Page 2
Fire Prevention and Emergency Action (General)
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Are all exits marked with an exit sign of the proper size and illuminated by a reliable light source (electric or fluorescent are acceptable)
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Is service center equipped with emergency lighting, is it operable?
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Are doors and stairs that could be mistaken for an exit appropriately marked? Ex. "Not an exit", "Basement", "Storeroom", etc?
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Are all exits kept free of obstructions, not locked?
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Are sufficient exits available?
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Are fire extinguishers inspected monthly by an ACT employee and annually by an authorized company?
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Does the inspection tag provide the name, phone number and certification number of the vendor?
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Are workplace diagrams or maps posted showing escape routes, gathering area and written instructions?
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Are emergency telephone numbers posted in conspicuous location? (Police, Fire, Medical, and Service Center Management after hours contact numbers)
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Is an audible alarm system available? (Require if 11 or more individuals occupy the facility at one time)
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Is the smoke free workplace policy enforced by management and rules observed by all employees?
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The Eyewash Station is clean, readily accessible, and inspected weekly.
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The Eyewash fluid is not expired and changed every 6 months.
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The Eyewash station is not blocked.
Page 3
Health and sanitation (general)
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Are eating facilities adequate and clean?
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Are appliances such as microwave and refrigerator kept clean?
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Are ample trash containers available and emptied frequently?
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Are restrooms clean?
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Is adequate privacy afforded the users? Locks on doors, partitions, locks on individual stalls?
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Are restrooms equipped with lined trash containers and properly stocked? Toilet paper, hand towels, soap?
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Are first aid supplies adequately stocked not expired , readily available and accessible.
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Can emergency response respond within 5 minutes?
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In general, is noise level ok?
Page 4
Electrical / Utilites room or area
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Is the area clean and free from dirt, and combustibles or other cleaning supplies, etc. that could pose a fire threat?
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Is the area well lighted?
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Are permanent wiring panels and breakers securely mounted and free of defects?
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Are outlet covers,switches and receptacles securely mounted and free of defects?
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Are extension cords in use where permanent wiring is required?
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Are breaker or fuse boxes equipped with a cover?
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Are all breakers or fuses labeled for use or location?
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Are all vacant spaces in breaker or fuse boxes filled with blanks?
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Does area in front of breaker panel have a 36 inch clearance?
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No apparent overloading of outlets?
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Is heating, cooling or water heating equipment clean and properly operating?
Page 5
Office
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Is ample work space available?
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Are all lead persons and supervisors wearing OSHA approved safety shoes and dressed in
a fashion that is worthy of business activity. -
Are all movements such as walking, climbing, use of stairs done in a safe manner?
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Are office machines, vending machines and water machines grounded and in good repair?
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Are work stations designed with employee safety and health in mind?
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Is office equipment clean, used properly,and in good repair?
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Are unattended desk and file drawers kept closed?
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Is only one file drawers opened at a time?
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Are floors and aisle free from trash and debris?
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Are floors and carpets and ceiling tiles dry and in good condition?no tripping or falling hazard, no water stains on ceiling tiles?
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Are stairways in good condition and stair railing secure?
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Are there sufficient trash containers? Are they emptied frequently?
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Are extension cords and wires free of kinks, splices, cuts and wear?
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Is the office well lighted, all lights working properly
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Are work areas kept clean and neat? free of wires or other tripping hazards?
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Are elevated storage areas or balconies posted as to maximum floor load capacity?
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Are elevated areas or balconies equipped with guardrails, railings, or other suitable type of fall protection?
Page 6
Service Center / Yard
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Are only authorized drivers and vehicles on the yard?
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Is a speed limit sign posted? (Maximum 10 mph)
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Is there a fasten seat belt sign posted at the exit gate?
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Is there a no trespassing-right to search sign and a Smoke Free Workplace sign posted?
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Are drivers wearing seat belts?
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Do drivers and hostlers obey speed limits and traffic pattern?
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Are hostlers following company procedures? (Wearing Safety Vest, Lights On,Seatbelt On, Both Airlines and Power Line Attached)
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Are hostlers inspected on a daily basis at the beginning of each shift?
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Do drivers and hostlers use hand holds and foot holds properly when getting in and out out tractors, trailers and hostlers?
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Do hostlers and drivers check to assure path is clear before backing and yielding right of way?
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Are tractors, trailers and converter gears parked in an orderly manner?
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Are yard traffic patterns clearly communicated to drivers and hostlers?
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Is the service center yard and employee parking area free of trash and accumulation?
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Are trash cans placed in convenient locations and emptied frequently?
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Is the service center yard and employee parking area free of holes, breaks,
protrusions or other hazards? -
Does the building appear to be in good repair
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Do all drains have adequate covers?
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Are both the service center yard and employee parking area adequately lighted?
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Are all lights secure and burning?
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Do drain gutters channel water away from a walk-ways , steps etc?
Page 7
Dock
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Is ample workspace available?
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Are employees wearing proper footwear (ANSI approved safety shoes)
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Are all movements such as walking, climbing, and use of stairs and ladders done in a safe manner?
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Are safe work practices being observed?
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Is freight handled in such a manner to prevent injury?
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Is freight stacked properly in vehicles?
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Are trailer interiors clean, free of hazards, damage, holes in floor, etc?
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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?
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Is material handling equipment being used properly?
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Is material handling equipment properly stored, in good repair and free of dirt and grease?
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Are stairs, ladders, and ramps in good repair, secure, equipped with hand holds or railings and free of trash and obstructions?
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Ae there sufficient trash containers and are they emptied frequently?
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Is dock and dock apron free of trash and debris?
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Is a dock plate available at each door? Is there an adequate supply of dock plate pullers?
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Are floors clean, with no defects and free of spilled material?
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Are dunnage and pallets stored neatly? No fire hazards?
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Are overhead doors operable and secure?
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Are all permanent isles clearly defined, marked, and free of freight and trash?
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Are loading lights available at each door?
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Are loading lights and wiring operable and free of defects?
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Are conduit and outlet boxes that supply power to dock free of defects? (No exposed wires - no loose connections)
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Are "Chock on the Dock" and "Driver Pull Away" procedures being followed?
Are chocks in use on all vehicles at the dock? (Front Wheel Chocked) -
Is overhead lighting adequate? Are all lights burning?
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Are all anti- tilt stands, pins and pin keepers in use on 32 FT lift gates and other vehicles as needed?
Page 8
Forklifts
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Are forklifts in overall good condition?
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Are forklifts inspected on a daily basis before each shift or at the beginning or end or each shift for 24 hour terminal?
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Are forklift inspections maintained on file for 30 days and then destroyed?
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Are the certifications of repair being signed off?
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Is each forklift equipped with:
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An operating back up alarm?
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An overhead guard (bolted down)?
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Are seat belts operable and being used? (no torn belt webbing)
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Are brakes, horn, mast, blades, tires and lights free of defects and in good operating condition?
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Are all forklifts equipped with a specification plate indicating the weight capacity?
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Are forklifts free of water, oil or other fluid leaks?
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Are forklifts operated in a safe manner? ( No wheel spinning - operated at a reasonable speed - horns being used)
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Are forklifts operated by only trained, tested and certified personnel?
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Do forklift drivers use handholds and footholds properly when getting on and off forklifts?
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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?
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Is forklift refueling area in good order and free of slip trip hazards?
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Are propane tanks stored in one designated area? Is the area protected from damage?
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Is the storage area marked "no smoking" and does it bear the NFPA or other suitable sign identifying the hazard "Flammable Gas"?
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Are personal protective equipment (PPE) requirements being followed when refueling forklifts?
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Is the personal protective equipment (PPE) clean and serviceable?
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Are safe work practices observed when refueling forklifts?
Page 9
Terminal Security
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Guards alert, require identification, know procedure for fire and or other emergency?
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Guard house well lit, proper lights?
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Fences in good condition, no overgrown areas, free of shadows?
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Is the electric fence working properly?
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Is the electric fence notification list updated with the accurate management contact information?
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Gates in good repair, unused gates locked?
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Are the extra truck tires secured and kept locked in a tire stand if stored outside?
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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?
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Is overall terminal security adequate?
Page 10
Fueling area ( if none leave blank)
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Are fuel pumps attend when in operation?
Is someone in control of the nozzle at the point of fueling? -
Is the fuel island kept free of trash and spills?
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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?)
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Are trash containers available and emptied frequently?
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Is lighting adequate?
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Are pumps protected from drainage?
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In the event of an emergency, is a cut off switch available in a location away from the pumps and clearly marked?
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Is a properly charged and inspected fire extinguisher available near the fuel pumps? (15-25 feet)
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Is the fuel area clearly marked as a no smoking area?
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Are tanks checked regularly to insure no leaks?
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Are caution fuel storage and fueling instructions signs posted?
Page 11
Equipment
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Is equipment clean and overall in good repair? (tread depth, windshield, placards, paint, etc.)
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Is the electronic VIR completed on a daily basis?
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Does the annual inspection plate appear on all equipment and is it properly completed?
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Does all power equipment have a current ERG?
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Does all power equipment have a Blank Log Book?
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Does all power equipment have both Omnitracs DOT Quick Reference Cards and a User Manual?
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Does all power equipment have an current insurance card?
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Does all power equipment have a current certificate of hazardous materials registration form?
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Does all power equipment have spare fuses?
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Are Emergency Triangles present and secure
Page 12
Hazardous Material Handling
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Are all personnel that are involved with the transportation of hazardous materials trained in accordance with OSHA standards, dot regulations and company policy?
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Do all service center personnel understand what hazmat commodities ACT does not transport?
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Do the employees know where the ACT written Hazard Communication Standard Program is located?
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Do employees know how to find an SDS sheets when on the company internal website - MyCooper?
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Do supervisors understand not to respond to hazardous material emergencies without the guidance of risk management personnel or Premium environmental services?
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Is a current emergency response guidebook on hand in the office?
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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?
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Are previous markings removed for the exteriors of the over pack drums?
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Does the service center have a spill kit and is it labeled?
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Does service center have a spill kit contain:
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Liquid proof gloves?
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Tight fitting eye protection?
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Adequate supply of non combustible absorbent?
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Is the HAZMAT ENFORCER program used for every hazardous material load? (Both inbound and outbound shifts)
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Are placards applied and removed as required?
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Are loading and storage restrictions observed?
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Are all hazmat shipments secured with straps, load bars or blocking? (Dunnage is not proper securement)
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Are hazardous materials loaded in such a manner as to protect them from damage by other freight or handling equipment?
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Is a hazardous material storage area clearly designated on the freight dock.
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Are delivery receipts properly tabbed with a red hazmat sticker per ACT requirements?
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Is the hazardous materials area free of trash and freight?
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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
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Are original copies of the BOL attached to travel copies ?
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Is the hazardous materials area inspected daily for leaking containers?
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Are all hazardous materials over packs lids fully closed?
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Are all hazardous materials over packs properly labeled with a placard to communicate the danger of materials inside?
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Is there an ample supply of Hazardous materials labels(small diamond stickers) and placards and a number kit?
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Do all hazardous materials over packs have a copy of the bill of lading attached to each over pack?
Page 13
Bulletin Boards
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Are bulletin boards kept neat, clean and free of postings unrelated to Company Business?
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Are the following required posters and notices displayed? (These are in addition to those already mentioned in other areas of this inspection)
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Federal 5 in 1 poster?
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Workers Compensation information including name of insurance carrier or license if state fund, how to report injuries and panel of physicians?
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Any posters or notices required by local or state government?
Page 14
OSHA Requirements
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Are OSHA record keeping requirements in order?
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Current OSHA 300 log on file?
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Previous 5 years OSHA 300 logs on file, complete and certified by manager?
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Injuries/illness entries made on OSHA 300 log within 6 days?
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All first reports of injury on file, kept separate from 300 log?
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Is the previous year OSHA 300 log displayed at the appropriate time? (Between February 1 to April 30)
General Requirements
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Is the terminal monthly self inspection report form being completed?
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Are the Building and Roof in good repair,
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Additional comments: