AAA Cooper Transportation Annual Service Center Compliance and Safety Inspection

Service Center Information

• Service Center
  Address

• Service Center Manager Name

Inspection Information

• Inspection Date

  Date

• Date of Previous Inspection

  Date

• Name of Person conducting inspection

  Sign

Instructions for form completion:

• Any entry marked as "no" which requires corrective action, must be identified in the comments following each section. All "no" entries made regarding previously identified areas needing attention must be marked with an asterisk (*) , and will require immediate action.
  
  N/A = Not Applicable
  

Managers acknowledgement of Corrective actions needed:

• I have read and discussed the items marked as needing corrective action. I understand that these require immediate attention. It is my responsibility to see that proper corrections are made so that we maintain compliance with all applicable regulations, both those of federal, state, and local agencies, as well as those set internally.

  Sign

• Date

  Date

Fire Prevention and Emergency Action (General)

• Are all exits marked with an exit sign of the proper size and illuminated by a reliable light source (electric or fluorescent are acceptable)

  Yes

  No

  N/A

• Is service center equipped with emergency lighting, is it operable?

  Yes

  No

  N/A

• Are doors and stairs that are neither exits nor lead to exits appropriately marked? Ex. "Not an exit", "Basement", "Storeroom", etc?

  Yes

  No

  N/A

• Are all exits kept free of obstructions, not locked?

  Yes

  No

  N/A

• Are sufficient exits available?

  Yes

  No

  N/A

• Are fire extinguishers inspected monthly by an ACT employee and annually by an authorized company?

  Yes

  No

  N/A

• Does the inspection tag provide the name, phone number and certification number of the vendor?

  Yes

  No

  N/A

• Are workplace diagrams or maps posted showing escape routes, gathering area and written instructions?

  Yes

  No

  N/A

• Are emergency telephone numbers posted in conspicuous location? (Police, Fire, Medical, and Service Center Management after hours contact numbers)

  Yes

  No

  N/A

• Is an audible alarm system available? (Require if 11 or more individuals occupy the facility at one time)

  Yes

  No

  N/A

• Is the smoke free workplace policy enforced by management and rules observed by all employees?

  Yes

  No

  N/A

Health and sanitation (general)

• Are eating facilities adequate and clean?

  Yes

  No

  N/A

• Are appliances such as microwave and refrigerator kept clean?

  Yes

  No

  N/A

• Are ample trash containers available and emptied frequently?

  Yes

  No

  N/A

• Are restrooms clean?

  Yes

  No

  N/A

• Is adequate privacy afforded the users? Locks on doors, partitions, locks on individual stalls?

  Yes

  No

  N/A

• Are restrooms equipped with lined trash containers and properly stocked? Toilet paper, hand towels, soap?

  Yes

  No

  N/A

• Are first aid supplies adequately stocked not expired , readily available and accessible.

  Yes

  No

  N/A

• Can emergency response respond within 5 minutes?

  Yes

  No

  N/A

• In general, is noise level ok?

  Yes

  No

  N/A

Electrical / Utilites room or area

• Is the area clean and free from dirt, and combustibles or other cleaning supplies, etc. that could pose a fire threat?

  Yes

  No

  N/A

• Is the area well lighted?

  Yes

  No

  N/A

• Are permanent wiring panels and breakers securely mounted and free of defects?

  Yes

  No

  N/A

• Are outlet covers,switches and receptacles securely mounted and free of defects?

  Yes

  No

  N/A

• Are extension cords in use where permanent wiring is required?

  YES

  NO

• Are breaker or fuse boxes equipped with a cover?

  Yes

  No

  N/A

• Are all breakers or fuses labeled for use or location?

  Yes

  No

  N/A

• Are all vacant spaces in breaker or fuse boxes filled with blanks?

  Yes

  No

  N/A

• Does area in front of breaker panel have a 36 inch clearance?

  Yes

  No

  N/A

• No apparent overloading of outlets?

  Yes

  No

  N/A

• Is heating, cooling or water heating equipment clean and properly operating?

  Yes

  No

  N/A

Office

• Is ample work space available?

  Yes

  No

  N/A

• Are all lead persons and supervisors wearing OSHA approved safety shoes and dressed in<br>a fashion that is worthy of business activity.

  Yes

  No

  N/A

• Are all movements such as walking, climbing, use of stairs done in a safe manner?

  Yes

  No

  N/A

• Are office machines, vending machines and water machines grounded and in good repair?

  Yes

  No

  N/A

• Are work stations designed with employee safety and health in mind?

  Yes

  No

  N/A

• Is office equipment clean, used properly,and in good repair?

  Yes

  No

  N/A

• Are unattended desk and file drawers kept closed?

  Yes

  No

  N/A

• Is only one file drawers opened at a time?

  Yes

  No

  N/A

• Are floors and aisle free from trash and debris?

  Yes

  No

  N/A

• Are floors and carpets and ceiling tiles dry and in good condition?no tripping or falling hazard, no water stains on ceiling tiles?

  Yes

  No

  N/A

• Are stairways in good condition and stair railing secure?

  Yes

  No

  N/A

• Are there sufficient trash containers? Are they emptied frequently?

  Yes

  No

  N/A

• Are extension cords and wires free of kinks, splices, cuts and wear?

  Yes

  No

  N/A

• Are work areas kept clean and neat? free of wires or other tripping hazards?

  Yes

  No

  N/A

• Are elevated storage areas or balconies posted as to maximum floor load capacity?

  Yes

  No

  N/A

• Are elevated areas or balconies equipped with guardrails, railings, or other suitable type of fall protection?

  Yes

  No

  N/A

Hazardous Materials Office Procedures

• Are inbound delivery receipts properly tabbed with a red hazmat sticker per ACT requirements?

  Yes

  No

  N/A

• Are outbound hazmat bill of ladings properly tabbed with a red hazmat sticker and attached to the company travel copy per ACT requirements?

  Yes

  No

  N/A

• Is the HAZMAT ENFORCER program used for every hazardous material load? (Both inbound and outbound shifts)

  Yes

  No

  N/A

• Do the employees know where the ACT written Hazard Communication Standard Program is located?<br>

  Yes

  No

  N/A

• Do supervisors understand not to respond to hazardous material emergencies without the guidance of risk management personnel or Premium environmental services?<br>

  Yes

  No

  N/A

• Do employees know how to find an SDS sheets when on the company internal website - MyCooper?<br>

  Yes

  No

  N/A

• Is a current emergency response guidebook on hand in the office?<br>

  Yes

  No

  N/A

• Is there an ample supply of Hazardous materials labels(small diamond stickers) and placards and a number kit?<br>

  Yes

  No

  N/A

• Do all service center personnel understand what hazmat commodities ACT does not transport?<br>

  Yes

  No

  N/A

• Are all personnel that are involved with the transportation of hazardous materials trained in accordance with OSHA standards, dot regulations and company policy?<br>

  Yes

  No

  N/A

Dock

• Is ample workspace available?

  Yes

  No

  N/A

• Are employees wearing proper footwear (ANSI approved safety shoes)

  Yes

  No

  N/A

• Are all movements such as walking, climbing, and use of stairs and ladders done in a safe manner?

  Yes

  No

  N/A

• Are safe work practices being observed?

  Yes

  No

  N/A

• Is freight handled in such a manner to prevent injury?

  Yes

  No

  N/A

• Is freight stacked properly in vehicles?

  Yes

  No

  N/A

• Are trailer interiors clean, free of hazards, damage, holes in floor, etc?

  Yes

  No

  N/A

• Is freight stacked properly on dock? Not likely to fall over and no overflow into aisles, not stacked more than 5 feet high at corners?

  Yes

  No

  N/A

• Is material handling equipment being used properly?

  Yes

  No

  N/A

• Is material handling equipment properly stored, in good repair and free of dirt and grease?

  Yes

  No

  N/A

• Are stairs, ladders, and ramps in good repair, secure, equipped with hand holds or railings and free of trash and obstructions?

  Yes

  No

  N/A

• Ae there sufficient trash containers and are they emptied frequently?

  Yes

  No

  N/A

• Is dock and dock apron free of trash and debris?

  Yes

  No

  N/A

• Is a dock plate available at each door? Is there an adequate supply of dock plate pullers?

  Yes

  No

  N/A

• Are floors clean, with no defects and free of spilled material?

  Yes

  No

  N/A

• Are dunnage and pallets stored neatly? No fire hazards?

  Yes

  No

  N/A

• Are overhead doors operable and secure?

  Yes

  No

  N/A

• Are all permanent isles clearly defined, marked, and free of freight and trash?

  Yes

  No

  N/A

• Are loading lights available at each door?

  Yes

  No

  N/A

• Are loading lights and wiring operable and free of defects?

  Yes

  No

  N/A

• Are conduit and outlet boxes that supply power to dock free of defects? (No exposed wires - no loose connections)

  Yes

  No

  N/A

• Are "Chock on the Dock" and "Driver Pull Away" procedures being followed? <br>Are chocks in use on all vehicles at the dock? (Front Wheel Chocked)

  Yes

  No

  N/A

• Is overhead lighting adequate? Are all lights burning?

  Yes

  No

  N/A

• Are all anti- tilt stands, pins and pin keepers in use on 32 FT lift gates and other vehicles as needed?

  Yes

  No

  N/A

Forklifts

• Are forklifts in overall good condition?

  Yes

  No

  N/A

• Are forklifts inspected on a daily basis before each shift or at the beginning or end or each shift for 24 hour terminal?<br>

  Yes

  No

  N/A

• Are forklift inspections maintained on file for 30 days and then destroyed?

  Yes

  No

  N/A

• Are the certifications of repair being signed off?

  Yes

  No

  N/A

• Is each forklift equipped with:

• An operating back up alarm?

  Yes

  No

  N/A

• An overhead guard (bolted down)?

  Yes

  No

  N/A

• Are seat belts operable and being used? (no torn belt webbing)

  Yes

  No

  N/A

• If equipped with a fire extinguisher, is it fully charged and properly mounted?

  Yes

  No

  N/A

• Are brakes, horn, mast, blades, tires and lights free of defects and in good operating condition?

  Yes

  No

  N/A

• Are all forklifts equipped with a specification plate indicating the weight capacity?

  Yes

  No

  N/A

• Are forklifts free of water, oil or other fluid leaks?

  Yes

  No

  N/A

• Are forklifts operated in a safe manner? ( No wheel spinning - operated at a reasonable speed - horns being used)

  Yes

  No

  N/A

• Are forklifts operated by only trained, tested and certified personnel?

  Yes

  No

  N/A

• Do forklift drivers use handholds and footholds properly when getting on and off forklifts?

  Yes

  No

  N/A

• Are forklifts TURNED OFF with brakes set, blades lowered flat to the floor, and controls in neutral when operator is away from the controls or lift is parked?

  Yes

  No

  N/A

• Is forklift refueling area in good order and free of slip trip hazards?

  Yes

  No

  N/A

• Are propane tanks stored in one designated area? Is the area protected from damage?

  Yes

  No

  N/A

• Is the storage area marked "no smoking" and does it bear the NFPA or other suitable sign identifying the hazard "Flammable Gas"?

  Yes

  No

  N/A

• Are personal protective equipment (PPE) requirements being followed when refueling forklifts?

  Yes

  No

  N/A

• Is the personal protective equipment (PPE) clean and serviceable?<br>

  Yes

  No

  N/A

• Are safe work practices observed when refueling forklifts?<br>

  Safe

  At Risk

  N/A

Terminal Yard

• Are only authorized drivers and vehicles on the yard?

  Yes

  No

  N/A

• Is a speed limit sign posted? (Maximum 10 mph)

  Yes

  No

  N/A

• Is there a fasten seat belt sign posted at the exit gate?

  Yes

  No

  N/A

• Is there a no trespassing-right to search sign and a Smoke Free Workplace sign posted?

  Yes

  No

  N/A

• Are drivers wearing seat belts?

  Yes

  No

  N/A

• Do drivers and hostlers obey speed limits and traffic pattern?

  Yes

  No

  N/A

• Are hostlers following company procedures? (Wearing Safety Vest, Lights On,Seatbelt On, Both Airlines and Power Line Attached)<br>

  Yes

  No

  N/A

• Are hostlers inspected on a daily basis at the beginning of each shift?

  Yes

  No

  N/A

• Do drivers and hostlers use hand holds and foot holds properly when getting in and out out tractors, trailers and hostlers?

  Yes

  No

  N/A

• Do hostlers and drivers check to assure path is clear before backing and yielding right of way?

  Yes

  No

  N/A

• Are tractors, trailers and converter gears parked in an orderly manner?

  Yes

  No

  N/A

• Are yard traffic patterns clearly communicated to drivers and hostlers?

  Yes

  No

  N/A

• Is the service center yard and employee parking area free of trash and accumulation?

  Yes

  No

  N/A

• Are trash cans placed in convenient locations and emptied frequently?

  Yes

  No

  N/A

• Is the service center yard and employee parking area free of holes, breaks,<br> protrusions or other hazards?

  Yes

  No

  N/A

• Do all drains have adequate covers?

  Yes

  No

  N/A

• Are both the service center yard and employee parking area adequately lighted?

  Yes

  No

  N/A

• Are all lights secure and burning?

  Yes

  No

  N/A

• Do drain gutters channel water away from a walk-ways , steps etc?

  Yes

  No

  N/A

Terminal Security

• Guards alert, require identification, know procedure for fire and or other emergency?

  Yes

  No

  N/A

• Guard house well lit, proper lights?

  Yes

  No

  N/A

• Fences in good condition, no overgrown areas, free of shadows?

  Yes

  No

  N/A

• Is the electric fence working properly?

  Yes

  No

  N/A

• Is the electric fence notification list updated with the accurate management contact information?

  Yes

  No

  N/A

• Gates in good repair, unused gates locked?

  Yes

  No

  N/A

• Are the extra truck tires secured and kept locked in a tire stand if stored outside?

  Yes

  No

  N/A

• Is there a secure cage , trailer, or area for high value items? Are all loaded trailers locked, sealed and accounted for at the end of each shift?

  Yes

  No

  N/A

• Is overall terminal security adequate?

  Safe

  At Risk

  N/A

Fueling area ( if none leave blank)

• Are fuel pumps attend when in operation? <br>Is someone in control of the nozzle at the point of fueling?

  Yes

  No

  N/A

• Is the fuel island kept free of trash and spills?

  Yes

  No

  N/A

• Have provisions been made to prevent fuel from getting into drains in the event of a spill? (Adequate supply of non combustible absorbent, or engineering controls?)

  Yes

  No

  N/A

• Are trash containers available and emptied frequently?

  Yes

  No

  N/A

• Is lighting adequate?

  Yes

  No

  N/A

• Are pumps protected from drainage?

  Yes

  No

  N/A

• In the event of an emergency, is a cut off switch available in a location away from the pumps and clearly marked?

  Yes

  No

  N/A

• Is a properly charged and inspected fire extinguisher available near the fuel pumps? (15-25 feet)

  Yes

  No

  N/A

• Is the fuel area clearly marked as a no smoking area?

  Yes

  No

  N/A

• Are tanks checked regularly to insure no leaks?

  Yes

  No

  N/A

• Are caution fuel storage and fueling instructions signs posted?

  Yes

  No

  N/A

Equipment

• Is equipment clean and overall in good repair? (tread depth, windshield, placards, paint, etc.)

  Yes

  No

  N/A

• Are DVIR's completed on a daily basis?

  Yes

  No

  N/A

• Is a copy of the latest inspection in the cab of all equipment and the old one removed?

  Yes

  No

  N/A

• Does the annual inspection plate appear on all equipment and is it properly completed?

  Yes

  No

  N/A

• Does all power equipment have an current ERG?

  Yes

  No

  N/A

• Does all power equipment have a Blank Log Book?

  Yes

  No

  N/A

• Does all power equipment have a Omnitracs DOT Quick Reference Card?

  Yes

  No

  N/A

• Does all power equipment have a tri-fold Accident information packet?

  Yes

  No

  N/A

• Does all power equipment have a post drug/alcohol testing chain of custody form?

  Yes

  No

  N/A

• Does all power equipment have an current insurance card?

  Yes

  No

  N/A

• Does all power equipment have a current certificate of hazardous materials registration form?

  Yes

  No

  N/A

• Does all power equipment have spare fuses?

  Yes

  No

  N/A

Hazardous Material Handling

• Does the service center have an adequate supply of metal and plastic salvage drums and has access to them in a reasonable amount of time?

  Yes

  No

  N/A

• Are previous markings removed for the exteriors of the over pack drums?

  Yes

  No

  N/A

• Does the service center have a spill kit and is it labeled?

  Yes

  No

  N/A

• Does service center have a spill kit contain:

• Liquid proof gloves?

  Yes

  No

  N/A

• Tight fitting eye protection?

  Yes

  No

  N/A

• Adequate supply of non combustible absorbent?

  Yes

  No

  N/A

• Are placards applied and removed as required?

  Yes

  No

  N/A

• Are loading and storage restrictions observed?

  Yes

  No

  N/A

• Are all hazmat shipments secured with straps, load bars or blocking? (Dunnage is not proper securement)

  Yes

  No

  N/A

• Are hazardous materials loaded in such a manner as to protect them from damage by other freight or handling equipment?

  Yes

  No

  N/A

• Is a hazardous material storage area clearly designated on the freight dock.

  Yes

  No

  N/A

• Is the hazardous materials area free of trash and freight?

  Yes

  No

  N/A

• Is the hazardous materials area inspected daily for leaking containers?

  Yes

  No

  N/A

• Are all hazardous materials over packs lids fully closed?

  Yes

  No

  N/A

• Are all hazardous materials over packs properly labeled with a placard to communicate the danger of materials inside?

  Yes

  No

  N/A

• Do all hazardous materials over packs have a copy of the bill of lading attached to each over pack?

  Yes

  No

  N/A

Bulletin Boards

• Are bulletin boards kept neat, clean and free of postings unrelated to Company Business?

  Yes

  No

  N/A

• Are the following required posters and notices displayed? (These are in addition to those already mentioned in other areas of this inspection)

• Federal 5 in 1 poster?

  Yes

  No

  N/A

• Workers Compensation information including name of insurance carrier or license if state fund, how to report injuries and panel of physicians?

  Yes

  No

  N/A

• Any posters or notices required by local or state government?

  Yes

  No

  N/A

OSHA Requirements

• Are OSHA record keeping requirements in order?

  Yes

  No

  N/A

• Current OSHA 300 log on file?

  Yes

  No

  N/A

• Previous 5 years OSHA 300 logs on file, complete and certified by manager?

  Yes

  No

  N/A

• Injuries/illness entries made on OSHA 300 log within 6 days?

  Yes

  No

  N/A

• All first reports of injury on file, kept separate from 300 log?

  Yes

  No

  N/A

• Is the previous year OSHA 300 log displayed at the appropriate time? (Between February 1 to April 30)

  Yes

  No

  N/A

General Requirements

• Is the terminal monthly self inspection report form being completed?

  Yes

  No

  N/A

• Additional Comments: