AgVantage Safety, Environmental, Regulatory Audit

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Is SPCC compliance part of this inspection?

  Yes

  No

SPCC

• Supplies for conducting inspections are readily available and appear to be being used appropriately. (Tube and Stick or Interstitial Gauge)

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• Observation

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• Annual Inspection Checklist is current, complete, and correct.

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• Observation

• Corrected By and Date Corrected:

• Monthly Inspection Checklist is current, complete, and correct.

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• Observation

• Corrected By and Date Corrected:

• Portable Container Monthly Inspection Checklist is current, complete, and correct.

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• Observation

• Corrected By and Date Corrected:

• Is this a PE SPCC facility?

  Yes

  No

• Spill Prevention Briefings are current, complete, and correct.

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• Observation

• Corrected By and Date Corrected:

• Drainage Discharge Report is current, complete, and correct.

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• Observation

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• Does this location have a "manned" office?

  Yes

  No

Safety Programs

• There is a site specific Emergency Action Plan with proof of training/review.

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• Observation

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• There is a site specific Emergency Response Plan with proof of training/review.

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• Observation

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• There is a Bloodborne Pathogens Program in place with proof of training/review.

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• Observation

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• There is a Confined Space Entry Program (or Non-Entry) in place with proof of training/review.

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• Observation

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• There is a site specific Fire Prevention Plan with proof of training/review.

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• Observation

• Corrected By and Date Corrected:

• There is a plan in place for Forklift Operator Evaluation.

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• Observation

• Corrected By and Date Corrected:

• There is a site specific Hazard Communication Program with proof of training/review.

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• Observation

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• There is a site specific Hot Work Program with proof of training/review.

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• Observation

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• There is a site specific Hazard Assesment Program with proof of training/review.

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• Observation

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• There is a site specific LOTO program, appropriate equipment, and proof of training/review.

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• Observation

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• Water supply is protected via air gap or by RPZ valve with documentation of annual inspection.

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• Observation

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• There is proper documentation of CMV annual inspector qualifications as well as brake inspector qualifications.

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• Observation

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• There is a site specific Respiratory Protection program, appropriate equipment, and proof of training/review.

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• Observation

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• There is a copy of the most recent site inspection.

• Have all corrections been made and properly documented?

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• Observation

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• There is proper documentation of monthly Safety Awareness Meetings.

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• Observation

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• Does this facility deal in NH3?

  Yes

  No

NH3 Proof of Training

• There is proof of Classroom Training.

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• Observation

• Corrected By and Date Corrected:

• There is proof of Hands on Training—Safety Phase 8 Appendix C—Appendix D

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• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

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• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

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• Observation

• Corrected By and Date Corrected:

Other Concerns

• Identified the name and phone number of the Local Emergency Planning Coordinator (LEPC)

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• Observation

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• Company use LP tanks have proper decals and current regulator dates (date code within 25 years)

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• Observation

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• Identified which way the water flows on the property.

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• Observation

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• Identified where the storm sewer/tile intakes are on the property and how to plug them.

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• Observation

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• Electrical breakers are properly labeled.

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• Observation

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• There is proof of annual fire department tour.

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• Observation

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• First aid kit and high vis are in appropriate vehicles including application equipment.

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• Observation

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• All application equipment has WPS decontamination kit and fire extinguisher.

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• Observation

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• All “dead” light bulbs are being recycled and not in the dumpster or being stored on site.

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• Observation

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• Exits and non-exits are labeled properly.

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• Observation

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• OSHA posters are prominently displayed.

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• Observation

• Corrected By and Date Corrected:

Additional Safety Issues

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

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• Observation

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• Does this location have a shop?

  Yes

  No

• Does this facility have used oil?

  Yes

  No

Used Oil

• Proper disposal information is posted/available.

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• Observation

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• Used oil is properly labeled.

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• Observation

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• Used oil is stored in proper receptacle.

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• Observation

• Corrected By and Date Corrected:

• Proper disposal information is posted/available.

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• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

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• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

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• 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.

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• Observation

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• Does this area have a bench grinder?

  Yes

  No

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

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• Observation

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• Does this area have any other machines requiring guards?

  Yes

  No

• Guards on other machines are set properly.

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• Observation

• Corrected By and Date Corrected:

Signage

• Are there areas requiring eye protection?

  Yes

  No

• Appropriate eye protection warning signs are posted.

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• Observation

• Corrected By and Date Corrected:

• Exits and Non-Exits are properly labeled.

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• 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)

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• Observation

• Corrected By and Date Corrected:

Other Concerns

• Company use LP tanks have proper decals and current regulator dates (date code within 25 years)

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• Observation

• Corrected By and Date Corrected:

• Electrical breakers are properly labeled.

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• Observation

• Corrected By and Date Corrected:

• Does this area have a portable air tank?

  Yes

  No

• Is it within the manufacturer’s stamped life expectancy?

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• Observation

• Corrected By and Date Corrected:

• Does this area have shelving and storage?

  Yes

  No

• Shelving and storage is properly anchored.

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• Observation

• Corrected By and Date Corrected:

• Combustible materials/trash are in a steel can with lid in accordance with a quality fire prevention plan.

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• Observation

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

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• Observation

• Corrected By and Date Corrected:

Additional Safety Issues

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

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• Observation

• Corrected By and Date Corrected:

• Does this location have Liquid Operations?

  Yes

  No

General

• Tanks and their contents are properly labeled.

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• Observation

• Corrected By and Date Corrected:

• Rinsate containers are labeled as such.

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• Observation

• Corrected By and Date Corrected:

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

  Yes

  No

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

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• Observation

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• Elevated walkways and platforms are constructed to OSHA standards.

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• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

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• Observation

• Corrected By and Date Corrected:

• External site gauges have lockable valves and are locked or otherwise secured when the facility is unattended.

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• Observation

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• Cracks and/or separations are sealed in containment and operational area.

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• Observation

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• Associated appurtenances and piping are located within or over a containment area. (Includes concentric piping)

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• Observation

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

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• Observation

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• There is an eyewash/safety shower station located nearby and there is proof of weekly activation.

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• Observation

• Corrected By and Date Corrected:

Signage

• Exits and Non-Exits are properly labeled.

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• 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)

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• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Is this facility required to have a fire extinguisher?

  Yes

  No

• Fire extinguishers are hung properly.

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• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

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• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

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• Observation

• Corrected By and Date Corrected:

• Electrical breakers are properly labeled.

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• Observation

• Corrected By and Date Corrected:

• Does this facility have shelving and storage?

  Yes

  No

• Shelving and storage is properly anchored.

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• Observation

• Corrected By and Date Corrected:

• All tanks have confined space labels as necessary.

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• Observation

• Corrected By and Date Corrected:

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

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• Observation

• Corrected By and Date Corrected:

Additional Safety Issues

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

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• Observation

• Corrected By and Date Corrected:

• Does this location have Dry Operations?

  Yes

  No

General

• The contents of all bins are properly labeled.

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• Observation

• Corrected By and Date Corrected:

• Does this facility have elevated walkways and platforms?

  Yes

  No

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

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• Observation

• Corrected By and Date Corrected:

• Elevated walkways and platforms are constructed to OSHA standards.

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• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

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• Observation

• Corrected By and Date Corrected:

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

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• Observation

• Corrected By and Date Corrected:

Signage

• Exits and Non-Exits are properly labeled.

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• 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)

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• Observation

• Corrected By and Date Corrected:

Guarding

• All guards are complete and have been installed properly.

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• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

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• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

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• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

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• Observation

• Corrected By and Date Corrected:

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

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  Media

• Observation

• Corrected By and Date Corrected:

Additional Safety Issues

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

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• 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.

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• 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)

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• 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.

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• Observation

• Corrected By and Date Corrected:

• Does this facility have other equipment requiring guards?

  Yes

  No

• Other guards are complete and installed properly.

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• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

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• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

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• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

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• 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.

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• Observation

• Corrected By and Date Corrected:

• Is this facility considered a chemical warehouse?

  Yes

  No

• Emergency spill kit is available and adequately stocked.

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• Observation

• Corrected By and Date Corrected:

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

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• Observation

• Corrected By and Date Corrected:

Additional Safety Issues

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

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• Observation

• Corrected By and Date Corrected:

• Does this location have NH3 Operations?

  Yes

  No

General

• Adequate and proper crash protection is installed.

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• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

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• Observation

• Corrected By and Date Corrected:

• Emergency water tank is full and water is generally clear and free of debris.

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• Observation

• Corrected By and Date Corrected:

• There is a NH3 safety kit that is readily available and contains the following: Burn Sheet Boots Slicker Gloves Goggles

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• Observation

• Corrected By and Date Corrected:

• Bleed off water tank is a minimum of 200 gallons and properly labeled.

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• Observation

• Corrected By and Date Corrected:

• Tank is properly labeled.

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• Observation

• Corrected By and Date Corrected:

• Piping and bulkhead have been painted to GROWMARK standards. Orange and yellow valves. Green bulkhead.

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• Observation

• Corrected By and Date Corrected:

• Relief valve and hydrostatic caps are properly installed on storage tank as well as nurse tanks.

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• Observation

• Corrected By and Date Corrected:

• Emergency shutdowns are properly labeled and in working order.

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• Observation

• Corrected By and Date Corrected:

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

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• Observation

• Corrected By and Date Corrected:

• There is a functional windsock/flag near the riser or at a minimum easily visible form the riser.

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• Observation

• Corrected By and Date Corrected:

Guarding

• 6 sided guards are complete and installed properly.

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• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

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  Media

• Observation

• Corrected By and Date Corrected:

Additional Safety Issues

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

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• Observation

• Corrected By and Date Corrected:

• Does this location have LP Operations?

  Yes

  No

General

• Adequate and proper crash protection is installed.

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• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

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• Observation

• Corrected By and Date Corrected:

• Tank is properly labeled.

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• Observation

• Corrected By and Date Corrected:

• Piping and Bulkhead are painted to GROWMARK standards. Red and White valves. Red Bulkhead.

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• Observation

• Corrected By and Date Corrected:

• Caps on relief valves and hydrostats are installed correctly.

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• Observation

• Corrected By and Date Corrected:

• Emergency shutdowns are properly labeled and in working order.

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• Observation

• Corrected By and Date Corrected:

Guarding

• 6 sided guards are complete and properly installed.

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• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

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  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

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  Media

• Observation

• Corrected By and Date Corrected:

Other Concerns

• Electrical breakers are properly labeled.

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• Observation

• Corrected By and Date Corrected:

Additional Safety Issues

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

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• Observation

• Corrected By and Date Corrected:

• Does this location have company use fuel tanks?

  Yes

  No

General

• All tanks are properly and adequately labeled.

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• Observation

• Corrected By and Date Corrected:

• Grounding rod has been properly installed.

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• Observation

• Corrected By and Date Corrected:

• Spill response materials are available nearby.

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• Observation

• Corrected By and Date Corrected:

• There is a safe step to fill the tank and read the meter.

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• Observation

• Corrected By and Date Corrected:

• Gasoline vent pipe is at least 12 feet above the ground.

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• Observation

• Corrected By and Date Corrected:

• Proper and adequate crash protection is installed.

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• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

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  Media

• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

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  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

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  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:

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• Observation

• Corrected By and Date Corrected:

• Does this location have Bulk Fuel Operations?

  Yes

  No

General

• All tanks are properly and adequately labeled.

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• Observation

• Corrected By and Date Corrected:

• Adequate measures have been taken to provide site security.

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• Observation

• Corrected By and Date Corrected:

• Valves are shut off at the tank when the facility is unattended.

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• Observation

• Corrected By and Date Corrected:

• Transport unload piping is properly labeled and plugs are installed.

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• Observation

• Corrected By and Date Corrected:

• Grounding rods are properly installed.

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• Observation

• Corrected By and Date Corrected:

• Gasoline nozzle extension is installed.

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• Observation

• Corrected By and Date Corrected:

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

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• Observation

• Corrected By and Date Corrected:

Fire Extinguishers

• Fire extinguishers are hung properly.

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  Media

• Observation

• Corrected By and Date Corrected:

• Monthly inspections have been properly documented.

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• Observation

• Corrected By and Date Corrected:

Other Concerns

• Adequate lovejoy guards are installed on pumps/motors.

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• Observation

• Corrected By and Date Corrected:

• Electrical breakers are properly labeled.

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• Observation

• Corrected By and Date Corrected:

• All tanks have confined space labels as necessary.

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• Observation

• Corrected By and Date Corrected:

Additional Safety Issues

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

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• Observation

• Corrected By and Date Corrected:

Contact Information

• 911 contact information sign is up to date.

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• Observation

• Corrected By and Date Corrected:

• Non-essential 911 information is updated or removed.

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• 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:

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• Observation

• Corrected By and Date Corrected:

• Does this location have a forklift?

  Yes

  No

General

• Inspection card is posted and legible.

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• Observation

• Corrected By and Date Corrected:

• Seatbelt is in working order.

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• Observation

• Corrected By and Date Corrected:

• Forklift is equipped with an operational horn.

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• 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:

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• 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:

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• 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