Ag Services, LLC Company Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

ACCIDENT PREVENTION PROGRAM

Active Management Support

• Is there active management support from the GM and Supervisors

  Yes

  No

  N/A

Return To Work

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

  Yes

  No

  N/A

New Hire Training

• Has new hire training been conducted timely and thoroughly?

  Yes

  No

  N/A

• Does the company have new employee protocols involving supervisors?

  Yes

  No

  N/A

Manager Facility Reviews

• Location manager is conducting and documenting a monthly facility review

  Yes

  No

  N/A

• Describe the documentation utilized.

On Going Training

• Documented monthly trainings being conducted?

  Yes

  No

  N/A

• Describe the documentation utilized.

Accident Investigations

• There is a written accident investigation program in place?

  Yes

  No

  N/A

• Written program addresses protocols and responsibilities?

  Yes

  No

  N/A

Near Miss Program

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Program Enforcement

• Violations of the safety programs are documented?

  Yes

  No

  N/A

• Job safety observations are completed by company supervisors?

  Yes

  No

  N/A

Written Programs

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Program Measurement

• What method is utilized to measure the safety program?

  Select DART Rate Work Comp Experince Mod Rate Incidence Rate Near Miss Program

  • DART Rate
  • Work Comp Experince Mod Rate
  • Incidence Rate
  • Near Miss Program

• Insert the rates from above.

• Yes

  No

  N/A

FERTILIZER & CHEMICAL

Restricted Use Sales

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

  Yes

  No

  N/A

• Describe the way to track.

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

  Yes

  No

  N/A

• Name of auditing agency, agent, and date.

Monthly Inspection Reports

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Statement of Service

• Is a statement of service sent to customers?

  Yes

  No

  N/A

• Does written statement of service address all state requirements?

  Yes

  No

  N/A

Risk Management Plan

• RMP contains written policies?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Current SDS is included in RMP manual?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• All findings from previous compliance audits have been addressed?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Documented maintenance activities meet manufacturers recommendations.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Consequences of deviation are included in the RMP manual?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

RMP 5 Year Update

• Are CDX usernames and passwords stored securely?

  Yes

  No

  N/A

• List where they are stored?

• When is the RMP due to be updated?

RMP Facility Inspection

• NH3 facility complies with current industry standards?

  Yes

  No

  N/A

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

  Select 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

  • 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

Permits & Licenses

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• Information Exchange takes place prior to application?

  Yes

  No

  N/A

• Select anything not included in the information exchange.

  Select Pesticide Name Active Ingredient EPA Registration # REI Time Posting or Oral Notification if Required Date, Time, and Location of 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?

  Yes

  No

  N/A

• Select any items missing from the decontamination kits.

  Select 5 Gallons Clean Water Soap Individual Use Towels Eye Wash Change of Clothes

  • 5 Gallons Clean Water
  • Soap
  • Individual Use Towels
  • Eye Wash
  • Change of Clothes

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

  Yes

  No

  N/A

• Select all PPE available.

  Select Protective Eyewear Gloves Chem Resistant Footwear Respirator Chem Resistant Apron Chem Resistant Coveralls Chem Resistant Headgear

  • Protective Eyewear
  • Gloves
  • Chem Resistant Footwear
  • Respirator
  • Chem Resistant Apron
  • Chem Resistant Coveralls
  • Chem Resistant Headgear

Bulk Chemicals

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

  Yes

  No

  N/A

• Are manufacturers agreements in place and filed?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Shuttles being filled meet current EPA and DOT requirements?

  Yes

  No

  N/A

• Describe shuttle documentation method.

• Plan in place to address chemical releases?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

Bulk Fertilizer

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

  Yes

  No

  N/A

• Fertilizer housekeeping is adequate.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Tier II Reports

• All chemicals in excess of the TPQ are filed.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

TRANSPORTATION DIVISION

Driver Qualification Files

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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.

  Yes

  No

  N/A

DOT Paperwork & Filings

• UCR completed and filed

  Yes

  No

  N/A

• MCS-150 completed biennially.

  Yes

  No

  N/A

• ISS Score is:

Hours of Service

• Log books are kept for non exempted drivers.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Hazardous Materials

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Statement of Purpose description in plan.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Current PVIKT inspections for appropriate vehicles and cargo tanks.

  Yes

  No

  N/A

• Documentation on file for each test mentioned above.

  Yes

  No

  N/A

• Shipping papers in place for all appropriate shipments.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Drug Testing Program

• Third party administrator.

  Yes

  No

  N/A

• Drug and alcohol testing policy.

  Yes

  No

  N/A

• Drug and alcohol testing procedures.

  Yes

  No

  N/A

• Consequences for non-compliance DOT mandated.

  Yes

  No

  N/A

• New employee drug training completed.

  Yes

  No

  N/A

• Supervisor reasonable suspicion training completed and filed.

  Yes

  No

  N/A

Driver Training

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

  Yes

  No

  N/A

• Defensive driver training completed at least every 3 years.

  Yes

  No

  N/A

GRAIN FACILITIES

Facility Audits

• Facilities are audited at least quarterly by safety director.

  Yes

  No

  N/A

Fumigation Management Plan

• Written FMP.

  Yes

  No

  N/A

• Application record keeping is documented and kept on file.

  Yes

  No

  N/A

• Employees and first responders are notified when fumigation occurs.

  Yes

  No

  N/A

• Monitoring records documented and available.

  Yes

  No

  N/A

• Monitoring equipment is adequate.

  Yes

  No

  N/A

• Fumigant is stored properly.

  Yes

  No

  N/A

• Label required PPE available for fumigation.

  Yes

  No

  N/A

FDA Bio-Security

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

  Yes

  No

  N/A

• FDA registration is renewed biennially.

  Yes

  No

  N/A

• FDA passwords and registration information saved and filed securely.

  Yes

  No

  N/A

Bin Entry Permits

• Permits filed and completed properly.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Out of Condition Grain

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

  Yes

  No

  N/A

• Training addresses out of condition grain.

  Yes

  No

  N/A

Hot Work Program

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Housekeeping & Maintenance

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

  Yes

  No

  N/A

• Documented housekeeping in place as per policy.

  Yes

  No

  N/A

• Training on elements of a dust explosion.

  Yes

  No

  N/A

• Choked leg procedure in place.

  Yes

  No

  N/A

• Written preventative maintenance schedule on file and trained on.

  Yes

  No

  N/A

• Maintenance activities documented as per company policy.

  Yes

  No

  N/A

Manlift

• Job specific training completed

  Yes

  No

  N/A

• Annual inspections completed by a 3rd party inspector.

  Yes

  No

  N/A

• Documented 6 month inspection documented in house.

  Yes

  No

  N/A

Rescue Equipment

• Select all rescue equipment available at the facility.

  Select cofferdam tripod winch lifeline body harnesses lanyards anchor points rope grabs come-a-long saws class II group G lighting other

  • cofferdam
  • tripod
  • winch
  • lifeline
  • body harnesses
  • lanyards
  • anchor points
  • rope grabs
  • come-a-long
  • saws
  • class II group G lighting
  • other

• Other.

OSHA

Safety Manuals

• Facility has current safety policies.

  Yes

  No

  N/A

• Facility has current emergency information.

  Yes

  No

  N/A

• Facility has current maps in the EAP.

  Yes

  No

  N/A

Lockout/Tag-Out

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

  Yes

  No

  N/A

• Completed LOTO permits as per company policy.

  Yes

  No

  N/A

• Annual/periodic inspections for all authorized employees.

  Yes

  No

  N/A

• List of authorized employees.

  Yes

  No

  N/A

Hazard Communication

• Current chemical list in place as per hazcomm policy.

  Yes

  No

  N/A

• Written hazcomm policy.

  Yes

  No

  N/A

• Training on new GHS standard.

  Yes

  No

  N/A

• All SDS' available for all chemicals on site.

  Yes

  No

  N/A

• Facilities are properly labeled for NFPA 704.

  Yes

  No

  N/A

Permit Required Confined Spaces

• Written program and training conducted.

  Yes

  No

  N/A

• An evaluation of all PRCS on site.

  Yes

  No

  N/A

• Written entry procedures for each space.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Forklift

• Classroom training completed on all operators.

  Yes

  No

  N/A

• Hands on training completed for all operators.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Specialized Equipment

• Training as per owners manual.

  Yes

  No

  N/A

• Written program for specialized equipment.

  Yes

  No

  N/A

• Performance evaluations for all equipment operators.

  Yes

  No

  N/A

Emergency Action Plans

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

  Yes

  No

  N/A

• Emergency phone numbers are current and complete.

  Yes

  No

  N/A

• Personnel roster is current and complete.

  Yes

  No

  N/A

Fire Prevention Plan

• Written plan adequately addresses major fire hazards on site.

  Yes

  No

  N/A

• Training on fire extinguishers as per policy.

  Yes

  No

  N/A

Personal Protective Equipment

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

  Yes

  No

  N/A

• Training of employees for required PPE.

  Yes

  No

  N/A

• Respiratory protection program is necessary.

  Yes

  No

  N/A

• Medical evaluations completed for employees in respiratory protection program.

  Yes

  No

  N/A

• Fit testing completed annually.

  Yes

  No

  N/A

Bloodborne Pathogens Program

• Written program and training.

  Yes

  No

  N/A

Contractor Safety

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

  Yes

  No

  N/A

• Contractor orientation guidelines are detailed and site specific.

  Yes

  No

  N/A

• Orientation is documented for all contract employees.

  Yes

  No

  N/A

Electrical Safety Program

• Written program in place.

  Yes

  No

  N/A

• Training for authorized employees.

  Yes

  No

  N/A

• PPE provided and trained on.

  Yes

  No

  N/A

Miscellaneous Programs

• Training for employees on safe lifting and back injuries.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

HAZWOPER

• 24 Hour HAZWOPER training for employees.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Welding/Cutting

• Written program, training, and PPE in place.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Accident Reporting

• OSHA 300 logs filled out appropriately.

  Yes

  No

  N/A

• State work comp form filled out and reported timely.

  Yes

  No

  N/A

• Supervisor is involved in accident reporting and investigation process.

  Yes

  No

  N/A

PETROLEUM

• Training on flammable liquids and flammable liquids storage.

  Yes

  No

  N/A

Aboveground Fuels

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

  Yes

  No

  N/A

• SPCC plan is reviewed internally annually.

  Yes

  No

  N/A

• SPCC is reviewed every 5 years by PE.

  Yes

  No

  N/A

Underground Fuels

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

  Yes

  No

  N/A

• State permitting in place for UST's.

  Yes

  No

  N/A

Propane

Leak Checks

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

  Yes

  No

  N/A

• List method of documentation to track leak checks.

• % of leak checks past due.

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Regulators

• Regulators are replaced at least every 15 years.

  Yes

  No

  N/A

• List method of documentation to track regulators.

• % of regulators past due.

Cargo Tanks

• Documented monthly cargo tank inspections on file.

  Yes

  No

  N/A

• Daily remote shutoff test documented.

  Yes

  No

  N/A

• Annual and 5 year cargo tank tests completed.

  Yes

  No

  N/A

Training

• CETP training documented for all drivers.

  Yes

  No

  N/A

• Refresher training for all LP employees.

  Yes

  No

  N/A

Bottle Fill

• Training for all bottle fill and exchange cabinet employees.

  Yes

  No

  N/A

• Documentation for bottles that cannot be filled.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Fire Safety Analysis

• Completed and meets current NFPA 58 standards for plant.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Duty to Warn

• Annual mailing sent to customers.

  Yes

  No

  N/A

• Renter/tenants also receive copies.

  Yes

  No

  N/A

Shipping Papers

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

SHOP & CONVENIENCE STORE

Housekeeping/Cleanliness

• All containers are labeled appropriately.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

General Shop Safety

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• PPE is clean and accessible.

  Yes

  No

  N/A

Automotive

• Auto lift has been trained on.

  Yes

  No

  N/A

• Lift hoist has been inspected annually.

  Yes

  No

  N/A

• Tire changing procedures have been trained on.

  Yes

  No

  N/A

• Wheel charts are posted in the tire shop.

  Yes

  No

  N/A

• Are widowmaker wheels still serviced in this shop?

  Yes

  No

  N/A

• 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.

  Yes

  No

  N/A

HOMELAND SECURITY

• Facilities have been registered under CFATS.

  Yes

  No

  N/A

• Password and username is documented and stored securely.

  Yes

  No

  N/A

• List where it is stored.

• Top screen completed.

  Yes

  No

  N/A

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

  Yes

  No

  N/A