ADI ROM HSE Assessment - V2

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

Fire Extinguishers and Exits

• First, take a look at the Evacuation Map that should be posted. Take a count of the extinguishers and exits to ensure you walk them all during your review. Check the box when you have made your notes in the next field.

• Note here how many Extinguishers and Exits at the location. Then proceed with the check

  Drawing

• Are fire extinguishers checked on a monthly basis?

  Safe

  At Risk

  N/A

• Are Fire Extinguishers marked and properly mounted?

  Safe

  At Risk

  N/A

• Are extinguishers checked annually by a qualified technician?

  Safe

  At Risk

  N/A

• Are paths to fire extinguishers clear of obstructions?

  Safe

  At Risk

  N/A

• Add any pictures if needed

  Media

Emergency Exits

• Are all exits marked properly and exit signs unobstructed?

  Safe

  At Risk

  N/A

• Is the path to the exit free of obstruction? (36" minimum)

  Safe

  At Risk

  N/A

• Are exit signs illuminated?

  Safe

  At Risk

  N/A

• If winter, and needed, does the site have a supply of ice melt or rock salt?

  Yes

  No

  N/A

• Add any pictures if needed

  Media

Warehouse Review (5-S and Chemical Storage)

• Is paint usable, stored away from heat sources, organized and properly identified?

  Safe

  At Risk

  N/A

• Are all cleaning chemicals labeled?

  Safe

  At Risk

  N/A

• Confirm no flammable material, i.e. propane, sterno or charcoal lighter fluid found in branch?

  Safe

  At Risk

  N/A

• Are designated aisles marked and no product stored in those aisles?

  Yes

  No

  N/A

• Overall cleanliness of the Warehouse area (1= Unacceptable 5= Acceptable 10=World Class)

• Add any pictures if needed

  Media

Warehouse Electrical and Stair

• Are all circuit breakers labeled?

  Safe

  At Risk

  N/A

• Do circuit breaker boxes have ARC Flash stickers affixed?

  Safe

  At Risk

  N/A

• Is there at least 36 inches clearance in front of electrical panels?

  Safe

  At Risk

  N/A

• Confirm no flammable material, i.e. propane, sterno or charcoal lighter fluid found in branch?

  Safe

  At Risk

  N/A

• If the site is equipped with a rolling stair, is it in good condition?

  Safe

  At Risk

  N/A

• Overall cleanliness of the Warehouse area (1= Unacceptable 5= Acceptable 10=World Class)

• Add any pictures if needed

  Media

Warehouse Racking / Storage

• If building is sprinklered, is storage at least 18 inches below sprinkler head height?

  Safe

  At Risk

  N/A

• Are there dents in the supporting legs of the warehouse racking?

  Safe

  At Risk

  N/A

• Is the load capacity 2500lbs posted on all pallet racking?

  Safe

  At Risk

  N/A

• Are items above 4' stretch wrapped for stability?

  Yes

  No

  N/A

• Add any pictures if needed

  Media

Environmental

• Is there a designated staging area for battery storage?

  Safe

  At Risk

  N/A

• Are terminals on recycled batteries taped down?

  Safe

  At Risk

  N/A

• Is the battery recycle storage area kept inside of the building at all times?

  Yes

  No

  N/A

• Are waste batteries on a pallet or in a container that will support the weight?

  Safe

  At Risk

  N/A

• Is the container/skid labeled "Universal Waste Recycled Batteries"? And date marked when the first battery put in?<br>(Required by EPA to keep batteries no longer in accumulation for >1 year)

  Safe

  At Risk

  N/A

• Is the shipping paperwork current? (Sites should be able to pull up prior shipments via the web or Bill of Lading)

  Safe

  At Risk

  N/A

• Is there documentation of a Storm Water No Exposure certification or similar Storm water compliance document Policy S013 in the safety section of the Policy book?

  Safe

  At Risk

  N/A

• Add any pictures if needed

  Media

Powered Industrial Truck (Excludes Pallet Jacks that are only powered for lifting)

• Does the site have powered industrial trucks such as Forklifts and Pallet Jacks. (Pallet Jacks that are only powered for up and down movement do not apply)

  Yes

  No

• Is the eyewash station clean?

  Safe

  At Risk

  N/A

• Is the eyewash station inspected on a monthly basis?

  Safe

  At Risk

  N/A

• If the site has a powered industrial truck, does the site have an eyewash station?

  Safe

  At Risk

  N/A

• Is there a daily documented inspection program with appropriate corrective action follow-up?

  Safe

  At Risk

  N/A

• Is there a current Manager's Evaluation Form for all employees operating powered industrial equipment?

  Yes

  No

  N/A

• Are annual certifications (driver tests) in place for all employees who operate a lift truck or other industrial vehicle?

  Yes

  No

  N/A

• Are truck wheels chocked, stops, or other means to prevent movement and is the driver out of the cab during truck loading / unloading operations? (any truck applies)

  Safe

  At Risk

  N/A

• Add any pictures if needed

  Media

Office / Record Review

• Branch has 5 HSE postings required as shown in reference. (Copies can be found in BSS-001)

  Yes

  No

  N/A

• See reference

  

• Does the site have the updated safety policies in their Branch P&P Binder?

  Safe

  At Risk

  N/A

• Is the "SDS Available upon Request" sign posted and visible?

  Safe

  At Risk

  N/A

• Has site conducted an evacuation drill during the calendar year and can provide a critique form as evidence?

  Safe

  At Risk

  N/A

• Does the site conduct weekly safety inspections and are copies retained for 1 year?

  Safe

  At Risk

  N/A

• Does the site conduct documented monthly safety talks? Retain 1 yr

  Safe

  At Risk

  N/A

• Check door closers for tension/speed (risk of caught fingers?)

  Safe

  At Risk

  N/A

• Verify video surveillance system: recording? Capacity? Cameras down? Blind spots?

  Safe

  At Risk

  N/A

• Add any pictures if needed

  Media

Questions anyone should know in the branch...ask the following:

• When questioned, do employees know how to report an incident or share safety observations?

  Safe

  At Risk

  N/A

• Do employees know where HSE issues are posted and/or tracked to closure?

  Yes

  No

  N/A

• Do the employees know how to get a SDS?

  Safe

  At Risk

  N/A

• Do the employees know where to go during an evacuation and shelter-in-place?

  Yes

  No

  N/A

• Add any pictures if needed

  Media

General HSE / Breakroom and Common Area

• Is the current version of the Honeywell "Commitment to Health, Safety and the Environment" signed by the site leader, posted at the main entrance and throughout the facility at all key communication points?

  Safe

  At Risk

  N/A

• Are all safety documents posted as per Policy BSS-001? (5 documents)

  Safe

  At Risk

  N/A

• Refrigerator, microwave, toaster and other breakroom appliances appear to be cleaned on a regular basis?

  Safe

  At Risk

  N/A

• Is there a separation between storage of food and chemicals?

  Safe

  At Risk

  N/A

• Add media

  Media

General Electrical Safety

• Are GFCI used for electrical outlets at sinks? Check Restrooms, Breakroom, Hospitality, or any locations within 8ft of a water source.

  Safe

  At Risk

  N/A

• Are electric cords being used as permanent wiring?

  Safe

  At Risk

  N/A

• Are surge protectors used correctly? (No daisy chaining)

  Yes

  No

  N/A

• Did you observe any exposed wiring?

  Safe

  At Risk

  N/A

• Add media

  Media

First Aid Cabinet

• Is the first aid kit being checked for expired medications? Are all inside the kit within the expiration date?

  Yes

  No

  N/A

• Is a log being used for the first aid kit to determine if event/injury is work related? And is the log current

  Yes

  No

  N/A

• Add media

  Media

• Upload picture(s) for items found as best practices

  Media

• Upload picture(s) for items found as UNSAFE conditions or Practices. Add actions as necessary.

  Media

• Add signature

  Sign