2022 ALL IN SAFETY COMMITTEE AUDIT

• Location

• Conducted on

  Date

• Prepared by

SAFETY ENGAGEMENT

• (x3) - ENGAGE / MONTHLY SAFETY TRAINING completed and documented each month since last All-In audit?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• (X3) - ENGAGE / Documentation is consistent with observations during audit (No evidence of pencil whipping required compliance documentation)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

Employee(s) Interviewed

• Employee(s) interviewed

Employee

Interviews

• PPE

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• EAP

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• HAZCOM

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• WPS (Worker Protection Standard)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LOTO

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• GRAIN SAFETY

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• NEAR MISS

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• RESPIRATORY PROTECTION

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PRCS

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FALL PROTECTION

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FORKLIFT/SKID STEER SAFETY

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• GAS METERS

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• NH3 SAFETY

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• RAIL SAFETY

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• COMMERCIAL VEHICLE COMPLIANCE

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• ARTICULATING BOOM LIFTS / TELEHANDLERS

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PROPANE BOTTLE FILL OPERATIONS

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• TIRE SHOP SAFETY

  YES

  Y-Notes

  NO

  N/A

  REPEAT

EMERGENCY ACTION PROGRAM

• EAP / Initial and annual training documented for EAP?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• EAP / Visitor log used for all visitor except customers?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• EAP / Updated when changes are made and reviewed for changes at once least annually?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• EAP / Exit routes posted for offices with 10 or more employees?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

NEAR MISS / UNSAFE CONDITION REPORTING PROGRAM

• NEAR MISS / Initial and annual training documented for NEAR MISS REPORTING PROGRAM?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• NEAR MISS / Forms are readily available for employee use?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• NEAR MISS / Proper follow-up on reports?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

LOTO PROGRAM

• LOTO / Initial and annual training documented for LOTO program?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LOTO / Written procedures are complete?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LOTO / Energy control forms are completed properly and maintained for at least 12 months?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LOTO / Annual LOTO review current?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

HAZ-COM SAFETY PROGRAM

• HAZCOM / Initial and annual TRAINING documented for HAZCOM PROGRAM?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• HAZCOM / Employees are TRAINED on the safe handling of the CATEGORIES OF HAZARDOUS MATERIALS they come into contact with?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• HAZCOM / EPA WPS Pesticide Handler Training current for all pesticide handlers (required annually).

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• HAZCOM / Written program includes a LIST of all onsite chemicals (except consumer products)?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• HAZCOM / All employees have completed GHS HAZCOM training on the LMS?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• HAZCOM / CDMS website readily available on computers at agronomy locations? (www.cdms.net/labelsmsds/lmdefault.aspx)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

GRAIN SAFETY PROGRAM

• Check box if this section is applicable.

• GRAIN / initial and annual training documented for GRAIN SAFETY PROGRAM.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• GRAIN / Each employee has completed annual grain safety course on LMS

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• GRAIN / HOUSEKEEPING documentation complete and certified by location manager.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• GRAIN / MAINTENANCE & INSPECTION documentation complete and verified by location manager.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• GRAIN / LUBRICATION completed according to schedule with proper documentation.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• GRAIN / BIN ENTRY PERMITS completed correctly and maintain for at least 12 months?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• GRAIN / HOTWORK permits completed properly and maintained for at least 12 months?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

ANHYDROUS AMMONIA SAFETY PROGRAM

• Check box if this section is applicable.

• NH3 / Initial and annual training documented for AMMONIA SAFETY PROGRAM

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• NH3 / Employees who fill NH3 nurse tanks are current on CVA's 3 year NH3 Handler Certification (LMS + Hand On Observations)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• NH3 / Anhydrous Ammonia Bulk Plants and Nurse Tanks maintenance and repair records

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• NH3 / Monthly Anhydrous Ammonia Bulk Plant Inspections completed and documented

  YES

  Y-Notes

  NO

  N/A

  REPEAT

RESPIRATORY PROGRAM

• Check box if this section is applicable.

• RESPIRATORY / Initial and annual training for all effected employees is documented for Respiratory PROGRAM?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• RESPIRATORY / All respirators are properly maintained and stored?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• RESPIRATORY / All employees are current on annual fit testing?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

FERTILIZER TANK, SHUTTLE, AND CONTAINMENT INSPECTION PROGRAM

• Check box if this section is applicable.

• TANK INSPECTION / Monthly Tank Inventory and Containment Inspection Forms completed properly and maintained for at least 2 years?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• TANK INSPECTION / Nitrogen testing completed and documented before pumping rain water from dikes?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• SHUTTLE COMPLIANCE / Repackaging facilities compliant on shuttle inspection/testing/documentation?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

PERMIT REQUIRED CONFINED SPACE PROGRAM

• Check box if this section is applicable.

• PRCS / Initial and annual training for all effected employees is documented for PRCS PROGRAM?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PRCS / All PRCS forms are completed properly and when required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PRCS / Fire Department tour of all PRCS at facility completed?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PRCS / Annual rescue training complete when required (Including use of rope retrieval kit)?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

PPE / FALL PROTECTION PROGRAM

• Check box if this section is applicable.

• PPE / Initial and annual training for all effected employees is documented for PPE PROGRAM?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PPE / Railcar Fall Protection LMS Course completed for all employees assigned to use trolly system.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PPE / FEED TRUCK Trolley system training and proper use of system?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PPE / Cable Grab Ladder Safety System training and proper use of system?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• PPE / All PPE & FALL PROTECTION equipment properly stored and cared for?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

DOT COMPLIANCE

• Check box if category is applicable.

• DOT / Daily truck inspections completed and filed in office at the end of each day. (Retain 90 days)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DOT / Vehicle Maintenance Records kept with the vehicle

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DOT / Proper Lubrication Being Performed and Documented

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DOT / All required employees are current on DOT HAZMAT Shipper Training? (3 yr certification)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DOT / Required HAZMAT Shipping documents are retained in files for 2 years.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• (X2) - DOT / All commercial trucks and trailers current on annual inspections with inspection report and sticker with the vehicle?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• Supervisor has completed DOT Substance Abuse Training

  YES

  Y-Notes

  NO

  N/A

  REPEAT

FACILITY GENERAL

• FACILITY GEN / ORGANIZED and free of clutter and rubbish?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FACILITY GEN / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FACILITY GEN / ELECTRICAL compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FACILITY GEN / PROPANE STORAGE compliant with NFPA standards?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FACILITY GEN / FUELING AREAS free of leaks and ground contamination?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FACILITY GEN / ROLLING STOCK & PORTABLE EQUIPMENT in safe condition (skid steers, loaders, trailers, yard trucks, conveyors, augers, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FACILITY GEN / No additional corrective action required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

FORKLIFT

• Check box if this section is applicable.

• FORKLIFT / OPERATORS are current on 3 year training and hold valid CVA forklift certification?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FORKLIFT / INSPECTIONS are completed and documented at the beginning of each shift?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FORKLIFT / COMPONENTS AND ATTACHMENTS are maintained in safe condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FORKLIFT / MAN BASKET Inspected prior to each use, properly stored, safe condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FORKLIFT / LOAD CAPACITY DATA PLATE is properly attached, legible in English, and maintained in clean condition.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• FORKLIFT / Telehandler - JLG 3 year training

  YES

  Y-Notes

  NO

  N/A

  REPEAT

SKID STEER / WRANGLER LOADER

• Check box if this section is applicable.

• SKID STEER-LOADER / OPERATORS are current on training and hold valid skid steer certification?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• SKID STEER-LOADER / INSPECTIONS are completed and documented at the beginning of each shift (using inspection tags)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• SKID STEER-LOADER / Skid steer machines and attachments are maintained in safe condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• SKID STEER-LOADER / USER'S MANUAL is available in the machine?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• SKID STEER-LOADER / All operator warning labels are legible and in good condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

ARTICULATING BOOM LIFT (JLG) / BUCKET TRUCKS

• Check box if this section is applicable.

• JLG / OPERATORS are current on 3 YEAR training and hold valid certification.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• JLG / INSPECTIONS are completed and documented at the beginning of each shift.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• JLG / Machines are maintained in safe condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• JLG / Annual Inspection Completed on Machine?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• JLG / USER'S MANUAL is available in the machine?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• JLG / All operator warning labels are legible and in good condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

TELEHANDLERS

• Check box if this section is applicable.

• TELEHANDLERS / OPERATORS are current on 3 YEAR training and hold valid certification.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• TELEHANDLERS / INSPECTIONS are completed and documented at the beginning of each shift.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• TELEHANDLERS / Machines are maintained in safe condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• TELEHANDLERS / Annual Inspection Completed on Machine?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• TELEHANDLERS / USER'S MANUAL is available in the machine?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• TELEHANDLERS / All operator warning labels are legible and in good condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

Office Areas

• Check box if section is applicable.

• OFFICE / FIRE EXTINGUISHERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / STAIRWAYS have proper handrails where required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / EGRESS routes kept clear of obstacles?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / ELECTRICAL SYSTEMS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / Facility SIGNAGE compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / INFOTRAC contact signs/stickers are displayed.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / Employee LABOR LAW POSTERS and OSHA 300 posted?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• OFFICE / No additional corrective actions required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

Grain Handling Areas

• Check box if section is applicable.

• GRAIN / FIRE EXTINGUISHERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Fire Extinguisher

• Y-Notes

  NO

  Repeat

• GRAIN / EGRESS routes kept clear of obstacles?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Egress

• Y-Notes

  NO

  Repeat

• GRAIN / ELECTRICAL SYSTEMS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Electrical

• Y-Notes

  NO

  Repeat

• GRAIN / RAILINGS AND HOLE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Railings and Hole Guarding

• Y-Notes

  NO

  Repeat

• GRAIN / MACHINE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Machine Guarding

• Y-Notes

  NO

  Repeat

• GRAIN / ORGANIZED and free of clutter and rubbish?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Organized

• Y-Notes

  NO

  Repeat

• GRAIN / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Working Walking Areas

• Y-Notes

  NO

  Repeat

• GRAIN / LADDERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Ladders

• Y-Notes

  NO

  Repeat

• GRAIN / PERMIT SPACES properly marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / PRCS Marking

• Y-Notes

  NO

  Repeat

• GRAIN / HOUSEKEEPING performed adequately? (Grain Dust or Spilled Grain)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Housekeeping

• Y-Notes

  NO

  Repeat

• GRAIN / MAINTENANCE (Equipment is in proper working condition)?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Maintenance

• Y-Notes

  NO

  Repeat

• GRAIN / DUST COLLECTION system is compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Dust Systems

• Y-Notes

  NO

  Repeat

• GRAIN / OILER SYSTEM(S) in proper working condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Oiler Systems

• Y-Notes

  NO

  Repeat

• GRAIN / EMERGENCY RESCUE EQUIPMENT on site and stored properly? (Rope retrieval kit, plywood coffer dams, proper harness, and lifelines)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Rescue Equipment

• Y-Notes

  NO

  Repeat

• GRAIN / DUMP PIT GRATES compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Dump Pit Grates

• Y-Notes

  NO

  Repeat

• GRAIN / Grain processing equipment MAGNETS are properly maintained? (Cleaned at least monthly)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Magnets

• Y-Notes

  NO

  Repeat

• GRAIN / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Chemical Containers

• Y-Notes

  NO

  Repeat

• GRAIN / Facility SIGNAGE compliant (Including NO SMOKING WITHIN 50 FEET)?<br><br>

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain Signage

• Y-Notes

  NO

  Repeat

• GRAIN / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / LOTO Markings

• Y-Notes

  NO

  Repeat

• GRAIN / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Extension Cords

• Y-Notes

  NO

  Repeat

• GRAIN / Adequate SECURITY at facility? (Ladders, doors, electrical, overheads, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Security

• Y-Notes

  NO

  Repeat

• GRAIN / FALL PROTECTION SYSTEMS safe condition (including rails, trolleys, and SRLs)?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Fall Protection Systems

• Y-Notes

  NO

  Repeat

• GRAIN / MAN-LIFTS are current on annual inspections and in safe operating condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain / Manlifts

• Y-Notes

  NO

  Repeat

• GRAIN / No additional corrective actions required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Grain Discrepancies

• Y-Notes

  NO

  Repeat

Shop Areas

• Check this box if this section is applicable.

• SHOP / FIRE EXTINGUISHERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Fire Extinguishers

• Y-Notes

  NO

  Repeat

• SHOP / EGRESS routes kept clear of obstacles?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Egress Routes

• Y-Notes

  NO

  Repeat

• SHOP / ELECTRICAL SYSTEMS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Electrical

• Y-Notes

  NO

  Repeat

• SHOP / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Extension Cords

• Y-Notes

  NO

  Repeat

• SHOP / MACHINE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Machine Guarding

• Y-Notes

  NO

  Repeat

• SHOP / ORGANIZED and free of clutter and rubbish?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Organized

• Y-Notes

  NO

  Repeat

• SHOP / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Working and Walking Areas

• Y-Notes

  NO

  Repeat

• SHOP / RAILINGS and HOLE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Railings and Hole Guarding

• Y-Notes

  NO

  Repeat

• SHOP / LADDERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Ladders

• Y-Notes

  NO

  Repeat

• SHOP / OILY RAGS and MATERIALS are placed in covered metal containers?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Oily Material Disposal

• Y-Notes

  NO

  Repeat

• SHOP / TOOLS are kept picked up and put away when not in use?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Tools Put Away

• Y-Notes

  NO

  Repeat

• SHOP / TOOLS and equipment are all OSHA compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Tools Compliant

• Y-Notes

  NO

  Repeat

• SHOP / All JACKS and HOISTS are marked with lifting capacities?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Jacks

• Y-Notes

  NO

  Repeat

• SHOP / Proper PPE is available? (Welding Equipment, Face Shields, Hearing Protection, Eye Protection, Hand Protection, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / PPE

• Y-Notes

  NO

  Repeat

• SHOP / BATTERY CHARGING stations have flushing water near by?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Battery Charging Stations

• Y-Notes

  NO

  Repeat

• SHOP / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / LOTO Markings

• Y-Notes

  NO

  Repeat

• SHOP / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Chemical Containers

• Y-Notes

  NO

  Repeat

• SHOP / FLAMMABLES and AEROSOLS stored to protect them from Hot Work? (sparks, slag, flying debris, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Flammables and Aerosols

• Y-Notes

  NO

  Repeat

• SHOP / ALL FUELS are stored in OSHA compliant containers?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / fuel containers

• Y-Notes

  NO

  Repeat

• SHOP / FLAMMABLES not stored in access or egress routes?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Flammables in Egress

• Y-Notes

  NO

  Repeat

• SHOP / OXYGEN CYLINDERS stored properly? (Greater than 20 feet from combustibles/Flammables)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Oxygen Storage

• Y-Notes

  NO

  Repeat

• SHOP / STORED CYLINDERS are capped and secured from falling over?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Cylinder Storage

• Y-Notes

  NO

  Repeat

• SHOP / PROPANE BOTTLES are not stored inside? (Gas grills stored indoors must have grill bottles removed)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Propane Storage

• Y-Notes

  NO

  Repeat

• SHOP / USED OIL is placed in covered containers that are marked as "USED OIL"?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Used Oil Storage

• Y-Notes

  NO

  Repeat

• SHOP / OVERHEAD STORAGE areas are marked with max load ratings.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Overhead Storage

• Y-Notes

  NO

  Repeat

• SHOP / STORAGE RACKS are secured and in good condition.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Storage Racks

• Y-Notes

  NO

  Repeat

• SHOP / All WEED SPRAYERS are emptied and rinsed before placing or storing inside shops?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Weed Sprayers

• Y-Notes

  NO

  Repeat

• SHOP / Facility SIGNAGE compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Signage

• Y-Notes

  NO

  Repeat

• SHOP / Eye Wash Station has an inspection tag and inspected monthly.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop / Eyewash Stations

• Y-Notes

  NO

  Repeat

• SHOP / No additional corrective actions required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Shop Discrepancies

• Y-Notes

  NO

  Repeat

Warehouse Areas

• Check this box if this section is applicable.

• WAREHOUSE / FIRE EXTINGUISHERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Fire Extinguishers

• Y-Notes

  NO

  Repeat

• WAREHOUSE / EGRESS routes kept clear of obstacles?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Egress Routes

• Y-Notes

  NO

  Repeat

• WAREHOUSE / ELECTRICAL SYSTEMS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Electrical

• Y-Notes

  NO

  Repeat

• WAREHOUSE / MACHINE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Machine Guarding

• Y-Notes

  NO

  Repeat

• WAREHOUSE / ORGANIZED and free of clutter and rubbish?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Organized

• Y-Notes

  NO

  Repeat

• WAREHOUSE / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Working and Walking Areas

• Y-Notes

  NO

  Repeat

• WAREHOUSE / RAILINGS and HOLE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Railings and Hole Guarding

• Y-Notes

  NO

  Repeat

• WAREHOUSE / LADDERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Ladders

• Y-Notes

  NO

  Repeat

• WAREHOUSE / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Extension Cords

• Y-Notes

  NO

  Repeat

• WAREHOUSE / STORAGE RACKS are secured and in good condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Storage Racks

• Y-Notes

  NO

  Repeat

• WAREHOUSE / STORAGE RACKS and STORAGE AREAS are not unsafely loaded or stacked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Storage Rack Safe Loading

• Y-Notes

  NO

  Repeat

• WAREHOUSE / OVERHEAD STORAGE areas are marked with max load ratings?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Overhead Storage

• Y-Notes

  NO

  Repeat

• WAREHOUSE / CHEMICAL CONTAINERS are free of leaks, properly stored, and labeled?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Chemical Containers

• Y-Notes

  NO

  Repeat

• WAREHOUSE / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / LOTO Markings

• Y-Notes

  NO

  Repeat

• WAREHOUSE / Facility SIGNAGE compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Signage

• Y-Notes

  NO

  Repeat

• WAREHOUSE / Adequate SECURITY at facility? (Ladders, doors, chemicals)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Security

• Y-Notes

  NO

  Repeat

• WAREHOUSE / Eye Wash Station has an inspection tag and inspected monthly.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse / Eyewash Stations

• Y-Notes

  NO

  Repeat

• WAREHOUSE / No additional corrective actions required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional Warehouse Discrepancies

• Y-Notes

  NO

  Repeat

Liquid Fertilizer & Chemical Areas

• Check this box if this section is applicable

• LIQ FERT / FIRE EXTINGUISHERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / EGRESS routes kept clear of obstacles?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / ELECTRICAL SYSTEMS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / MACHINE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / ORGANIZED and free of clutter and rubbish?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / RAILINGS and HOLE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / LADDERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / Proper PPE including chemical goggles and appropriate chemical gloves readily available in shuttle filling and truck loading areas?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / STORAGE RACKS are secured and in good condition?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / STORAGE RACKS and storage areas are not unsafely loaded or stacked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / OVERHEAD STORAGE areas are marked with max load ratings?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / Facility SIGNAGE compliant (including "NO SMOKING")?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / Bulk chemical tanks have SDS's readily available?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / INFOTRAC signs posted?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / PERMIT REQUIRED SPACES marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / EYEWASH-SHOWER STATION clear of obstacles and inspected monthly with inspection tag?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / CHEMICAL CONTAINMENT SYSTEM free of defects or damage?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / Adequate SECURITY at facility? (Ladders, doors, chemicals, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• LIQ FERT / No additional corrective actions required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

Dry Fertilizer Storage Areas

• Check box if this section is applicable

• DRY FERT / FIRE EXTINGUISHERS compliant.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / EGRESS routes kept clear of obstacles?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / ELECTRICAL SYSTEMS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / MACHINE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / ORGANIZED and free of clutter, rubbish, and spilled fertilizers?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / RAILINGS and HOLE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / LADDERS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / OVERHEAD STORAGE areas are marked with max load ratings?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / Proper PPE available?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / PERMIT REQUIRED SPACES marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / Facility SIGNAGE compliant (including "NO SMOKING")?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / INFOTRAC signs posted.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / Adequate SECURITY at facility? (Ladders, doors, chemicals, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / Eye Wash Station has an inspection tag and inspected monthly.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / FALL PROTECTION SYSTEMS safe condition (including rails, trolleys, and SRLs)?

  YES

  Y-Notes

  NO

  N/A

  REPEAT

• DRY FERT / No additional corrective actions required.

  YES

  Y-Notes

  NO

  N/A

  REPEAT

ANHYDROUS AMMONIA

• Check this box if this section is applicable.

• NH3 / LOAD-OUT STANDS maintained and in safe condition.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Loadout Stands

• Y-Notes

  NO

  Repeat

• NH3 / Area within 10 feet of TANKS and PIPING kept clear of vegetation and other combustible items.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Combustibles

• Y-Notes

  NO

  Repeat

• NH3 / Adequate EMERGENCY WATER on site?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Emergency Water

• Y-Notes

  NO

  Repeat

• NH3 / Required PPE available? (protective boots, protective slicker, non-vented goggles, NH3 gloves)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / PPE

• Y-Notes

  NO

  Repeat

• NH3 / Free of clutter and rubbish.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Clutter

• Y-Notes

  NO

  Repeat

• NH3 / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Working and Walks no Areas

• Y-Notes

  NO

  Repeat

• NH3 / System free of LEAKS?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Leaks

• Y-Notes

  NO

  Repeat

• NH3 / MACHINE GUARDING compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Machine Guarding

• Y-Notes

  NO

  Repeat

• NH3 / ELECTRICAL SYSTEMS compliant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Electrical

• Y-Notes

  NO

  Repeat

• NH3 / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / LOTO Markings

• Y-Notes

  NO

  Repeat

• NH3 / Proper SECURITY of plant?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Security

• Y-Notes

  NO

  Repeat

• NH3 / Adequate MAINTENANCE of plant and tanks. (Paint, repair, tank markings, pop off valve covers, etc.)

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Maintenance

• Y-Notes

  NO

  Repeat

• NH3 / Adequate numbers of CHOCK BLOCKS are available for loading and unloading.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Chock Blocks

• Y-Notes

  NO

  Repeat

• NH3 / WINDSOCK properly located on or in close proximity to NH3 risers and in good condition.

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Wind Socks

• Y-Notes

  NO

  Repeat

• NH3 / Facility SIGNAGE compliant (Including Emergency Contact Sign and "DANGER Only authorized CVA employees allowed within 25 feet of risers during loading"

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Signage

• Y-Notes

  NO

  Repeat

• NH3 / HOSES in safe condition

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 / Hoses

• Y-Notes

  NO

  Repeat

• NH3 / No additional corrective actions required?

  YES

  Y-Notes

  NO

  N/A

  REPEAT
Additional NH3 Discrepancies

• Y-Notes

  NO

  Repeat

Audit Severity Comments

• AUDIT SEVERITY RANKING

  Severe Risks

  High Risks

  Moderate Risks

  Low Risks

• AUDIT COMMENTS

Sign Off

• Auditor's signature

  Sign

• On site representative

  Sign