AgVantage FS Site Inspection

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

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

  Media

• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Exits and non-exits are labeled properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• OSHA posters are prominently displayed.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• OSHA 300 Log has been taken down.

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

• Does this location have a shop?

  Yes

  No

• Does this facility have used oil?

  Yes

  No

Used Oil

• Used oil is properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Used oil is stored in proper receptacle.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Proper disposal information is posted/available.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Guarding

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

  Yes

  No

• 6 sided guards are complete and installed properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this area have a bench grinder?

  Yes

  No

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this area have any other machines requiring guards?

  Yes

  No

• Guards on other machines are set properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Signage

• Are there areas requiring eye protection?

  Yes

  No

• Appropriate eye protection warning signs are posted.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Exits and Non-Exits are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Proper and adequate NFPA signs are posted.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this area have electrical overhead doors?

  Yes

  No

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this area have shelving and storage?

  Yes

  No

• Shelving and storage is properly anchored.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

• Does this location have Liquid Operations?

  Yes

  No

General

• Tanks and their contents are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

  Yes

  No

• Elevated walkways and platforms are constructed to OSHA standards.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Signage

• Exits and Non-Exits are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Proper and adequate NFPA signs have been posted.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this facility have electrical overhead doors?

  Yes

  No

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Is this facility required to have a fire extinguisher?

  Yes

  No

• Fire extinguishers are hung properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this facility have shelving and storage?

  Yes

  No

• Shelving and storage is properly anchored.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• All tanks have proper confined space stickers.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

• Does this location have Dry Operations?

  Yes

  No

General

• The contents of all bins are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this facility have elevated walkways and platforms?

  Yes

  No

• Elevated walkways and platforms are constructed to OSHA standards.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Signage

• Exits and Non-Exits are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Proper and adequate NFPA labels have been posted.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this facility have electrical overhead doors?

  Yes

  No

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Guarding

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

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

  Yes

  No

Signage

• Exits and Non-Exits are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Proper and adequate NFPA signs have been posted.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this facility have electrical overhead doors?

  Yes

  No

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Guarding

• Does this facility have equipment requiring 6 sided guards?

  Yes

  No

• 6 sided guards are complete and installed properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this facility have other equipment requiring guards?

  Yes

  No

• Other guards are complete and installed properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Does this facility have shelving and storage?

  Yes

  No

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

• Does this location have NH3 Operations?

  Yes

  No

General

• Adequate and proper crash protection is installed.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Emergency water tank is full.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Bleed off water tank is properly sized and labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Tank is properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Emergency shutdowns are properly labeled and in working order.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Guarding

• 6 sided guards are complete and installed properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

• Does this location have LP Operations?

  Yes

  No

General

• Adequate and proper crash protection is installed.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Tank is properly labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Emergency shutdowns are properly labeled and in working order.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Guarding

• 6 sided guards are complete and properly installed.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

• Does this location have Bulk Fuel Operations?

  Yes

  No

General

• All tanks are properly and adequately labeled.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

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

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

Contact Information

• 911 contact information sign is up to date.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Non-essential 911 information is updated or removed.

• Add media

  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

  Media

• Observation

• Corrected By and Date Corrected:

• Does this location have a forklift?

  Yes

  No

General

• Green inspection card is posted and legible.

• Add media

  Media

• Observation

• Corrected By and Date Corrected:

• Seatbelt is in working order.

• Add media

  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

  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

  Media

• Observation

• Corrected By and Date Corrected:

Review and Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign