Title Page

  • Facility Name

  • Audit Date

  • Auditors

  • Section 1 = Safety & Health Administration - Eligible Points = 21

  • Section 2 = Regulatory Compliance - Eligible Points = 122

  • Section 3 = Machine Specific - Eligible Points = 5

  • Section 4 = Equipment Inspections - Eligible Points = 14

  • Section 5 = Air Monitoring - Eligible Points = 1

  • Comments

Safety & Health Administration

Reporting and Tracking of Accidents and Illnesses

  • A. Current OSHA log (Form 300) is maintained and up to date

  • Comments

  • B. Completed OSHA logs are maintained and available for review for the previous five years

  • Comments

  • C. An OSHA Form 301 (Injury and Illness Incident Report) or adequate State Workers' Compensation First Report of Injury is on file for the current year each injury or illness

  • Comments

  • D. OSHA Form 301 (or State Workers' Compensation First Report of Injury) is on file and maintained for the previous five years

  • Comments

  • E. The completed OSHA 300-A Summary forms is posted in a prominent place between February 1 - April 30

  • Comments

  • F. Completed OSHA 300-A summary forms are maintained for the previous 5 years

  • Comments

  • G. OSHA required information is readily accessible to meet 4 hour accessibility requirement. (OSHA 300 and 300-A forms)

  • Comments

Medical/Treatment

  • A. First Aid/CPR/AED training is completed for site personnel with documentation

  • Comments

  • B. Standing orders have been developed by a physician and reviewed every two years with documentation

  • Comments

  • C. First aid kits available and appropriately stocked

  • Comments

Incident Reporting and Investigation Procedures

  • A. Supervisor incident reports are completed for all OSHA record-able accidents and near misses deemed serious

  • Comments

  • B. Incident Review Boards are conducted for any OSHA record-able, property damage, involving powered industrial equipment or other incidents with potential for serious injury. (IRB form completed)

  • Comments

Safety Committee

  • A. Safety Steering team meetings are held monthly with documentation

  • Comments

  • B. Facility Safety teams meet at least on a monthly basis with documentation & include ergonomics

  • Comments

  • C. Facility Safety team members are provided documented training on their responsibilities

  • Comments

  • D. Facility Safety teams conduct periodic audits of the facility to include ergonomics

  • Comments

  • E. Process Safety Management (PSM) meetings are held at least on a monthly basis with documentation

  • Comments

  • F. Facility safety/engineering/maintenance planning meetings are held on a weekly basis

  • Comments

Facility Safety Inspections

  • A. Daily safety inspections are conducted and documented. Deficiencies identified are corrected with documentation

  • Comments

  • B. Monthly safety inspections are conducted and documented. Deficiencies identified are corrected with documentation

  • Comments

  • C. Quarterly facility inspections are conducted and documented. Deficiencies are corrected and documented

  • Comments

Regulatory Compliance

Fire Prevention and Protection

  • A. Fire extinguisher training is conducted on an annual basis for authorized users through the Alchemy LMS

  • Comments

  • B. Fire extinguishers are inspected monthly with documentation

  • Comments

  • C. Fire extinguishers are inspected annually by a third party with documentation

  • Comments

  • D. Fire extinguishers are not blocked

  • Comments

  • E. Maximum travel distance for a fire extinguisher is 75 feet

  • Comments

  • F. Fire extinguishers are not mounted above 5 feet and no less than 4 inches off the floor

  • Comments

  • G. Authorized employees receive initial "Hot Work" training with refresher training every three years through the Alchemy LMS

  • Comments

  • H. Hot Work Permits are fully utilized and completed accurately

  • Comments

  • I. Areas requiring hot work permits are identified with documentation

  • Comments

  • J. Hot Work Permits are maintained onsite for 30 days

  • Comments

  • K. The hot work program and completed hot work permits (30 days) are evaluated on an annual basis with documentation

  • Comments

  • L. Sprinklers Systems and alarms are inspected quarterly by a third party with documentation

  • Comments

  • M. Annual Pump test are completed for sprinkler systems by a third party with documentation

  • Comments

  • N. Sprinkler pumps are test run weekly (in-house) with documentation

  • Comments

  • O. Monthly valve position inspections for each sprinkler riser is conducted monthly in-house with documentation

  • Comments

Walking Surfaces

  • A. All work platforms, stairs, ladders and mezzanines are designed according to Mountaire and OSHA construction standards

  • Comments

  • B. Floors are in good condition and slip resistant

  • Comments

  • C. Drain grating is in good condition and slip resistant

  • Comments

  • D. Signage and warning cones are used during floor cleaning

  • Comments

Personal Protective Equipment (PPE)

  • A. Job/task specific PPE hazard assessments have been performed to determine PPE needs

  • Comment

  • B. Job/task specific PPE hazard assessments are reviewed on an annual basis

  • Comment

  • C. Observations indicate that employees are wearing PPE as required by job task

  • Comment

Hearing Conservation

  • A. Sound levels have been measured and documented for all areas of the facility (annually)

  • Comments

  • B. Warning signs are posted in high noise areas

  • Comments

  • C. Audiometric examinations are conducted for affected employees on an annual basis

  • Comments

  • D. The OSHA hearing conservation program standard is posted in the facility

  • Comments

  • E. The written hearing conservation program is audited on an annual basis

  • Comments

  • F. Hearing conservation training is conducted on an annual basis

  • Comments

  • G. Employees with hearing shifts are retrained on the proper use of hearing protection with documentation

  • Comments

Hazard Communication

  • A. All chemicals on-site are pre-approved by Safety & Environmental and in the MSDS online system

  • Comments

  • B. All containers are clearly labeled including the appropriate warnings and pictograms

  • Comments

  • C. Chemicals not in original container and not for immediate use have GHS labels (pictograms, signal word & precautionary statements)

  • Comments

  • D. MSDS online icon is available on Kiosks

  • Comments

  • E. The written hazard communication program is audited on an annual basis

  • Comments

Hazardous Energy Control - Lockout/Tagout

  • A. Types of locks utilized are identifiable and issued to authorized employees

  • Comments

  • B. All authorized employees are properly trained on the lockout/tagout program through the Alchemy & Training Department (initial & annual refresher)

  • Comments

  • C. All authorized employees are trained on the "LOTO Observation Skills Steps" annually with documentation (form developed)

  • Comments

  • D. Written lockout/tagout procedures have been developed for each piece of equipment addressing all types of energy as required

  • Comments

  • E. Locations for lockout/tagout disconnects are listed for each unit in the written procedure

  • Comments

  • F. An annual inspection of energy control procedures will be conducted to include verification of authorized personnel understanding of LOTO machine specific procedures (documented)

  • Comments

  • G. Line opening permits are maintained on-site for 1 year

  • Comments

  • H. Annual review of completed line opening permits is completed with documentation

  • Comments

Powered Industrial Equipment

  • A. Authorized pallet jack operators receive initial training with refresher training every 2 years (documented)

  • Comments

  • B. Authorized fork lift operators receive initial training with refresher training every 2 years (documented)

  • Comments

  • C. Pallet jack pre-trip inspections are completed with documentation

  • Comments

  • D. Fork lift pre-trip inspections are completed with documentation

  • Comments

  • E. Forklifts are equipped with backup alarms, horns, lights & fire extinguishers

  • Comments

  • F. All forklifts are equipped with overhead protection and seat belts

  • Comments

  • G. Pallet jack and fork lift operators are carrying their certification license

  • Comments

  • H. Seat belts are being worn on all forklifts

  • Comments

  • I. Authorized skid steer operators receive initial training with refresher training every 2 years (documented)

  • Comments

  • J. Skid steer pre-trip inspections are completed with documentation

  • Comments

  • K. Authorized articulating boom operators receive initial training with refresher training every 3 years (documented)

  • Comments

Emergency Action Plans - Egress

  • A. An Emergency Action Plan has been developed and updated when facility changes are made. (fire, chemical, weather, bomb threat & medical emergency)

  • Comments

  • B. The Emergency Action Plan is reviewed on an annual basis with documentation

  • Comments

  • C. Exit signs are illuminated with a minimum of 5 foot candles of light

  • Comments

  • D. Doors that are not exits are marked "Not an Exit"

  • Comments

  • E. Exits are not blocked

  • Comments

  • F. Egress exit doors are not locked or equipped with appropriate panic bars

  • Comments

  • G. Annual fire evacuation drills are conducted by shift with documentation (includes head count)

  • Comments

  • H. All supervisors are trained on emergency evacuation procedures on an annual basis with documentation

  • Comments

  • I. Evacuation assembly areas are designated (Signage for processing facilities)

  • Comments

  • J. Emergency lighting is in working order and inspected on a monthly basis with documentation

  • Comments

  • K. Local Fire Department has conducted site visit within the last three years with documentation

  • Comments

Bloodborne Pathogens

  • A. Bio-waste bags and/or sharps containers are labeled and utilized

  • Comments

  • B. Authorized employees are trained on an annual basis through Alchemy (medical, janitorial, first aid & others)

  • Comments

  • C. Documentation exists that hepatitis vaccinations are offered to employees

  • Comments

  • D. Personal protective equipment (PPE) has been issued to all bloodborne pathogen responders

  • Comments

Confined Space Entry

  • A. All authorized employees are trained on confined space entry through the Alchemy LMS every three years

  • Comments

  • B. Rescue training is completed for authorized confined space trained employees with documentation (if needed)

  • Comments

  • C. Air monitoring equipment is maintained and available on-site for any confined space entries

  • Comments

  • D. A master list of confined spaces is maintained

  • Comments

  • E. All confined spaces are posted with appropriate signage

  • Comments

  • F. Rescue equipment is maintained or available on-site at time of any confined space entry. (confined spaces not declassified)

  • Comments

  • G. Confined space permits are maintained on-site for one year

  • Comments

  • H. The confined space program and confined space permits are evaluated on an annual basis with documentation

  • Comments

Respiratory Protection

  • A. Respiratory protection training is conducted through the Alchemy LMS on an annual basis

  • Comments

  • B. Appendix D form is completed for all employees wearing respirators on a voluntary basis

  • Comments

  • C. Respiratory physicals are performed on an annual basis with documentation of clearance from our medical provider

  • Comments

  • D. Fit testing is performed for all employees wearing respirators. Requires documentation by each type of mask/regulator

  • Comments

  • E. Respirators are clean and stored in an appropriate container or bag

  • Comments

Formaldehyde

  • A. New hire orientation training for Formaldehyde is completed for affected employees through the Alchemy LMS to include temporary and contract workers

  • Comments

  • B. Annual formaldehyde training is completed for authorized employees through the Alchemy LMS to include temporary and contract workers

  • Comments

  • C. Warning signage is utilized to identify hallways/rooms during formaldehyde use

  • Comments

  • D. Bulk storage of formaldehyde has appropriate warning signage

  • Comments

  • E. Procedures are developed for dispensing of formaldehyde to include wick cleaning and emergency spills

  • Comments

  • F. Medical Disease physicals are performed as based on air monitoring results. (above STEL=2.0 ppm, above AL=.5 PPM TWA)

  • Comments

Machine and Power Transmission Guarding

  • A. Blades of fans less than seven (7) feet above the floor or working level are guarded. The guard must not have openings larger than one-half (1/2) inch

  • Comments

  • B. Power transmission equipment (pulleys/chains/gears/sprockets) less than seven (7) feet above the floor or working level are guarded front and back

  • Comments

  • C. All exposed parts of shafts less than (7) feet above the floor or working level is protected by casing enclosing the shaft

  • Comments

  • D. Projecting shaft ends have smooth edges and do not project more than one half diameter of the shaft unless guarded by non-rotating caps

  • Comments

  • E. Unused shaft keyways are filled or covered

  • Comments

Contractor Safety

  • A. "Contractor Safety Approval" form is completed for each contractor

  • Comments

  • B. Periodic audits are conducted of contractors on-site work with documentation

  • Comments

Fall Protection

  • A. Initial fall protection training is provided to authorized employees with refresher training every 3 years through the Alchemy LMS

  • Comments

Electrical Safety

  • A. No observed missing electrical covers

  • Comments

  • B. Electric panels are not blocked (3 feet)

  • Comments

  • C. Electrical panels are clearly labeled

  • Comments

  • D. Electric panel covers/doors/troughs are not missing anchor screws with all knockouts sealed

  • Comments

  • E. Electrical panel blanks are properly covered

  • Comments

  • F. Electrical conduit is utilized for all permanent machinery and equipment

  • Comments

  • G. Extension cords are in good condition with appropriate ground plugs

  • Comments

  • H. GFCI's are utilized for construction like work. (extension cords for portable power tool, ect...)

  • Comments

  • I. Arc flash analysis and appropriate labels are posted on all electric panels

  • Comments

  • J. Arc flash analysis is re-certified every 5 years with documentation

  • Comments

  • K. Initial NFPA 70 E training has been conducted through the Alchemy LMS with refresher every 3 years for affected personnel

  • Comments

  • L. Arc flash PPE is available on-site with reasonable access

  • Comments

Shipping and Loading Docks

  • A. Wheel chocks are available and utilized

  • Comments

  • B. Daily pre-trip inspections are conducted for jockey trucks with documentation

  • Comments

  • C. Dock doors are lighted and identified

  • Comments

  • D. Dock plates and levelers are in good condition

  • Comments

  • E. Docking safety systems are in good working condition (lights)

  • Comments

Grain and Feed Handling

  • A. All pit grates have an opening grid of 2.5 inches or less

  • Comments

  • B. Good housekeeping exists which includes evidence or 1/8 inch or less of grain dust

  • Comments

  • C. A written program for emergency action plans for grain and feed handling has been established (fire, explosion, rescue, ect...)

  • Comments

  • D. Employees have been trained on emergency action plans for grain and feed handling situations with documentation

  • Comments

  • E. Affected employees have been trained on bin entry procedures with documentation

  • Comments

  • F. A written housekeeping program has been developed by area/equipment with documented compliance

  • Comments

  • G. A written program for preventive maintenance established for grain legs and key equipment with documentation of compliance

  • Comments

  • H. Rail/train car safety procedures have been developed with documented training

  • Comments

  • I. Bin entry permits are maintained for 1 year

  • Comments

  • J. Annual review of the bin entry procedure to include bin entry permits is completed with documentation

  • Comments

Machine Specific

Machine Specific and Task Training

  • A. Verify new hire orientation is being conducted per approved playlist/learning plan. (random select 20 - processing, 5-Live & 2-Grain)

  • Comments

  • B. Monthly awareness safety training is conducted for the entire facility with documentation

  • Comments

  • C. Boiler low water cut-out safeties are tested daily with documentation

  • Comments

  • D. Boiler daily operating pressure logs are maintained to ensure safe parameters with documentation

  • Comments

  • E. Procedures have been developed for pallet jack battery changing with documented training

  • Comments

Equipment Inspections

Equipment Inspection

  • A. Engineered fall protection systems are inspected on an annual basis by a third party with documentation

  • Comments

  • B. Safety harnesses & lanyards inspected annually with documentation (in-house)

  • Comments

  • C. Self retracting lifelines (SRL's) are inspected on an annual basis with documentation (non-engineered system, in-house)

  • Comments

  • D. Anchor (slings) hardware inspected annually with documentation (in-house)

  • Comments

  • E. Ladders are inspected on annual basis by safety with documentation

  • Comments

  • F. Emergency eye wash and showers are available and inspected on a monthly basis with documentation

  • Comments

  • G. Emergency eye wash and showers are clean and functioning

  • Comments

  • H. Hoist are inspected on an annual basis by a third party with documentation

  • Comments

  • I. Hoist beams are marked with load rating

  • Comments

  • J. Storage mezzanines have signage for load rating

  • Comments

  • K. Bench grinders have all the guards with tool rest not to exceed 1/4 inch and shatter guard not to exceed 1/8 inch

  • Comments

  • L. Drill press is mounted to the floor and has bit guarding

  • Comments

  • M. Welders are in good condition including leads, power cords, and plugs

  • Comments

  • N. Oxygen cylinders are stored at least 20 feet from flammable tanks or separated by 5 foot high - one hour fire barrier

  • Comments

Air Monitoring

Air Monitoring

  • A. Personal air monitoring conducted every two years for dust with the results posted. Note: Change in process requires new monitoring. (Live Hang, Hatchery & Feed Mill)

  • Comments

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.