Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

Office

Company Reference Manual

  • There is a copy of the Safety Expectation Sheet in Section 0.

  • Corrected By and Date Corrected:

  • There is proof of an Annual Fire Department Tour in Section 15.

  • Corrected By and Date Corrected:

  • There is proof of LOTO Certification in Section 24.

  • Corrected By and Date Corrected:

  • There is a copy of last year's Risk Management Site Inspection in Section 26.

  • Have all corrections been made and properly documented?

  • Corrected By and Date Corrected:

  • There is proper documentation in Section 29 of On Site Training regarding the Work Comp Costs and Frequency email dated 3-28-16.

  • Corrected By and Date Corrected:

  • There is proper documentation in Section 29 of On Site Training regarding Man Basket Expectations from the December CTO Meetings.

  • Corrected By and Date Corrected:

  • There is proper documentation in Section 29 of On Site Training regarding the Medcor Procedure Reminder email dated 11-18-15.

  • Corrected By and Date Corrected:

  • There is proper documentation in Section 29 of On Site Training regarding the Forklift Safety Incident email dated 10-12-15.

  • Corrected By and Date Corrected:

  • There is proper documentation in Section 29 of On Site Training regarding the NH3 Safety Incident email dated 9-10-15.

  • Corrected By and Date Corrected:

RMP Binder

  • There is proof of 2016 Classroom Training from Peosta.

  • Corrected By and Date Corrected:

  • There is proof of Spring 2016 Hands on Training Appendix C completed for each employee.

  • Corrected By and Date Corrected:

  • There is proof of Spring 2016 Hands on Training Appendix D completed for each employee.

  • Corrected By and Date Corrected:

  • There is proof of Fall 2015 Hands on Training Appendix C completed for each employee.

  • Corrected By and Date Corrected:

  • There is proof of Fall 2015 Hands on Training Appendix D completed for each employee.

  • Corrected By and Date Corrected:

NH3 Supplies

  • Does this location have readily available the following: Burn Sheet Boots Slicker Spare Gloves Spare Goggles Windsock/Flag

  • Items still needed:

SPCC

  • This facility is in compliance with SPCC regulations.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Fire Extinguishers

  • Fire extinguishers are hung properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Monthly inspections have been properly documented.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Exits and non-exits are labeled properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • OSHA posters are prominently displayed.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • OSHA 300 Log has been taken down.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Shop

  • Does this location have a shop?

  • Does this facility have used oil?

Used Oil

  • Used oil is properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Used oil is stored in proper receptacle.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Proper disposal information is posted/available.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Fire Extinguishers

  • Fire extinguishers are hung properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Monthly inspections have been properly documented.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Guarding

  • Does this area have equipment requiring a 6 sided guard?

  • 6 sided guards are complete and installed properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this area have a bench grinder?

  • Guards on grinder are set properly. 1/4" Tongue and 1/8" Rest

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this area have any other machines requiring guards?

  • Guards on other machines are set properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Signage

  • Are there areas requiring eye protection?

  • Appropriate eye protection warning signs are posted.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Exits and Non-Exits are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Proper and adequate NFPA signs are posted.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this area have electrical overhead doors?

  • All overhead doors have proper and adequate crush protection. (Sign or Photo Eyes)

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this area have shelving and storage?

  • Shelving and storage is properly anchored.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • The general cleanliness of this area promotes prevention of slips, trips, and falls.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Liquid Operations

  • Does this location have Liquid Operations?

General

  • Tanks and their contents are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have elevated walkways and/or platforms?

  • Elevated walkways and platforms are constructed to OSHA standards.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Access to elevated walkways, platforms, and tanks is controlled to OSHA standards.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Adequate measures have been taken to provide site security.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Secondary containment structures are in good repair and appear to be functioning properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • There is an eyewash/safety shower station located on site.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Signage

  • Exits and Non-Exits are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Proper and adequate NFPA signs have been posted.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have electrical overhead doors?

  • All overhead doors have proper and adequate crush protection. (Sign or Photo Eyes)

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Fire Extinguishers

  • Is this facility required to have a fire extinguisher?

  • Fire extinguishers are hung properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Monthly inspections have been properly documented.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have shelving and storage?

  • Shelving and storage is properly anchored.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • All tanks have proper confined space stickers.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • The general cleanliness of this area promotes prevention of slips, trips, and falls.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Dry Operations

  • Does this location have Dry Operations?

General

  • The contents of all bins are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have elevated walkways and platforms?

  • Elevated walkways and platforms are constructed to OSHA standards.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Access to elevated walkways and platforms is controlled to OSHA standards.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Adequate measures have been taken to provide site security.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Secondary containment structures are in good repair and appear to be functioning properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Signage

  • Exits and Non-Exits are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Proper and adequate NFPA labels have been posted.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have electrical overhead doors?

  • All overhead doors have proper and adequate crush protection. (Sign or Photo Eyes)

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Guarding

  • 6 sided guards are complete and have been installed properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Fire Extinguishers

  • Fire extinguishers are hung properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Monthly inspections have been properly documented.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • The general cleanliness of this area promotes prevention of slips, trips, and falls.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Chemical Warehouse, Seed Storage, Treatment

  • Does this location have a Chemical Warehouse, Seed Storage, Treatment area?

Signage

  • Exits and Non-Exits are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Proper and adequate NFPA signs have been posted.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have electrical overhead doors?

  • All overhead doors have proper and adequate crush protection. (Sign or Photo Eyes)

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Guarding

  • Does this facility have equipment requiring 6 sided guards?

  • 6 sided guards are complete and installed properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have other equipment requiring guards?

  • Other guards are complete and installed properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Fire Extinguishers

  • Fire extinguishers are hung properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Monthly inspections have been properly documented.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have shelving and storage?

  • Shelving and storage is properly anchored to floor or wall.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • The general cleanliness of this area promotes prevention of slips, trips, and falls.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

NH3 Operations

  • Does this location have NH3 Operations?

General

  • Adequate and proper crash protection is installed.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Adequate measures have been taken to provide site security.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Emergency water tank is full.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Bleed off water tank is properly sized and labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Tank is properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Emergency shutdowns are properly labeled and in working order.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Stairs to the riser are built according to OSHA standards.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Guarding

  • 6 sided guards are complete and installed properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

LP Operations

  • Does this location have LP Operations?

General

  • Adequate and proper crash protection is installed.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Adequate measures have been taken to provide site security.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Tank is properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Emergency shutdowns are properly labeled and in working order.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Guarding

  • 6 sided guards are complete and properly installed.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Fire Extinguishers

  • Fire extinguishers are hung properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Monthly inspections have been properly documented.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Bulk Fuel Operations

  • Does this location have Bulk Fuel Operations?

General

  • All tanks are properly and adequately labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Adequate measures have been taken to provide site security.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Secondary containment structures are in good repair and appear to be working properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Fire Extinguishers

  • Fire extinguishers are hung properly.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Monthly inspections have been properly documented.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

911 Information

Contact Information

  • 911 contact information sign is up to date.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Non-essential 911 information is updated or removed.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

    Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Forklift

  • Does this location have a forklift?

General

  • Green inspection card is posted and legible.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Seatbelt is in working order.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

    Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Areas

Other Concerns

    Additional Safety Issues
  • If this box is not checked you have the following additional concerns to address:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Review and Sign

Review and Sign

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.