Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

Office

  • Is SPCC compliance part of this inspection?

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

  • Corrected By and Date Corrected:

  • 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.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Is this a PE SPCC facility?

  • 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

  • Corrected By and Date Corrected:

  • Does this location have a "manned" office?

Safety Programs

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

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • 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.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

  • Have all corrections been made and properly documented?

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  • Observation

  • Corrected By and Date Corrected:

  • There is proper documentation of monthly Safety Awareness Meetings.

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  • Observation

  • Corrected By and Date Corrected:

  • Does this facility deal in NH3?

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

  • Corrected By and Date Corrected:

  • 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:

  • Identified which way the water flows on the property.

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  • Observation

  • Corrected By and Date Corrected:

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

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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:

  • There is proof of annual fire department tour.

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

  • Exits and non-exits are labeled properly.

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  • Observation

  • Corrected By and Date Corrected:

  • 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:

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Shop

  • Does this location have a shop?

  • Does this facility have used oil?

Used Oil

  • Proper disposal information is posted/available.

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  • Observation

  • Corrected By and Date Corrected:

  • Used oil is properly labeled.

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  • Observation

  • Corrected By and Date Corrected:

  • 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.

  • 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

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  • Observation

  • Corrected By and Date Corrected:

  • Does this area have any other machines requiring guards?

  • Guards on other machines are set properly.

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  • Observation

  • Corrected By and Date Corrected:

Signage

  • Are there areas requiring eye protection?

  • 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?

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Other Concerns

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

  • Add media

  • 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?

  • 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?

  • Shelving and storage is properly anchored.

  • Add media

  • 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

  • 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.

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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?

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Elevated walkways and platforms are constructed 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:

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

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  • Observation

  • Corrected By and Date Corrected:

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

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  • Observation

  • Corrected By and Date Corrected:

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

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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:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

Signage

  • Exits and Non-Exits are properly labeled.

  • 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:

  • 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 confined space labels as necessary.

  • 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.

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  • Observation

  • Corrected By and Date Corrected:

  • Does this facility have elevated walkways and platforms?

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Elevated walkways and platforms are constructed 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:

  • 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

  • All 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.

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  • 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.

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  • Observation

  • Corrected By and Date Corrected:

  • Is this facility considered a chemical warehouse?

  • Emergency spill kit is available and adequately stocked.

  • 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.

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  • 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 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.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Tank is properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • 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:

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

  • 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:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Caps on relief valves and hydrostats are installed correctly.

  • 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:

Company Use Fuel Tanks and Bulk Fuel Operations

  • Does this location have company use fuel tanks?

General

  • All tanks are properly and adequately labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Grounding rod has been properly installed.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Spill response materials are available nearby.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Proper and adequate 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:

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

    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:

  • 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:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

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

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Grounding rods are properly installed.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Gasoline nozzle extension is installed.

  • 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

  • Adequate lovejoy guards are installed on pumps/motors.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • Electrical breakers are properly labeled.

  • Add media

  • Observation

  • Corrected By and Date Corrected:

  • All tanks have confined space labels as necessary.

  • 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

  • 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:

  • Forklift is equipped with an operational horn.

  • 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.