Agronomy Branch

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Plant:

• Sanitation: Refrigerators, drinking fountains, coffee pots, microwaves Poor-1 Fair-3 Good-6 Excellent-10

• Picture?

  Media

• Clutter Inside, Office Area & Plant Area Poor-1 Fair-3 Good-6 Excellent-10

• Picture?

  Media

• Dust & Cob web Accumulation Poor-1 Fair-3 Good-6 Excellent-10

• Picture?

  Media

• Inside cabs of Trucks, Floaters, Rogators, Etc. Clean Poor-1 Fair-3 Good-8 Excellent-12

• Picture?

  Media

• Maintenance Program & Log for mixers, augers, drags, etc. Poor-1 Fair-3 Good-6 Excellent-10

• Picture?

  Media

Safety:

• Lock Out Tag Out Observed Poor-0 Fair-0 Good-2 Excellent-12

• Picture?

  Media

• Guards in place & secure Poor-0 Fair-0 Good-2 Excellent-12

• Picture?

  Media

• Electrical Boxes: Knock outs in tact, boxes in good repair and closed. Poor-1 Fair-3 Good-6 Excellent-10

• Picture

  Media

• Extension cords and welder leads Poor-1 Fair-2 Good-4 Excellent-8

• Picture?

  Media

• Area around electrical boxes and fire extinguishers maintained (3') Poor-1 Fair-2 Good-4 Excellent-8

• Picture?

  Media

Programs:

• Maintenance Program & Annual Inspections for Trucks, Floaters, Rogators, etc. Poor-1 Fair-2 Good-6 Excellent-10

• Fertilizer and Chemical Dikes free of clutter Poor-1 Fair-2 Good-3 Excellent-7

• Picture?

  Media

• Fire Extinguishers checked monthly. Poor-0 Fair-1 Good-2 Excellent-6

• Daily record keeping: Fork Lift, Skid Loader, Wrangler, 4 Wheeler, Kubota, Other Equipment Poor-1 Fair-2 Good-4 Excellent-8

• Safety Meetings: Monthly (minimum) Poor-0 Fair-1 Good-2 Excellent-6

• Written Programs kept up to date Poor-0 Fair-0 Good-1 Excellent-5

General:

• Product Labeling Poor-0 Fair-1 Good-2 Excellent-6

• Picture?

  Media

• Vegetation Control (Weeds/Grass) Poor-0 Fair-0 Good-1 Excellent-4

• Picture?

  Media