ACT - Quarterly Branch EH&S Checklist

• Location:

  Select Sunnyvale Escondido Merced Santa Fe Springs Albuquerque Chaparral Mexico

  • Sunnyvale
  • Escondido
  • Merced
  • Santa Fe Springs
  • Albuquerque
  • Chaparral
  • Mexico
• Physical Location
  Address

• Conducted by

• Conducted on

  Date

• Note: Quarterly safety inspections at ACT are conducted to identify unsafe conditions and work practices and identify and evaluate hazards.

Posting:

• 1. Is the Business License posted?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 2. Are the OSHA Postings complete and posted?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 3. Is the Access to Exposure & Medical Records posted (CA only)?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

SAFETY AND ORDERLY OPERATING CONDITIONS:

• 1. Are all areas clean and orderly?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 2. Are eating areas clean and sanitary?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 3. Are work areas free of rodents, insects and vermin?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 4. Are designated smoking areas properly identified?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 5. There are no tripping hazards, wet spots, grease/oils, protruding objects, miscellaneous debris?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 6. Are permanent aisles/passageways where forklifts are used properly marked?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 7. Is adequate and functioning lighting provided in all work areas?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 8. In elevated area(s), are the load limits for stored items clearly marked?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 9. In elevated area(s), are the load limits for stored items clearly marked?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 10. Is unused equipment kept in a safe and orderly manner?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 11. Is there sufficient ventilation?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 12. Does the noise level permit normal, working conversation and safe communications?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 13. Do elevated platforms and working areas have standard rails?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 14. Do elevated platforms and working areas have toe boards?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 15. Are fixed industrial stairs in good repair?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 16. Are ladders maintained in good condition: the joints between steps and side rails are tight; all hardware and fittings securely attached and movable parts operate freely without binding or undue play?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 17. Are non-slip safety feet are provided on each ladder?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 18. Are ladder rungs and steps free of dirt and oil?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 19. Do forklifts have an operating fire extinguisher (monthly inspections?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 20. Are daily inspections being conducted on forklifts (verify book is in place and being utilized)?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 21. Are retains for vacuum truck pick-ups being maintained in accordance with the Vacuum Truck Services Manual (90-days for each pick-up)?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 22. Dock blocks are up and in place when loading dock is not in immediate use.

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 23. Only trained loaders and unloaders perform loading and unloading duties in that area.

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 24. Dock door/chain, etc. is kept closed when a truck is not backed against it.

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

ELECTRICAL SAFETY:

• 1. Extension cords; not used in place of permanent wiring; not run through walls, ceilings, doors; equipped with proper plugs; three-conductor cable used; no damaged or taped cords; not daisy-chained?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 2. Are power cords in good condition; no fraying; ground pins in place; necessary strain-relief measures taken?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 3. Have frayed wires been replaced?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 4. Is access to electrical panels clear and not obstructed (36" minimum)?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 5. Is access to switches and circuit breakers clear and not obstructed?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 6. Do Ground-fault Circuit Interrupters (GFCIs) pass first test using push buttons built into the outlet receptacle?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 7. Of the electrical receptacles located within 6 feet of sinks and exterior doors, on all metal-surfaced workbenches, and on all outdoor receptacles: Are they all GFCIs?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 8. Are there protective covers in place over boxes, raceways, fittings, and so forth?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 9. Are power cabinets and breakers properly labeled?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 10. Are all energized parts (for example, power panels, junction boxes, switch equipment) guarded to prevent accidental contact?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 11. Are electrical panel directories in place and accurate?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 12. Is the access door to the panel breakers or fuses unlocked to allow access to the breakers or fuses?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

FIRE SAFETY:

• 1. Are fire extinguishers clearly accessible; are their seals intact; are they properly mounted to wall panels; are current inspection tags securely attached?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 2. Is the correct number of fire extinguishers required for the facility provided and are they suitably located in the building?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 3. Have new extinguishers been ordered to replace missing, damaged, or discharged units?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 4. Are backs of inspection tags initialed and dated by parties responsible for monthly checks?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 5. Are annual maintenance checks of portable fire extinguishers completed and do inspection tags on each extinguisher reflect the date completed?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 6. Is there an 18" minimum clearance below all fire sprinklers; are sprinklers clear of interference by stored materials (boxes and so forth) and

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 7. Is the presence of combustible materials minimized?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 8. Are emergency exits correctly marked, visible, accessible, a minimum width of 36 inches?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 9. Are doors that are not exits but could be mistaken for exits clearly marked “NOT AN EXIT?”

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 10. Are exit-access corridors free of storage?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 11. The height of the pile shall not exceed the width by more than three (3) feet.

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 12. The maximum dimensions of a pile shall not exceed 20' x 20' x 20'.

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 13. There shall be ten (10) feet of aisle way between piles.

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 14. The separation distance is allowed to be reduced to three (3) feet for storage not exceeding six (6) feet in height.

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 15. Storage of pallets shall not be located within ten (10) feet of a property line.<br><br>"Wood Pallet Requirements: California Fire Code (C.F.C.), Section 1103.3, N.F.C., Standard 231, Table A-4-4.1.1, N.F.C. Handbook, 16th Edition, and Table 11-1B"

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

EARTHQUAKE SAFETY:

• 1. Are furniture and equipment that could tip and block an exit properly anchored?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

• 2. Are stored materials stacked securely to prevent tipping, scattering, tripping?

  Yes

  No

  N/A

• Recommendations

• Responsible Party

• Resolution

• Completion Date

  Date

RANDOM GEAR BACK CHECK:

• Note: Randomly select two gear bags to check the contents. If contents are missing, meet with employee to go over checklist and provide him with the appropriate materials.

• RANDOM GEAR BACK CHECK

Employee's Bag

• Employee's Name

• 1. Full Face Respirator - (Amount Needed 1)

  Yes

  No

  N/A

• 2. Defender (multi purpose) cartridges - (Amount Needed 4 pairs)

  Yes

  No

  N/A

• 3. Ammonia cartridges - (Amount Needed 1 pair)

  Yes

  No

  N/A

• 4. Acid gas cartridges - (Amount Needed 1 pair)

  Yes

  No

  N/A

• 5. Dust Masks - (Amount Needed 2)

  Yes

  No

  N/A

• 6. Tyvek Coveralls - (Amount Needed 5)

  Yes

  No

  N/A

• 7. Poly-Tyvek Coveralls - (Amount Needed 2)

  Yes

  No

  N/A

• 8. Tyvek Labcoats - (Amount Needed 5)

  Yes

  No

  N/A

• 9. Leather gloves – (Amount Needed 5 pairs)

  Yes

  No

  N/A

• 10. Nitrile gloves – (Amount Needed 2 boxes)

  Yes

  No

  N/A

• 11. Thick nitrile gloves – (Amount Needed 2)

  Yes

  No

  N/A

• 12. Ear plugs – (Amount Needed 5)

  Yes

  No

  N/A

• 13. RCRA labels – (Amount Needed 20)

  Yes

  No

  N/A

• 14. Safety glasses – (Amount Needed 5)

  Yes

  No

  N/A

• 15. Hard hat – (Amount Needed 1)

  Yes

  No

  N/A

• 16. Respirator Wipes – (Amount Needed 1 Box)

  Yes

  No

  N/A

• Signature of the employee

  Sign