Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

ACCIDENT PREVENTION PROGRAM

Active Management Support

  • Is there active management support from the GM and Supervisors

Return To Work

  • Is there a written return-to-work program?

New Hire Training

  • Has new hire training been conducted timely and thoroughly?

  • Does the company have new employee protocols involving supervisors?

Manager Facility Reviews

  • Location manager is conducting and documenting a monthly facility review

  • Describe the documentation utilized.

On Going Training

  • Documented monthly trainings being conducted?

  • Describe the documentation utilized.

Accident Investigations

  • There is a written accident investigation program in place?

  • Written program addresses protocols and responsibilities?

Near Miss Program

  • There is a process in place to identify near misses?

  • Once near misses are identified, are they adequately addressed?

Program Enforcement

  • Violations of the safety programs are documented?

  • Job safety observations are completed by company supervisors?

Written Programs

  • Are there written SOP's for different job duties?

  • Are there specific written programs to address unique hazards of the workplace?

Program Measurement

  • What method is utilized to measure the safety program?

  • Insert the rates from above.

FERTILIZER & CHEMICAL

Restricted Use Sales

  • Is documentation available to track the sales of RUP's to customers with applicator licenses?

  • Describe the way to track.

  • Has the sale of RUP's been audited by an agency in the last 12 months?

  • Name of auditing agency, agent, and date.

Monthly Inspection Reports

  • Is a monthly fertilizer containment inspection form utilized and documented by the manager?

  • Is a monthly pesticide containment inspection form utilized and documented by the manager?

Statement of Service

  • Is a statement of service sent to customers?

  • Does written statement of service address all state requirements?

Risk Management Plan

  • RMP contains written policies?

  • Documented SOP's address filling, emergency situations, etc?

  • Current SDS is included in RMP manual?

  • There are 2 documented compliance audits within 3 years in the RMP?

  • All findings from previous compliance audits have been addressed?

  • 2 documented hazard reviews within 5 years are included in the RMP?

  • All findings from previous hazard reviews have been adequately addressed?

  • Documented maintenance activities meet manufacturers recommendations.

  • Employees that need it have access to the plant maintenance manual?

  • Consequences of deviation are included in the RMP manual?

  • Worst case and alternate release scenario maps match the modeling documented in the RMP.

  • Accidents and incidents that should be included in the RMP are documented and filed in the manual?

  • Documented classroom and NCT is current (within 3 years).

RMP 5 Year Update

  • Are CDX usernames and passwords stored securely?

  • List where they are stored?

  • When is the RMP due to be updated?

RMP Facility Inspection

  • NH3 facility complies with current industry standards?

  • Select all that are not currently in place at the plant.

Permits & Licenses

  • Are all business licenses current and up-to-date? (Pesticide business, dealer, seed registration, Fertilizer blending, etc.)

  • Is there a current commercial applicator licensed at the facility?

  • List commercial applicators name, expiration date, and license #.

  • List stored pest commercial applicators name, license #, and expiration date.

Worker Protection Standard

  • Unlicensed applicators and other handlers have WPS training documented at least once every 5 years?

  • Information Exchange takes place prior to application?

  • Select anything not included in the information exchange.

  • Decontamination sites are available within 1/4 mile for any pesticide handler?

  • Select any items missing from the decontamination kits.

  • Is label required PPE available to all handlers, mixers, and loaders?

  • Select all PPE available.

Bulk Chemicals

  • Is the bulk repackaging report completed before March 1st each year?

  • Are manufacturers agreements in place and filed?

  • Are repackaged chemicals appropriately labeled including establishment number, EPA number, contents, etc?

  • Shuttles being filled meet current EPA and DOT requirements?

  • Describe shuttle documentation method.

  • Plan in place to address chemical releases?

  • Bulk chemical containment in place for areas with 1,000 gallons aggregate in any 365 day period and an approval of containment is on file from the state?

Bulk Fertilizer

  • Containment and load pad is adequate and state approval documentation is on site?

  • Fertilizer housekeeping is adequate.

  • A discharge response plan is in place for fertilizer releases.

Tier II Reports

  • All chemicals in excess of the TPQ are filed.

  • Filing is completed annually and prior to March 1st?

  • Copy is mailed to the LEPC, and local first responders.

TRANSPORTATION DIVISION

Driver Qualification Files

  • Driver Qualification files are current and contain each of the items on the DQ tracking spreadsheet.

  • Truck maintenance files are adequate and include each of the following:

  • Current Annual Inspection

  • Maintenance Log including: Year, Make, Model, VIN #, Truck #, and Tire size.

  • Maintenance Schedule

  • Accident Listing

Daily Vehicle Inspection Reports

  • DVIR's are documented and filed for 90 days.

DOT Paperwork & Filings

  • UCR completed and filed

  • MCS-150 completed biennially.

  • ISS Score is:

Hours of Service

  • Log books are kept for non exempted drivers.

  • For log book exemptions, time cards reflect compliance with HOS regulations.

Hazardous Materials

  • DOT HazMat Security Plan is updated at least every 3 years?

  • DOT HazMat Security Plan is reviewed annually, and there is documentation to support this.

  • Vulnerability assessment is site specific to each HM Security Plan.

  • Statement of Purpose description in plan.

  • HM registration paid for and a copy in each cargo vehicle and posted.

  • Current PVIKT inspections for appropriate vehicles and cargo tanks.

  • Documentation on file for each test mentioned above.

  • Shipping papers in place for all appropriate shipments.

  • HM training for general, function specific, and driver training conducted at least every 3 years.

Drug Testing Program

  • Third party administrator.

  • Drug and alcohol testing policy.

  • Drug and alcohol testing procedures.

  • Consequences for non-compliance DOT mandated.

  • New employee drug training completed.

  • Supervisor reasonable suspicion training completed and filed.

Driver Training

  • New driver training conducted for employees that obtain CDL during employment.

  • Defensive driver training completed at least every 3 years.

GRAIN FACILITIES

Facility Audits

  • Facilities are audited at least quarterly by safety director.

Fumigation Management Plan

  • Written FMP.

  • Application record keeping is documented and kept on file.

  • Employees and first responders are notified when fumigation occurs.

  • Monitoring records documented and available.

  • Monitoring equipment is adequate.

  • Fumigant is stored properly.

  • Label required PPE available for fumigation.

FDA Bio-Security

  • Bio Security plan is updated and trained on at least every 5 years.

  • FDA registration is renewed biennially.

  • FDA passwords and registration information saved and filed securely.

Bin Entry Permits

  • Permits filed and completed properly.

  • Audited annually and purged or filed away as per policy.

  • SOP's included in bin entry program are appropriate for each type of bin.

Out of Condition Grain

  • Policy addresses out of condition grain and procedures when problem arises.

  • Training addresses out of condition grain.

Hot Work Program

  • Completed hot work permits for work conducted in grain and feed facilities.

  • Program in place to find all possible alternatives to hot work.

  • Program addresses all hazardous locations outside of elevator or mill.

Housekeeping & Maintenance

  • Written housekeeping plan in place that addresses priority and non-priority housekeeping areas.

  • Documented housekeeping in place as per policy.

  • Training on elements of a dust explosion.

  • Choked leg procedure in place.

  • Written preventative maintenance schedule on file and trained on.

  • Maintenance activities documented as per company policy.

Manlift

  • Job specific training completed

  • Annual inspections completed by a 3rd party inspector.

  • Documented 6 month inspection documented in house.

Rescue Equipment

  • Select all rescue equipment available at the facility.

  • Other.

OSHA

Safety Manuals

  • Facility has current safety policies.

  • Facility has current emergency information.

  • Facility has current maps in the EAP.

Lockout/Tag-Out

  • HECP's in place for all energized equipment in detail.

  • Completed LOTO permits as per company policy.

  • Annual/periodic inspections for all authorized employees.

  • List of authorized employees.

Hazard Communication

  • Current chemical list in place as per hazcomm policy.

  • Written hazcomm policy.

  • Training on new GHS standard.

  • All SDS' available for all chemicals on site.

  • Facilities are properly labeled for NFPA 704.

Permit Required Confined Spaces

  • Written program and training conducted.

  • An evaluation of all PRCS on site.

  • Written entry procedures for each space.

  • Alternate procedures, reclassifications, and entry permits are reviewed annually.

  • Rescue procedures and evaluations completed for all PRCS on site.

Forklift

  • Classroom training completed on all operators.

  • Hands on training completed for all operators.

  • Performance evaluation conducted on all operators at least every 3 years.

Specialized Equipment

  • Training as per owners manual.

  • Written program for specialized equipment.

  • Performance evaluations for all equipment operators.

Emergency Action Plans

  • Written plan of what to do, where to go, and responsibilities.

  • Emergency phone numbers are current and complete.

  • Personnel roster is current and complete.

Fire Prevention Plan

  • Written plan adequately addresses major fire hazards on site.

  • Training on fire extinguishers as per policy.

Personal Protective Equipment

  • Hazard assessment completed and signed off by management that details required PPE.

  • Training of employees for required PPE.

  • Respiratory protection program is necessary.

  • Medical evaluations completed for employees in respiratory protection program.

  • Fit testing completed annually.

Bloodborne Pathogens Program

  • Written program and training.

Contractor Safety

  • Procedure in place to inform contractors of potential hazards they may encounter.

  • Contractor orientation guidelines are detailed and site specific.

  • Orientation is documented for all contract employees.

Electrical Safety Program

  • Written program in place.

  • Training for authorized employees.

  • PPE provided and trained on.

Miscellaneous Programs

  • Training for employees on safe lifting and back injuries.

  • Training completed for fixed, extension, and step ladders.

  • Training and PPE for slips, trips, and falls.

  • Machine guarding is in place to protect employees from all pinch, nip, and sheer points.

HAZWOPER

  • 24 Hour HAZWOPER training for employees.

  • 8 hour refresher training for 24 hour trained employees annually.

Welding/Cutting

  • Written program, training, and PPE in place.

  • Storage of compressed gases is safe. 20' separation or 30 min firewall.

Accident Reporting

  • OSHA 300 logs filled out appropriately.

  • State work comp form filled out and reported timely.

  • Supervisor is involved in accident reporting and investigation process.

PETROLEUM

  • Training on flammable liquids and flammable liquids storage.

Aboveground Fuels

  • SPCC plan in place for 1,320 gallons or more. More than 10,000 requires a plan by a PE.

  • SPCC plan is reviewed internally annually.

  • SPCC is reviewed every 5 years by PE.

Underground Fuels

  • Class A/B/C operators on site according to state and EPA regulations.

  • State permitting in place for UST's.

Propane

Leak Checks

  • Documented leak checks for new, out-of-gas, and I smell gas customers.

  • List method of documentation to track leak checks.

  • % of leak checks past due.

  • Leak checks in place annually for places of public assembly.

  • Residential customers must have a leak check at least every 5 years.

Regulators

  • Regulators are replaced at least every 15 years.

  • List method of documentation to track regulators.

  • % of regulators past due.

Cargo Tanks

  • Documented monthly cargo tank inspections on file.

  • Daily remote shutoff test documented.

  • Annual and 5 year cargo tank tests completed.

Training

  • CETP training documented for all drivers.

  • Refresher training for all LP employees.

Bottle Fill

  • Training for all bottle fill and exchange cabinet employees.

  • Documentation for bottles that cannot be filled.

  • RIN number and documentation if company re-qualifies cylinders.

Fire Safety Analysis

  • Completed and meets current NFPA 58 standards for plant.

  • Planning with local fire department (section 8) completed and sufficient.

Duty to Warn

  • Annual mailing sent to customers.

  • Renter/tenants also receive copies.

Shipping Papers

  • Kept in the door of the truck and accurate information.

  • Delivery tickets are kept for 3 years to replace shipping paper exemption for "one cargo tank"

SHOP & CONVENIENCE STORE

Housekeeping/Cleanliness

  • All containers are labeled appropriately.

  • Shop is free from slip, trip, and fall hazards. Is clutter free. Is well kept.

General Shop Safety

  • Power tools have guards in place and cords in good shape.

  • Grinder has rest within 1/8" tongue within 1/4" and 2 shields in place.

  • Grinding wheels are inspected and a ring test completed prior to putting into service.

  • PPE is clean and accessible.

Automotive

  • Auto lift has been trained on.

  • Lift hoist has been inspected annually.

  • Tire changing procedures have been trained on.

  • Wheel charts are posted in the tire shop.

  • Are widowmaker wheels still serviced in this shop?

  • Date the last recommendation to stop servicing these wheels.

  • Tire service manager trains new employees with hands on training for all types of wheels. Training is documented.

HOMELAND SECURITY

  • Facilities have been registered under CFATS.

  • Password and username is documented and stored securely.

  • List where it is stored.

  • Top screen completed.

  • Security vulnerability assessment and site security plan completed if deemed necessary.

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