132d Wing Safety Program Assessment and Facility Inspection

• Document No.

• Inspection Title (Group/ Squadron)

• Program Inspection

• Facility Inspection

• Squadron Commander (Rank, Full Name)

• Safety Inspection Personnel (Rank, Name)

• Prepared by (Rank, Name, Unit, Office Symbol)

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, 132d Wing Safety has 30 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

  Select Met and Effective Met but Needs Minor Improvement(s) Met but Needs Significant Improvement(s) Was Not Effective

  • Met and Effective
  • Met but Needs Minor Improvement(s)
  • Met but Needs Significant Improvement(s)
  • Was Not Effective

• Commander's Support of Safety

  Select Aggressively Supports Moderately Supports Little Support

  • Aggressively Supports
  • Moderately Supports
  • Little Support

• Unit Supervisor's Support of Safety

  Select Aggressively Supports Moderately Supports Little Support

  • Aggressively Supports
  • Moderately Supports
  • Little Support

• Weapons Safety Program Score

  Select Met and Effective Met but Needs Minor Improvement(s) Met but Needs Significant Improvement(s) Was Not Effective

  • Met and Effective
  • Met but Needs Minor Improvement(s)
  • Met but Needs Significant Improvement(s)
  • Was Not Effective

• Squadron Flight Safety Officer's Score

  Select Met and Effective Met but Needs Minor Improvement(s) Met but Needs Significant Improvement(s) Was Not Effective

  • Met and Effective
  • Met but Needs Minor Improvement(s)
  • Met but Needs Significant Improvement(s)
  • Was Not Effective

• Best Practices

• Inspection Report Sent to Unit

  Date

• Inspection Follow-up Due to Wing Safety

  Date

IN-BRIEF RECAP

• In-Brief Date/ Time

  Date

• In-Brief Attendees (Rank, Name, Unit)

• Total Number Attended

• FY Mishap Trends (Past Year - Current Year)

  Select Positive Trend Negative Trend

  • Positive Trend
  • Negative Trend

• Mishap Trend Comments

• Open Discrepancies

• Open Discrepancy Comments

• Open Hazards (Hazard Abatement)

• Hazard Abatement Comments

• Program Assessment?

  Select Applicable Non-Applicable

  • Applicable
  • Non-Applicable

OCCUPATIONAL SAFETY

• COMMANDER SAFETY POLICY LETTER

POLICY

• Has the Unit Commander published their safety policy and goals?

  Yes

  No

  N/A

• UNIT SAFETY REPRESENTATIVE (USR)

USR

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

  Yes

  No

  N/A

• Has USR been trained within 60 days of appointment?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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.<br>- The activity or work are inspected.<br>- The date and time of the inspection.<br>- The name of the person conducting the spot inspection.<br>- Brief description of the area or hazard.<br>- Applicable RAC, if assigned by Bio, Safety, Fire.<br>- Corrective actions taken or planned.<br>- Follow-up actions every 30 days until closed.

  Yes

  No

  N/A

• 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.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• MOTORCYCLE SAFETY REPRESENTATIVE (MSR)

MSR

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

  Yes

  No

  N/A

• Has the MSR been trained within 30 days of appointment?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are all motorcycle riders tracked in AFSAS/MUSTT?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A
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

  Yes

  No

  N/A

• DISCREPANCY

Discrepancy

• Discrepancy

• Recommendation

• Reference

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Supervisor annual review:

• When was the review last accomplished?

  Date

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

HAZARDOUS ENERGY CONTROL PROGRAM

• OCCUPATIONAL SAFETY: APPLICABLE/NON-APPLICABLE

  Select Applicable Non-Applicable

  • Applicable
  • Non-Applicable

• HAZARDOUS ENERGY CONTROL PROGRAM

LOTO

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has a training plan been developed for initial and recurring training on lockout and tagout procedures? Reference 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? Reference 21.2.1.7

  Yes

  No

  N/A

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

  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? Reference 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? Reference 21.3.8

  Yes

  No

  N/A

• Was a management above supervisor review accomplished?

  Yes

  No

  N/A

• Management above supervisor review:

• Date of management review

  Date

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

FALL PROTECTION PROGRAM

• OCCUPATIONAL SAFETY: APPLICABLE/NON-APPLICABLE

  Select Applicable Non-Applicable

  • Applicable
  • Non-Applicable

• FALL PROTECTION

Fall Protection

• Are workers provided fall protection when exposed to falls of four (4) feet or more? Reference AFI 91-203 para 13.2.2

  Yes

  No

  N/A

• Are all PFAS components marked to indicate compliance with ANSI Z359.14.? Reference AFI 91-203 para 13.4.6.2

  Yes

  No

  N/A

• Can anchorage connectors withstand a 5000 pound load for each PFAS connected? Reference AFI 91-203 para 13.4.6.7

  Yes

  No

  N/A

• Do workers inspect their PFAS prior to each use for mildew, wear, damage and other deterioration? Reference AFI 91-203 para 13.4.6.10.2

  Yes

  No

  N/A

• Does the competent person thoroughly inspect all PFAS components at least quarterly and keep the record of inspection for at least one year? Reference AFI 91-203 para 13.4.6.10.3

  Yes

  No

  N/A

• Are workeers/competent persons trained and evaluated on the fall protection/fall arrest system prior to use? Reference AFI 91-203 para 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 and does it contain a rescue plan developed to assure prompt rescue of fallen workers? Reference AFI 91-203 para 13.6, 13.7

  Yes

  No

  N/A

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

GOVERNMENT-VEHICLE OPERATOR TRAINING

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

  Select Applicable Non-Applicable

  • 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)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is training/certification documented?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

• Is training/certification documented?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Safe loading and unloading requirements.

  Yes

  No

  N/A

• Flight line rules and regulations, when applicable.

  Yes

  No

  N/A

• Operating techniques inside and outside of warehouses.

  Yes

  No

  N/A

• Fire extinguisher training (initial and annual). Refer to AFI 91-203 Chapter 6, Fire Protection and Prevention, for additional guidance.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Clearances, heights and limitations.

  Yes

  No

  N/A

• Safety clothing and equipment. Refer to AFI 91-203 Chapter 14, Personal Protective Equipment (PPE), for additional guidance.

  Yes

  No

  N/A

• Fire protection, fuel spills, maintenance of equipment, smoking, etc. Refer to AFI 91-203 Chapter 6 for additional guidance.

  Yes

  No

  N/A

• Operating restrictions in potentially hazardous storage areas, which include flammable, toxic, lumber, coal, etc. Refer to AFI 91-203 Chapter 22, Flammable and Combustible Liquids, for additional guidance.

  Yes

  No

  N/A

• Load composition and stability.

  Yes

  No

  N/A

• Damage that may be caused by acid or caustic material.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Applicable information contained in AFI 91-203 paragraphs 35.2. and 35.3.2.1. of this standard.

  Yes

  No

  N/A

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

• OFFICE AREAS

  Applicable

  Non-Applicable

• 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?

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Electrical receptacles & cover plates free from cracks and secured in place?<br>

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Is the prohibition of multiple plug adapters enforced to prevent overloading electrical<br>circuits?

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are heavy materials stored in the bottom of file cabinets?

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are stepstools or ladders used to access anything above shoulder level? Reference AFI 91-203 para 10.2.2.4

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are drawers and file cabinets closed when not being used?

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are heating appliances, such as coffee makers, plugged directly into a facility outlet and unplugged at the end of the work shift? Reference AFI 91-203 para 10.5.7.3

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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 )

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Unit corrective actions:

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

• Industrial Areas (Housekeeping, General Checklists)

  Applicable

  Non-Applicable
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.<br>Are aisles and passageways kept clear of stacked materials? Reference 5.7

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are fire extinguishers visually inspected by the workcenter supervisor at a minimum of 30-day intervals to detect and correct discrepancies? Reference AFI 91-203 para 6.2.4.7.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are exterior garbage cans securely covered when not actually being filled or emptied? Reference AFI 91-203 5.9.1<br>Are trash and garbage cans leak-proof and adequate in number and size? Reference AFI 91-203 5.9.2

  Yes

  No

  N/A

• Discrepancy:

• Recommendation:

• Cause of deficiencies or hazard:

• Reference:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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. Reference AFI 91-203 Para. 5.6

  Yes

  No

  N/A

• Discrepancy:

• Recommendation:

• Cause of deficiencies or hazard:

• Reference:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are protruding nails, brads and staples removed from packing materials to prevent injury to personnel? Reference AFI 91-203 para 5.4.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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 AFI 91-203 para 5.7.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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 5.8.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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 AFI 91-203 para 5.10.11

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Is apparel not needed to perform official duties stored in lockers and not stored on top of or under clothing lockers? Reference AFI 91-203 para 5.10.8.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are packing materials such as excelsior (fine wood shavings), packing straw and shredded paper stored in an isolated fire-resistant building? Reference AFI 91-203 para 5.4.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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 )

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Recommendation:

• Cause of deficiencies or hazard:

• Reference:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are hazardous materials in piping systems clearly identified? Reference 20.3.5.2

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Unit corrective actions:

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

• 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<br>Do supervisors ensure PPE is provided, used and maintained in a sanitary, serviceable condition? Reference 14.3.2<br>Is previously used PPE disinfected before reissue to another worker? Reference 14.4.2.15.<br>Do workers maintain and disinfect eye and/or face protection equipment IAW the following instructions: Reference 14.4.2.16<br>- 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.<br>- Ultraviolet disinfecting equipment or spray type disinfecting solutions may be used in conjunction with the washing procedure.

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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<br>Do protective helmets have the manufacturer’s name, ANSI designation and the class identified inside the shell? Reference 14.4.3.1.3

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Unit corrective actions:

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

• Aircraft Maintenance Facilities

  Applicable

  Non-Applicable

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are suitable fire extinguishers placed throughout maintenance areas? Reference 24.3.3.6

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Unit corrective actions:

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

• MATERIALS HANDLING/WAREHOUSE

  Applicable

  Non-Applicable

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Have qualified personnel been identified as training instructors? Reference 35.3.3.1<br>(Forklifts)

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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)

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Recommendation

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

• HYDROCARBON FUELS

  Applicable

  Non-Applicable
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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Unit corrective actions:

• Database Reference # (For Internal Use Only)

• Add media

  Media

• Open/Closed

  Select Open Closed

  • Open
  • Closed

• Date Closed

  Date

• VEHICLE MAINTENANCE

  Applicable

  Non-Applicable

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Are vented lockers provided for workers‘ clothing? Reference 32.2.4.4

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• 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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

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

  Yes

  No

  N/A

• Discrepancy:

• Reference:

• Recommendation:

• Cause of deficiencies or hazard:

• Unit corrective actions:

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• DISCREPANCY

Discrepancy

• Discrepancy

• Reference

• Recommendation

• RAC

  Select 1(I,A) - Critical 1(II,A) - Critical 1(I,B) - Critical 2(III,A) - Serious 2(II,B) - Serious 2(I,C) - Serious 3(III,B) - Moderate 3(II,C) - Moderate 4(IV,A) - Minor 4(IV,B) - Minor 4(III,C) - Minor 4(I,D) - Minor 4(II,D) - Minor 5(IV,C) - Negligible 5(III,D) - Negligible 5(IV,D) - Negligible

  • 1(I,A) - Critical
  • 1(II,A) - Critical
  • 1(I,B) - Critical
  • 2(III,A) - Serious
  • 2(II,B) - Serious
  • 2(I,C) - Serious
  • 3(III,B) - Moderate
  • 3(II,C) - Moderate
  • 4(IV,A) - Minor
  • 4(IV,B) - Minor
  • 4(III,C) - Minor
  • 4(I,D) - Minor
  • 4(II,D) - Minor
  • 5(IV,C) - Negligible
  • 5(III,D) - Negligible
  • 5(IV,D) - Negligible

• Unit corrective actions:

• Database Reference # (For Internal Use Only)

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  Date