Is there active management support from the GM and Supervisors
Is there a written return-to-work program?
Has new hire training been conducted timely and thoroughly?
Does the company have new employee protocols involving supervisors?
Location manager is conducting and documenting a monthly facility review
Describe the documentation utilized.
Documented monthly trainings being conducted?
Describe the documentation utilized.
There is a written accident investigation program in place?
Written program addresses protocols and responsibilities?
There is a process in place to identify near misses?
Once near misses are identified, are they adequately addressed?
Violations of the safety programs are documented?
Job safety observations are completed by company supervisors?
Are there written SOP's for different job duties?
Are there specific written programs to address unique hazards of the workplace?
- DART Rate
- Work Comp Experince Mod Rate
- Incidence Rate
- Near Miss Program
Insert the rates from above.
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.
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?
Is a statement of service sent to customers?
Does written statement of service address all state requirements?
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).
Are CDX usernames and passwords stored securely?
List where they are stored?
When is the RMP due to be updated?
NH3 facility complies with current industry standards?
- Collision Protection
- Bulk Head
- Emergency Shutoff Valve
- Saddles with Adequate Support
- Corrosion Barrier between Tank and Saddles
- Pull-Away Protection at Risers
- Underground Plumbing Leak Checked
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.
Unlicensed applicators and other handlers have WPS training documented at least once every 5 years?
Information Exchange takes place prior to application?
- Pesticide Name
- Active Ingredient
- EPA Registration #
- REI Time
- Posting or Oral Notification if Required
- Date, Time, and Location of Application
Decontamination sites are available within 1/4 mile for any pesticide handler?
- 5 Gallons Clean Water
- Individual Use Towels
- Eye Wash
- Change of Clothes
Is label required PPE available to all handlers, mixers, and loaders?
- Protective Eyewear
- Chem Resistant Footwear
- Chem Resistant Apron
- Chem Resistant Coveralls
- Chem Resistant Headgear
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?
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.
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.
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.
DVIR's are documented and filed for 90 days.
UCR completed and filed
MCS-150 completed biennially.
Log books are kept for non exempted drivers.
For log book exemptions, time cards reflect compliance with HOS regulations.
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.
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.
New driver training conducted for employees that obtain CDL during employment.
Defensive driver training completed at least every 3 years.
Facilities are audited at least quarterly by safety director.
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.
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.
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.
Policy addresses out of condition grain and procedures when problem arises.
Training addresses out of condition grain.
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.
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.
Job specific training completed
Annual inspections completed by a 3rd party inspector.
Documented 6 month inspection documented in house.
- body harnesses
- anchor points
- rope grabs
- class II group G lighting
Facility has current safety policies.
Facility has current emergency information.
Facility has current maps in the EAP.
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.
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.
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.
Classroom training completed on all operators.
Hands on training completed for all operators.
Performance evaluation conducted on all operators at least every 3 years.
Training as per owners manual.
Written program for specialized equipment.
Performance evaluations for all equipment operators.
Written plan of what to do, where to go, and responsibilities.
Emergency phone numbers are current and complete.
Personnel roster is current and complete.
Written plan adequately addresses major fire hazards on site.
Training on fire extinguishers as per policy.
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.
Written program and training.
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.
Written program in place.
Training for authorized employees.
PPE provided and trained on.
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.
24 Hour HAZWOPER training for employees.
8 hour refresher training for 24 hour trained employees annually.
Written program, training, and PPE in place.
Storage of compressed gases is safe. 20' separation or 30 min firewall.
OSHA 300 logs filled out appropriately.
State work comp form filled out and reported timely.
Supervisor is involved in accident reporting and investigation process.
Training on flammable liquids and flammable liquids storage.
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.
Class A/B/C operators on site according to state and EPA regulations.
State permitting in place for UST's.
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 are replaced at least every 15 years.
List method of documentation to track regulators.
% of regulators past due.
Documented monthly cargo tank inspections on file.
Daily remote shutoff test documented.
Annual and 5 year cargo tank tests completed.
CETP training documented for all drivers.
Refresher training for all LP employees.
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.
Completed and meets current NFPA 58 standards for plant.
Planning with local fire department (section 8) completed and sufficient.
Annual mailing sent to customers.
Renter/tenants also receive copies.
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"
All containers are labeled appropriately.
Shop is free from slip, trip, and fall hazards. Is clutter free. Is well kept.
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.
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.
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.