Information
-
CVA Location
-
Conducted on
-
Prepared by
1.0 - Audit Comments
-
AUDIT PRIORITY LEVEL (provide comments to justify ranking)
-
Comments
-
List of items needed from Safety Team
2.0 - Employee Interviews
-
2.1 - EAP / Interviews
-
2.2 - HAZCOM / Interviews
-
2.3 - NH3 / Interviews
-
2.4 - LOTO / Interviews
-
2.5 - PRCS / Interviews
-
2.6 - GAS METERS / Demonstrate
-
2.7 - GRAIN / Interview
-
2.8 - FALL PROTECTION / Interviews
-
2.9 - DOT / Interviews
-
2.10 - NEAR MISS / Interviews
3.0 - Emergency Action Plan
-
3.1 - EAP / Initial and annual TRAINING documented for EAP?
-
3.2 - EAP / REVIEWED and UPDATED annually?
-
3.3 - EAP / VISITORS LOGS used? (except customers)
-
3.4 - EAP / No additional corrective actions required?
4.0 - Lockout Tagout Safety Program
-
4.1 - LOTO / Initial and annual TRAINING documented for LOTO PROGRAM?
-
4.2 - LOTO / Machine specific WRITTEN PROCEDURES are complete?
-
4.3 - LOTO / Annual LOTO REVIEWS current within 12 months?
-
4.4 - LOTO / All LOCKS/TAGS identify authorized employees?
-
4.5 - LOTO / Required LOTO EQUIPMENT is available?
-
4.6 - LOTO / No additional corrective actions required?
5.0 - Grain Handling Facility Safety Program
-
5.1 - GRAIN / Initial and annual TRAINING documented for GRAIN HANDLING FACILITY SAFETY PROGRAM?
-
5.2 - GRAIN / HOUSEKEEPING LOGS properly documented and certified by supervisor.?
-
5.3 - GRAIN / MAINTENANCE LOG properly documented and certified by supervisor?
-
5.4 - GRAIN / BIN ENTRY PERMITS are completed properly and maintained for at least 12 months?
-
5.5 - GRAIN / Boot pit and confined space ENTRY PERMITS completed properly and maintained for at least 12 months?
-
5.6 - GRAIN / No additional corrective actions required?
6.0 - HAZ-COM Safety Program
-
6.1 - HAZCOM / Initial and annual TRAINING documented for HAZCOM PROGRAM?
-
6.2 - HAZCOM / Employees are TRAINED on the safe handling of the CATEGORIES OF HAZARDOUS MATERIALS they come into contact with?
-
6.3 - HAZCOM / Written program includes a LIST of all onsite chemicals (except consumer products)?
-
6.4 - HAZCOM / All required employees have completed GHS HAZCOM training on LMS?
-
6.5 - HAZCOM / Agronomy facilities have CDMS website readily available on computer for accessing ag chemical SDS's?
-
6.6 - HAZCOM / No additional corrective actions required?
7.0 - Near Miss & Unsafe Condition Reporting Safety Program
-
7.1 - NEAR MISS / Initial and annual training documented for NEAR MISS REPORTING PROGRAM?
-
7.2 - NEAR MISS / Report forms are readily available for employee use.
-
7.3 - NEAR MISS / Proper implementation of program?
8.0 - Office Areas
-
8.1 - OFFICE / FIRE EXTINGUISHERS compliant?
-
8.2 - OFFICE / EGRESS routes kept clear of obstacles?
-
8.3 - OFFICE / ELECTRICAL SYSTEMS compliant?
-
8.4 - OFFICE / Free of SLIP or TRIP hazards?
-
8.5 - OFFICE / Facility SIGNAGE compliant?
-
8.6 - OFFICE / INFOTRAC contact signs/stickers are displayed.
-
8.7 - OFFICE / Employee LABOR LAW POSTERS and OSHA 300 posted?
-
8.8 - OFFICE / CHEMICALS properly marked and stored?
-
8.9 - OFFICE / No additional corrective actions required?
9.0 - Grain Handling Areas
-
9.1 - GRAIN / FIRE EXTINGUISHERS compliant?
-
9.2 - GRAIN / EGRESS routes kept clear of obstacles?
-
9.3 - GRAIN / ELECTRICAL SYSTEMS compliant?
-
9.4 - GRAIN / MACHINE GUARDING compliant?
-
9.5 - GRAIN / ORGANIZED and free of clutter, rubbish, and spilled grain?
-
9.6 - GRAIN / Free of SLIP or TRIP hazards?
-
9.7 - GRAIN / RAILINGS AND HOLE GUARDING compliant?
-
9.8 - GRAIN / LADDERS compliant?
-
9.9 - GRAIN / PERMIT SPACES properly marked?
-
9.10 - GRAIN / HOUSEKEEPING performed adequately?
-
9.11 - GRAIN / MAINTENANCE performed adequately?
-
9.12 - GRAIN / DUST COLLECTION system is compliant?
-
9.13 - GRAIN / EMERGENCY RESCUE EQUIPMENT on site and stored properly? (Rope retrieval kit, plywood coffer dams, proper harness, and lifelines)
-
9.14 - GRAIN / DUMP PIT GRATES compliant?
-
9.15 - GRAIN / Grain processing equipment MAGNETS are properly maintained?
-
9.16 - GRAIN / All CHEMICALS are properly stored and labeled?
-
9.17 - GRAIN / NO SMOKING WITHIN 50 FEET properly marked?
-
9.18 - GRAIN / LOTO ENERGY ISOLATION POINTS properly marked?
-
9.19 - GRAIN / EXTENSION CORDS are OSHA compliant including GFCI where required?
-
9.20 - GRAIN / Adequate SECURITY at facility? (Ladders, doors, electrical, overheads, etc.)
-
9.21 - GRAIN / LOADERS, skid steers etc. compliant and in safe operating condition?
-
9.22 - GRAIN / No additional corrective actions required?
10.0 - Shop Areas
-
10.1 - SHOP / FIRE EXTINGUISHERS compliant?
-
10.2 - SHOP / EGRESS routes kept clear of obstacles?
-
10.3 - SHOP / ELECTRICAL SYSTEMS compliant?
-
10.4 - SHOP / MACHINE GUARDING compliant?
-
10.5 - SHOP / ORGANIZED and free of clutter and rubbish?
-
10.6 - SHOP / Free of SLIP or TRIP hazards?
-
10.7 - SHOP / RAILINGS and HOLE GUARDING compliant?
-
10.8 - SHOP / LADDERS compliant?
-
10.9 - SHOP / OILY RAGS and MATERIALS are placed in covered metal containers?
-
10.10 - SHOP / TOOLS are kept picked up and put away when not in use?
-
10.11 - SHOP / TOOLS and equipment are all OSHA compliant?
-
10.12 - SHOP / EXTENSION CORDS are OSHA compliant including GFCI where required?
-
10.13 - SHOP / All JACKS and HOISTS are marked with lifting capacities?
-
10.14 - SHOP / Proper PPE is available?
-
10.15 - SHOP / BATTERY CHARGING stations have flushing water near by?
-
10.16 - SHOP / LOTO ENERGY ISOLATION POINTS properly marked?
-
10.17 - SHOP / CHEMICALS properly stored and labeled?
-
10.18 - SHOP / FLAMMABLES and AEROSOLS stored away from spark and heat producing equipment?
-
10.19 - SHOP / ALL FUELS are stored in OSHA compliant containers?
-
10.20 - SHOP / FLAMMABLES not stored in access or egress routes?
-
10.21 -SHOP / OXYGEN CYLINDERS stored properly? (Greater than 20 feet from combustibles/Flammables)
-
10.22 - SHOP / All STORED CYLINDERS are capped and secured from falling over?
-
10.23 - SHOP / PROPANE BOTTLES are not stored inside? (Gas grills stored indoors must have grill bottles removed)
-
10.24 - SHOP / USED OIL is placed in covered containers that are marked as "USED OIL"?
-
10.25 - SHOP / OVERHEAD STORAGE areas are marked with max load ratings.
-
10.26 - SHOP / STORAGE RACKS are secured and in good condition.
-
10.27 - SHOP / All WEED SPRAYERS are emptied and rinsed before placing or storing inside shops?
-
10.28 - SHOP / Proper facility MARKINGS and SIGNS?
-
10.29 - SHOP / No additional corrective actions required?
11.0 - Warehouse Areas
-
11.1 - WAREHOUSE / FIRE EXTINGUISHERS compliant?
-
11.2 - WAREHOUSE / EGRESS routes kept clear of obstacles?
-
11.3 - WAREHOUSE / ELECTRICAL SYSTEMS compliant?
-
11.4 - WAREHOUSE / MACHINE GUARDING compliant?
-
11.5 - WAREHOUSE / ORGANIZED and free of clutter and rubbish?
-
11.6 - WAREHOUSE / Free of SLIP or TRIP hazards?
-
11.7 - WAREHOUSE / RAILINGS and HOLE GUARDING compliant?
-
11.8 - WAREHOUSE / LADDERS compliant?
-
11.9 - WAREHOUSE / EXTENSION CORDS are OSHA compliant including GFCI where required?
-
11.10 - WAREHOUSE / STORAGE RACKS are secured and in good condition?
-
11.11 - WAREHOUSE / STORAGE RACKS and STORAGE AREAS are not unsafely loaded or stacked?
-
11.12 - WAREHOUSE / OVERHEAD STORAGE areas are marked with max load ratings?
-
11.13 - WAREHOUSE / CHEMICAL CONTAINERS are free of leaks and stored in approved areas?
-
11.14 - WAREHOUSE / Compliant with HAZCOM and DOT package marking requirements?
-
11.15 - WAREHOUSE / LOTO ENERGY ISOLATION POINTS properly marked?
-
11.16 - WAREHOUSE / Proper facility MARKINGS and SIGNS?
-
11.17 - WAREHOUSE / Adequate SECURITY at facility? (Ladders, doors, chemicals)
-
11.18 - WAREHOUSE / FORKLIFTS used and maintained in compliance with OSHA standards.
-
11.19 - WAREHOUSE / No additional corrective actions required?
12.0 - Liquid Fertilizer & Chemical Areas
-
12.1 - LIQ FERT / FIRE EXTINGUISHERS compliant?
-
12.2 - LIQ FERT / EGRESS routes kept clear of obstacles?
-
12.3 - LIQ FERT / ELECTRICAL SYSTEMS compliant?
-
12.4 - LIQ FERT / MACHINE GUARDING compliant?
-
12.5 - LIQ FERT / ORGANIZED and free of clutter and rubbish?
-
12.6 - LIQ FERT / Free of TRIP or SLIP hazards?
-
12.7 - LIQ FERT / RAILINGS and HOLE GUARDING compliant?
-
12.8 - LIQ FERT / LADDERS compliant?
-
12.9 - LIQ FERT / EXTENSION CORDS are OSHA compliant including GFCI where required?
-
12.10 - LIQ FERT / STORAGE RACKS are secured and in good condition?
-
12.11 - LIQ FERT / STORAGE RACKS and storage areas are not unsafely loaded or stacked?
-
12.12 - LIQ FERT / OVERHEAD STORAGE areas are marked with max load ratings?
-
12.13 - LIQ FERT / CHEMICAL containers are free of leaks and stored in approved areas?
-
12.14 - LIQ FERT / LOTO ENERGY ISOLATION POINTS properly marked?
-
12.15 - LIQ FERT / Proper MARKINGS and SIGNS (including "NO SMOKING")?
-
12.16 - LIQ FERT / Bulk chemical tanks have SDS's readily available?
-
12.17 - LIQ FERT / INFOTRAC signs posted?
-
12.18 - LIQ FERT / PERMIT SPACES marked?
-
12.19 - LIQ FERT / Proper PPE available?
-
12.20 - LIQ FERT / EYEWASH-SHOWER STATION clear of obstacles and operational?
-
12.21 - LIQ FERT / Adequate SECURITY at facility? (Ladders, doors, chemicals, etc.)
-
12.22 - LIQ FERT / FORKLIFTS used and maintained in compliance with OSHA standards.
-
12.23 - LIQ FERT / No additional corrective actions required?
13.0 - Dry Fertilizer Storage Areas
-
13.1 - DRY FERT / FIRE EXTINGUISHERS compliant.
-
13.2 - DRY FERT / EGRESS routes kept clear of obstacles?
-
13.3 - DRY FERT / ELECTRICAL SYSTEMS compliant?
-
13.4 - DRY FERT / MACHINE GUARDING compliant?
-
13.5 - DRY FERT / ORGANIZED and free of clutter, rubbish, and spilled fertilizers?
-
13.6 - DRY FERT / Free of TRIP and SLIP hazards?
-
13.7 - DRY FERT / RAILINGS and HOLE GUARDING compliant?
-
13.8 - DRY FERT / LADDERS compliant?
-
13.9 - DRY FERT / EXTENSION CORDS are OSHA compliant including GFCI where required?
-
13.10 - DRY FERT / OVERHEAD STORAGE areas are marked with max load ratings?
-
13.11 - DRY FERT / CHEMICAL containers are free of leaks and stored in approved areas.
-
13.12 - DRY FERT / Proper PPE available?
-
13.13 - DRY FERT / LOTO ENERGY ISOLATION POINTS properly marked?
-
13.14 - DRY FERT / PERMIT REQUIRED SPACE marked?
-
13.15 - DRY FERT / Proper MARKINGS and SIGNS (including "NO SMOKING")?
-
13.16 - DRY FERT / INFOTRAC signs posted.
-
13.17 - DRY FERT / Adequate SECURITY at facility? (Ladders, doors, chemicals, etc.)
-
13.18 - DRY FERT / No additional corrective actions required.
14.0 - Anhydrous Ammonia Facilities
-
14.1 - NH3 / Initial and annual TRAINING documented.
-
14.2 - NH3 / Load out facility compliant with NFPA standards?
-
14.3 - NH3 / EMERGENCY WATER on site?
-
14.4 - NH3 / Proper PPE available?
-
14.5 - NH3 / INSPECTION and MAINTENANCE documented for bulk plants and nurse tanks?
-
14.6 - NH3 / System free of LEAKS?
-
14.7 - NH3 / MACHINE GUARDING compliant?
-
14.8 - NH3 / ELECTRICAL SYSTEMS compliant?
-
14.9 - NH3 / LOTO ENERGY ISOLATION POINTS properly marked?
-
14.10 - NH3 / Proper SECURITY of plant?
-
14.11 - NH3 / Adequate MAINTENANCE of plant and tanks. (Paint, repair, etc.)
-
14.12 - NH3 / Adequate MARKINGS and SIGNS.
-
14.13 - NH3 / No additional corrective actions required?
15.0 - Facility General
-
15.1 - FACILITY GEN / FIRST AID adequate? (kit may be shared among multiple worksites within a facility if located in close proximity)
-
15.2 - FACILITY GEN / PERSONAL FALL PROTECTION EQUIPMENT properly stored and in safe condition?
-
15.3 - FACILITY GEN / RESPIRATORY PROTECTION EQUIPMENT properly stored and in safe condition?<br>
-
15.4 - FACILITY GEN / Proper SIGNAGE? (free of excessive fading and damage)
-
15.5 - FACILITY GEN / ORGANIZED and free of clutter and rubbish?
-
15.6 - FACILITY GEN / Free of SLIP and TRIP hazards?
-
15.7 - FACILITY GEN / WORKING and WALKING AREAS safe? (Impalement hazards, sharp edges, etc.)
-
15.8 - FACILITY GEN / RAILING and HOLE GUARDING compliant?
-
15.9 - FACILITY GEN / Adequate LIGHTING at facility?
-
15.10 - FACILITY GEN / RAILROAD SIDINGS in safe condition?
-
15.11 - FACILITY GEN / FALL PROTECTION SYSTEMS in safe condition? (Rail trolleys, cable systems, etc.)
-
15.12 - FACILITY GEN / BULK PROPANE STORAGE compliant with NFPA standards?
-
15.13 - FACILITY GEN / Other ELECTRICAL
-
15.14 - FACILITY GEN / Other GUARDING
-
15.15 - FACILITY GEN / Other LADDERS
-
15.13 - FACILITY GEN / No additional corrective action required?
16.0 - ROLLING STOCK & EQUIPMENT
-
16.1 - ROLLING STOCK & EQMT / Tractors, skid steers, loaders, and accessories compliant?
-
16.2 - ROLLING STOCK & EQMT / Portable augers and conveyors compliant?
-
16.3 - ROLLING STOCK & EQMT / Yard trucks and trailers in safe condition?
-
16.4 - ROLLING STOCK & EQMT / Commercial trucks and trailers maintained and inspected in compliance with DOT standards?
-
16.5 - ROLLING STOCK & EQMT / No additional corrective actions required?
17.0 - ALL IN SAFETY
-
17.1 - ALL-IN / Safety training documented each month since last inspection?
-
17.2 - ALL-IN / Representative attends company safety committee meetings?
-
17.3 - ALL-IN / No workplace injuries since last inspection?
-
17.4 - ALL-IN / No vehicle or machine crashes since last inspection?
-
17.5 - ALL-IN / No FMCSA violations since last inspection?
-
17.6 - ALL-IN / No observation reports of employees engaged in unsafe actions or in violations of any safety rules since previous inspection.
Sign Off
-
Auditor's signature
-
On site representative
