293

Equipment design, to include restrictions, limitations and hazards relative to the environment where used, e.g., steering, maneuvering and visibility.

Operating and maintenance instructions, including manufacturer’s instructions and those contained in this standard.

Safe loading and unloading requirements.

Flight line rules and regulations, when applicable.

Operating techniques inside and outside of warehouses.

Fire extinguisher training (initial and annual). Refer to Chapter 6, Fire Protection and Prevention, for additional guidance.

Use of attachments such as extended forks or tines or personnel lift pallets.

Clearances, heights and limitations.

Safety clothing and equipment. Refer to Chapter 14, Personal Protective Equipment (PPE), for additional guidance.

Fire protection, fuel spills, maintenance of equipment, smoking, etc. Refer to Chapter 6 for additional guidance.

Operating restrictions in potentially hazardous storage areas, which include flammable, toxic, lumber, coal, etc. Refer to Chapter 22, Flammable and Combustible Liquids, for additional guidance.

Load composition and stability.

Damage that may be caused by acid or caustic material.

Workplace related topics such as surface condition; local policies on stacking, unstacking, and load manipulation; pedestrian traffic; and narrow aisles.

Applicable information contained in paragraphs 35.2. and 35.3.2.1. of this standard.

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

Database Reference # (For Internal Use Only)

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OFFICE AREAS

OFFICE AREAS

Office Area

Office

BLDG, Room Number and Responsible Section

Floors and walking surfaces free of potential tripping hazards such as tools, Elec, cords, air hoses, materials and liquids?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Electrical receptacles & cover plates free from cracks and secured in place?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are receptacles located in damp or wet locations protected by GFCI breakers or receptacles?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is the prohibition of multiple plug adapters enforced to prevent overloading electrical
circuits?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are cords that show signs of fraying, cracking, wearing or damage removed from service?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are electrical extension cords not run through holes in ceilings, walls, floors, doorways,
windows or similar openings?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Unless their purpose is evident, are circuit breakers and fuse boxes legibly marked to indicate
their purpose?
Is access to fuses, circuit breakers and electrical controls clear and unobstructed? Reference 10.5.7.6

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are telephone and electrical cords located where they do not pose a tripping hazard?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are heavy materials stored in the bottom of file cabinets?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are stepstools or ladders used to access anything above shoulder level? Reference 10.2.2.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are drawers and file cabinets closed when not being used?

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do not place cords under rugs, carpets or other combustible material. AFI 91-203 para 8.4.1.16.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Exit sign: The illuminated surface value of the exit sign should have a value of not less than five foot-candles. 29 CFR 1910.37 ( b )( 6 )

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Exit signs shall be clearly visible from all directions of egress and shall not be obstructed at any time. If occupancy is permitted at night, or if normal lighting levels are reduced at times during working hours, exit signs shall be suitably illuminated by a reliable light source. New exit signs shall be the internally illuminated, light emitting diode (LED) type. Existing signs may be internally or externally illuminated. AFI 91-203 para 25.4.9.5.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Monthly testing of exit lights shall be accomplished IAW NFPA 101, The Life Safety Code. AFI 91-203 para 25.4.9.10.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Fire exits shall be clearly marked and exit paths shall be kept clear of equipment and materials, emergency lighting shall be provided and all workers trained in proper evacuation procedures. AFI 91-203 para 6.3.2.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Floors or means of egress shall be illuminated to at least one (1) foot-candle (measured at all points at the floor), including angles and intersections of corridors and passageways, stairways, landings of stairs and exit doors. AFI 91-203 para 6.3.8.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Doors, passageways or stairways which are neither exits nor ways to an exit but may be mistaken for an exit, shall be clearly marked ―NOT AN EXIT or a sign indicating their actual use; for example, ―STORAGE ROOM or ―BASEMENT. AFI 91-203 para 6.3.3.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Ensure escape routes are kept free of obstruction—to include stairways and office doors. Ensure doors leading outside open easily. AFI 91-203 para 6.2.15.2.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

RAC

Unit corrective actions:

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INDUSTRIAL AREAS

Industrial Areas (Housekeeping, General Checklists)

Housekeeping

BLDG, Room Number and Responsible Section

Keep areas where personnel walk and work free of potential tripping and slipping hazards such as tools, electrical cords, air lines and packaging materials. AFI 91-203 para 5.1.
Are aisles and passageways kept clear of stacked materials? Reference 5.7

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are fire extinguishers visually inspected by the workcenter supervisor at a minimum of 30-day intervals to detect and correct discrepancies? Reference 6.2.4.7

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are exterior garbage cans securely covered when not actually being filled or emptied? Reference 5.9.1
Are trash and garbage cans leak-proof and adequate in number and size? Reference 5.9.2

Discrepancy:

Recommendation:

Cause of deficiencies or hazard:

Reference:

Unit corrective actions:

RAC

Maintain ceilings in good repair and free of loose plaster. Replace damaged, broken or missing fire rated ceiling tiles. Openings in ceilings can delay activation of smoke detectors and sprinkler heads. AFI 91-203 Para. 5.5

Discrepancy:

Recommendation:

Cause of deficiencies or hazard:

Reference:

Unit corrective actions:

RAC

Are protruding nails, brads and staples removed from packing materials to prevent injury to personnel? Reference 5.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is material stacked less then 15 feet at least 18-inches below ceiling sprinkler heads, joists, rafters, beams and roof trusses. If material is stacked more than 15 feet is there at least 36 inches of clearance from ceiling sprinkler heads, joists, rafters, beams and roof trusses. Is all stacked material positioned to ensure a 18 inch clearance around light or heating fixtures, or follow manufactures instructions, regardless of height. Reference 5.7

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do all fluorescent light fixtures without self-locking tubes have shields, clamps or other devices installed to keep the tubes from falling out of the fixture. AFI 91-203 Para 5.7

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are all surfaces maintained as free as practicable of accumulations of dust, lead, chromium, cadmium or any other foreign particles.? Are floors kept clean and spills cleaned up as soon as possible.? Reference 5.10.9

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is apparel not needed to perform official duties stored in lockers and not stored on top of or under clothing lockers? Reference 5.10.8

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are packing materials such as excelsior (fine wood shavings), packing straw and shredded paper stored in an isolated fire-resistant building? Reference 5.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are cords not placed under rugs, carpets or other combustible material. AFI 91-203 para 8.4.1.16.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Exit sign: The illuminated surface value of the exit sign should have a value of not less than five foot-candles. 29 CFR 1910.37 ( b )( 6 )

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Exit signs shall be clearly visible from all directions of egress and shall not be obstructed at any time. If occupancy is permitted at night, or if normal lighting levels are reduced at times during working hours, exit signs shall be suitably illuminated by a reliable light source. New exit signs shall be the internally illuminated, light emitting diode (LED) type. Existing signs may be internally or externally illuminated. AFI 91-203 para 25.4.9.5.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Monthly testing of exit lights shall be accomplished IAW NFPA 101, The Life Safety Code. AFI 91-203 para 25.4.9.10.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Fire exits shall be clearly marked and exit paths shall be kept clear of equipment and materials, emergency lighting shall be provided and all workers trained in proper evacuation procedures. AFI 91-203 para 6.3.2.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Floors or means of egress shall be illuminated to at least one (1) foot-candle (measured at all points at the floor), including angles and intersections of corridors and passageways, stairways, landings of stairs and exit doors. AFI 91-203 para 6.3.8.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Doors, passageways or stairways which are neither exits nor ways to an exit but may be mistaken for an exit, shall be clearly marked ―NOT AN EXIT or a sign indicating their actual use; for example, ―STORAGE ROOM or ―BASEMENT. AFI 91-203 para 6.3.3.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Ensure escape routes are kept free of obstruction—to include stairways and office doors. Ensure doors leading outside open easily. AFI 91-203 para 6.2.15.2.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

Unit corrective actions:

RAC

Database Reference # (For Internal Use Only)

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Safety Color Coding, Labeling and Marking for Piping Systems

Labeling Piping

BLDG, Room Number and Responsible Section

Is each location evaluated and the number of markings kept at a minimum? Reference 20.3.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are piping systems labeled and color coded IAW guidance in paragraph 20.3.4.? Reference 20.3.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Does the method of identification of piping systems conform to the requirements in paragraph 20.3.5.? Reference 20.3.5.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do the colors used to distinguish the hazard potential of piping systems conform to those in this standard? Reference 20.3.5.5.1

Discrepancy:

Recommendation:

Cause of deficiencies or hazard:

Reference:

Unit corrective actions:

RAC

Are hazardous materials in piping systems clearly identified? Reference 20.3.5.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is a secondary warning color applied to a piping system possessing a secondary hazard? Reference 20.3.5.5.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

RAC

Unit corrective actions:

Database Reference # (For Internal Use Only)

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Personal Protective Equipment

PPE

BLDG, Room Number and Responsible Section

Are workers provided appropriate eye or face protection when exposed to hazards from flying particles, molten metal, liquid chemicals, corrosives, caustics, chemical gases, vapors or potentially injurious radiation? Reference 14.4.2
Do supervisors ensure PPE is provided, used and maintained in a sanitary, serviceable condition? Reference 14.3.2
Is previously used PPE disinfected before reissue to another worker? Reference 14.4.2.15.
Do workers maintain and disinfect eye and/or face protection equipment IAW the following instructions: Reference 14.4.2.16
- Several methods for disinfecting eye-protective equipment are acceptable. The most effective method is to disassemble the goggles or spectacles and thoroughly clean all parts with soap and warm water. Carefully rinse all traces of soap and replace defective parts with new ones. Swab thoroughly or immerse all parts for 10 minutes in a solution of germicidal deodorant fungicide. Remove parts from solution and suspend in clean place after air drying at room temperature or with heated air. Do not rinse after removing parts from the solution because this will remove the germicidal residue.
- Ultraviolet disinfecting equipment or spray type disinfecting solutions may be used in conjunction with the washing procedure.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do management, supervisors and visitors wear appropriate PPE while within a hazardous area? Reference 14.4.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are protective helmets provided for and used by workers exposed to injury from falling or flying objects, bumping head against a fixed object or electrical shock or burns? Reference 14.4.3
Do protective helmets have the manufacturer’s name, ANSI designation and the class identified inside the shell? Reference 14.4.3.1.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are chemical protective gloves worn by personnel handling acids, alkalis, organic solvents and other harmful chemicals? Reference 14.4.7.2
Are workers able to remove gloves without causing skin contamination? Reference 14.4.7.2.4.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is protective footwear provided and worn when there is a reasonable possibility of foot injuries? Reference 14.4.10

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

RAC

Unit corrective actions:

Database Reference # (For Internal Use Only)

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AIRCRAFT FACILITY

Aircraft Maintenance Facilities

BLDG, Room Number and Responsible Section

Are pressure regulators installed to prevent over-pressurization of components being serviced with compressed air? Reference 24.2.5.2.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are suitable fire extinguishers placed throughout maintenance areas? Reference 24.3.3.6

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do parking lines have spots painted where the nose or forward wheel of the aircraft are positioned on aircraft parking spaces on the flight line and in maintenance hangars? Reference 24.5.5

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

At the end of each day or shift, are flammable waste containers emptied or removed to an approved location outside the shop for pickup and disposal? Reference 24.11.2.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are flammable storage areas kept cool (55o to 80o F) and free from spark or heat-producing equipment? Reference 24.11.2.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are tire cages used when servicing aircraft tires in the tire shop? Reference 24.12.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are FOD Check signs posted at entrances to ramp area/flight line? Reference 24.13.13

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are pintle assemblies and towing connections secured with a pintle hook safety locking device or cotter pin that will positively lock towing connections? Reference 24.7.16

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do facility managers conduct monthly inspections of hangar door operational and safety features? Reference 24.14.8.7

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is temporary or makeshift electrical wiring prohibited in hangars? Reference 24.14.13

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do supervisors prohibit wear of finger rings and loose clothing when they pose a hazard to workers? Reference 24.15.1.6

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are locking pins or other devices, as required, in place IAW manufacturer’s specifications before anyone is allowed to ascend the stairs or ladder? Reference 24.16.7.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is fall protection available and used by workers exposed to a fall of 4 feet/10 feet or more? Reference 24.16

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

RAC

Unit corrective actions:

Database Reference # (For Internal Use Only)

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MATERIALS HANDLING / WAREHOUSE

MATERIALS HANDLING/WAREHOUSE

Materials Handling Checklist

Warehouse

BLDG, Room Number and Responsible Section

Are manual materials handling activities kept to a minimum through the application and use of engineering controls when possible? Reference 4.5.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is PPE provided and used when needed to protect the hands and feet of workers involved in manual materials handling activities? Reference 4.7.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Have training outlines been developed for all material handling equipment? Reference 35.3.3.2
(Forklifts)

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Have qualified personnel been identified as training instructors? Reference 35.3.3.1
(Forklifts)

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Does the instructor provide written certification of training completion to the OR&L? Reference 35.3.3.3. (Forklifts)

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do materials handling and lifting equipment operators conduct daily or prior-to-use inspections and document them on AF Form 1800 per requirements of paragraph 35.1.1? Reference 35.3.6 (Forklifts)

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are inspections of manual hoisting and pulling devices conducted annually? Reference 35.5.2.3.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do Storage Racks have load rating posted on the unit? Reference 35.2.5.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are storage racks/shelving inspected per manufacturer's instructions and is it documented properly. Reference 35.2.5.5

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Unit corrective actions:

RAC

Recommendation

Database Reference # (For Internal Use Only)

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HYDROCARBIN FUELS COMPLEX

HYDROCARBON FUELS

POL

BLDG, Room Number and Responsible Section

Have possible sources of ignition been identified and prohibited from areas where flammable vapor may exist? Reference 36.1.5.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Have all damaged static grounds been repaired and retested for resistance values? Reference 36.1.6.5

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Have all personnel in work environments where petroleum products are present been instructed on hazards of static electricity? Reference 36.2.2.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are all personnel involved in fuel handling operations trained in minimizing the possibility of fuel spills and proper response procedures if a spill does occur? Reference 36.2.2.5

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are proper procedures used when entering petroleum storage tanks? Reference 36.2.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are the minimum safety features present in locations where petroleum products are handled or stored? Reference 36.2.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are fuel transport vehicles electrically bonded to the offloading header during fuel handling operations? Reference 36.3.2.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are emergency shower and eyewash units in place IAW Chapter 19? Reference 36.2.4.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are proper procedures utilized for fuel transfer operations, including gauging and temperature measurement? Reference 36.3.2.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is fire protection equipment properly located prior to fuel handling operations? Reference 36.3.2.6

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do local fuel movement procedures include emergency shutdown procedures? Reference 36.3.2.9

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Has a Fuel Servicing Safety Zone (FSSZ) been established for fuel servicing operations? Reference 36.4.1.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are spotters used when backing refueling trucks toward the aircraft? Reference 36.4.2.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are the specific precautions for hydrant system fueling being followed? Reference 36.4.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

RAC

Unit corrective actions:

Database Reference # (For Internal Use Only)

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VEHICLE MAINTENANCE

VEHICLE MAINTENANCE

Vehicle Maintenance

VM

BLDG, Room Number and Responsible Section

Are vehicle maintenance operations, such as painting, welding, battery work, and wheel and tire maintenance operations performed in separate parts of the facility to prevent operations of one kind from being hazardous to another? Reference 32.2.4.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are vented lockers provided for workers‘ clothing? Reference 32.2.4.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do vehicle operators and mechanics ensure roll down or side sliding doors are completely opened before a vehicle enters or exits the maintenance shop? Reference 32.4.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are tools not in use kept in suitable containers? Reference 32.4.15.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are emergency eyewash station(s) provided for workers who may come in contact with corrosive materials? Reference 32.4.7

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do workers remove all items of jewelry before working on or around shop equipment or vehicles? Reference 32.4.8

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is clear, unrestricted access maintained to on-off power control switches and stations? Reference 32.8.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are all compressed gas cylinders stored upright with valves closed and protective caps in place? Reference 32.12.2.5.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are current OSHA tire charts (such as OSHA 3086), rim manuals, and applicable TOs available to ensure extensive damage to equipment and serious or fatal injuries to personnel are prevented? Reference 32.14.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are vehicles with leaking fuel tanks immediately removed from the maintenance shop? Reference 32.15.6.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are open flame and spark-producing devices kept at least 50 feet from the refueling maintenance shop? Reference 32.15.7.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is maintenance of fuel servicing vehicles prohibited in maintenance shops with other vehicular equipment? Reference 32.15.8.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do vehicle operators and mechanics sound vehicle horns before backing, intermittently during backing (unless vehicle is equipped with backup alarms) and prior to entering or leaving the maintenance shop? Reference 32.4.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Where compressed air is used for cleaning, is the discharge end of the air line restricted to less than 30 psi? Reference 32.4.14.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are workers prohibited from storing fuel-contaminated clothing in lockers or other confined areas? Reference 32.7.1.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are workers prohibited from working under vehicles supported only on hydraulic floor jacks, post jacks or mechanical jacks? Reference 32.13.3.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

RAC

Unit corrective actions:

Database Reference # (For Internal Use Only)

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COMMUNICATIONS CABLE, ANTENNA and COMMUNICATIONS SYSTEMS

Communications Cable, Antenna and Communications Systems Checklist

Communications Cable, Antenna and Communications Systems Checklist

Computer

BLDG, Room Number and Responsible Section

Are flammable wastes disposed of at the end of each shift in clearly marked metal
containers? Reference 30.1.1.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are electrical circuits de-energized, and locked and tagged out before attempting any
work, unless the work requires the circuits to remain energized? Reference 30.3.5.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are metal workbenches and those that are metal framed or metal legged, which are
used for repairing and testing electronic equipment, grounded? Reference 30.3.14.1.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is the soldering work area free of combustible materials and equipped with fire
extinguishers? References 30.3.15

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is proper face protection used by personnel performing soldering tasks? Reference
30.3.15.1.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is the soldering work area properly ventilated? Reference 30.3.15.2.

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Have all workers required to perform duties on communications systems or act as
safety observers received first aid and CPR training? Reference 30.4.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are hard hats issued to personnel who work on and around poles, overhead
structures, tower and antenna construction jobs? Reference 30.5.8.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are all tools and equipment maintained in safe condition? Reference 30.6.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

RAC

Unit corrective actions:

Database Reference # (For Internal Use Only)

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DFAC

Dining Facility

Dining Facility

DFAC

BLDG, Room Number and Responsible Section

Are all food service workers trained in proper lifting, safe use of cutlery and food processing machinery, handling of hot foods, and the dangers of falls? Reference 44.2.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are cleaning supplies kept separate from food products? Reference 44.3.2.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are drain plugs designed so pot and pan sinks can be drained without the employee having to place their hands in hot water? Reference 44.3.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is a by-pass or other type device installed on doors of walk-in freezers or refrigerated spaces to permit escape from inside if an employee is locked in? Reference 44.3.5.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do supervisors ensure outside stairways, entrances, sidewalks, loading docks and ramps are cleared of snow and ice and that abrasive materials are used during inclement weather? Reference 44.4.1.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are floor surfaces kept clean and in good condition, free of water, defects and slippery materials? Reference 44.4.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are defective electrical equipment/cords taken out of service immediately? Reference 44.5.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are all control switches (on and off) accessible to workers at their normal operating positions so workers do not reach over moving machine parts to activate the switch? Reference 44.5.14

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do supervisors maintain manufacturer’s manuals or locally developed guidance for all machinery or equipment under their control? Reference 44.6.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Does the supervisor or a designated trainer train personnel prior to allowing them to operate machinery or equipment? Reference 44.6.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do supervisors ensure all machines are inspected at least every 60 days unless the manufacturer’s manual, use or working environment requires more frequent inspections? Reference 44.7.2.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are all machine guards securely in place and operational? Reference 44.7.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Does the supervisor provide food services personnel fire prevention training initially and annually thereafter? Reference 44.8.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are doors leading to passageways or providing access to rooms blocked only with approval of the installation FES Flight? Reference 44.8.3.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are garbage cans securely covered when not being filled or emptied? Reference 44.10.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are garbage cans washed with hot soapy water and sanitized weekly, or more often if required to control odor or vermin? Reference 44.10.8

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

DISCREPANCY

Discrepancy

Discrepancy

Reference

Recommendation

RAC

Unit corrective actions:

Database Reference # (For Internal Use Only)

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EMERGENCY SHOWER & EYEWASH UNITS

EMERGENCY SHOWER & EYEWASH

Emergency shower & eyewash

Shower

BLDG, Room Number and Responsible Section

Do supervisors ensure emergency showers and eyewashes are provided, inspected, tested and maintained IAW this standard? Reference 19.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are emergency showers installed in conjunction with, or in close proximity to, eye and face or eyewash facilities? Reference 19.5

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are the units connected to a supply of water free from contamination and equal in purity to potable water? Reference 19.6

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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? Reference 19.6.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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? Reference 19.6.3

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

When actuated, does the water flow remain on without use of the operator’s hands? Reference 19.7.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Is the actuating device (pull handle, walk-on treadle, or push handle) readily accessible and easily located? Reference 19.7.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

If audible alarms or blinking lights are installed to show that the unit is in use, are they working properly? Reference 19.8

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are units installed in unoccupied or infrequently used areas tested prior to commencing any operations that could expose personnel to hazardous substances? Reference 19.9.1

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Do supervisors inspect permanently installed units monthly IAW instructions in paragraph 19.12.? Reference 19.9.2

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

Are eyewash bottles and self contained eyewash stations maintained IAW the manufacturer’s instructions? Reference 19.9.4

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC

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

Discrepancy:

Reference:

Recommendation:

Cause of deficiencies or hazard:

Unit corrective actions:

RAC