Page 1

  • no label

Service Center Information

  • Service Center
  • Service Center Manager Name

Inspection Information

  • Inspection Date

  • Date of Previous Inspection

  • Name of Person conducting inspection

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.

  • Date

Page 2

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)

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

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

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

  • Are sufficient exits available?

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

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

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

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

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

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

Page 3

Health and sanitation (general)

  • Are eating facilities adequate and clean?

  • Are appliances such as microwave and refrigerator kept clean?

  • Are ample trash containers available and emptied frequently?

  • Are restrooms clean?

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

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

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

  • Can emergency response respond within 5 minutes?

  • In general, is noise level ok?

Page 4

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?

  • Is the area well lighted?

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

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

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

  • Are breaker or fuse boxes equipped with a cover?

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

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

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

  • No apparent overloading of outlets?

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

Page 5

Office

  • Is ample work space available?

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

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

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

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

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

  • Are unattended desk and file drawers kept closed?

  • Is only one file drawers opened at a time?

  • Are floors and aisle free from trash and debris?

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

  • Are stairways in good condition and stair railing secure?

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

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

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

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

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

Page 6

Hazardous Materials Office Procedures

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

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

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

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

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

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

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

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

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

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

Page 7

Dock

  • Is ample workspace available?

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

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

  • Are safe work practices being observed?

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

  • Is freight stacked properly in vehicles?

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

  • 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?

  • Is material handling equipment being used properly?

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

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

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

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

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

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

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

  • Are overhead doors operable and secure?

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

  • Are loading lights available at each door?

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

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

  • 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)

  • Is overhead lighting adequate? Are all lights burning?

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

Page 8

Forklifts

  • Are forklifts in overall good condition?

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

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

  • Are the certifications of repair being signed off?

  • Is each forklift equipped with:

  • An operating back up alarm?

  • An overhead guard (bolted down)?

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

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

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

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

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

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

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

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

  • 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?

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

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

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

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

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

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

Page 9

Terminal Yard

  • Are only authorized drivers and vehicles on the yard?

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

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

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

  • Are drivers wearing seat belts?

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

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

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

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

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

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

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

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

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

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

  • Do all drains have adequate covers?

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

  • Are all lights secure and burning?

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

Page 10

Terminal Security

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

  • Guard house well lit, proper lights?

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

  • Is the electric fence working properly?

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

  • Gates in good repair, unused gates locked?

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

  • 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?

  • Is overall terminal security adequate?

Page 11

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?

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

  • 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?)

  • Are trash containers available and emptied frequently?

  • Is lighting adequate?

  • Are pumps protected from drainage?

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

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

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

  • Are tanks checked regularly to insure no leaks?

  • Are caution fuel storage and fueling instructions signs posted?

Page 12

Equipment

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

  • Are DVIR's completed on a daily basis?

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

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

  • Does all power equipment have an current ERG?

  • Does all power equipment have a Blank Log Book?

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

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

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

  • Does all power equipment have an current insurance card?

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

  • Does all power equipment have spare fuses?

Page 13

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?

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

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

  • Does service center have a spill kit contain:

  • Liquid proof gloves?

  • Tight fitting eye protection?

  • Adequate supply of non combustible absorbent?

  • Are placards applied and removed as required?

  • Are loading and storage restrictions observed?

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

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

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

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

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

  • Are all hazardous materials over packs lids fully closed?

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

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

Page 14

Bulletin Boards

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

  • 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?

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

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

Page 15

OSHA Requirements

  • Are OSHA record keeping requirements in order?

  • Current OSHA 300 log on file?

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

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

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

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

General Requirements

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

  • Additional Comments:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.