Branch Compliance Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Office Safety

Office Ergonomics

• How is the Ergonomic program being implemented in the office?

  Safe

  At Risk

  N/A

• How many workstations need modifying to meet standards?

  Select Zero One Two Three Four Five Six

  • Zero
  • One
  • Two
  • Three
  • Four
  • Five
  • Six

Hazards

• Are there any slips, trips or fall hazards?

  Yes

  No

  None

• Are electrical cords routed correctly?

  Yes

  No

  N/A

• Are there any overloaded circuits?

  Yes

  No

• Are there any daisy chained power cords?

  Yes

  No

Facilities-Fire Prevention

• Are there fire extinguishers every 75 ft. And on each level?

  Yes

  No

  N/A

• Have the fire extinguishers been inspected? When?

  Yes

  No

  N/A

• Are the fire nozzles inspected quarterly?

  Yes

  No

  N/A

• What frequency is the fire system tested?

• Do the nozzles have the 18" of clearance?

  Yes

  No

  N/A

• Are the emergency escape postings in place?

  Yes

  No

  N/A

• Is ther an intercom system for warning employees of emergency?

  Yes

  No

  N/A

• Is it tested monthly?

  Yes

  No

  N/A

Facilities-Building and Grounds

• Is there any uneven ground on property?

  Yes

  No

• Is there any overhead hazards?

  Yes

  No

• Is there any pedestrian traffic choke points?

  Yes

  No

• Is there any slip, trip or fall hazards.

  Yes

  No

• Is there any other hazards?

  Yes

  No

Facilities-Storage

• Is storage of documents a fire hazard?

  Yes

  No

• Is there propane stored inside of the building?

  Yes

  No

• Is the propane stored outside?

  Yes

  No

  N/A

• Is there a flammable storage locker?

  Yes

  No

  N/A

• Are fuels like gasoline in safety cans?

  Yes

  No

  N/A

Universal Waste

• Are the fluorescent bulbs and dry cell batteries recycled every year?

  Yes

  No

  N/A

Pesticide Storage

• Are the pesticide storage areas locked?

  Yes

  No

  N/A

• Are all pesticide storage areas posted with Danger signs?

  Yes

  No

  N/A

• Are all containers labeled correctly?

  Yes

  No

  N/A

• Is there any mystery materials?

  Yes

  No

• Are service containers labeled properly?

  Yes

  No

  N/A

• Are any food containers used for pesticide storage?

  Yes

  No

  None

• Are used containers properly tripled rinsed and cut?

  Yes

  No

  N/A

• Is there any quantity of material over 55 gallons, 500 pounds, or 200 cubic feet of gas?

  Yes

  No

  N/A

• Does the office have a chemical exchange system?

  Yes

  No

  N/A

Decontamination Kit

• Is the kit readily available?

  Yes

  No

  N/A

• Is the kit complete?

  Yes

  No

  N/A

• What is missing?

  Yes

  No

  N/A

• Is the decontamination documentation on top of the material when opened?

  Yes

  No

  N/A

• Has the kit been used?

  Yes

  No

• Is there an eye wash station near the material storage?

  Yes

  No

  N/A

• Is it plumbed?

  Yes

  No

  N/A

• Is the saline out of date?

  Yes

  No

Clothing changing area

• Is there a men's changing area?

  Yes

  No

  N/A

• Is there a woman's changing area?

  Yes

  No

  N/A

Personal protective equipment

• Is the PPE stored separate from the pesticide materials?

  Yes

  No

  N/A

• Is the PPE correct for the materials stored?

  Yes

  No

  N/A

Vehicles

• Is washing vehicles allowed at the branch?

  Yes

  No

  N/A

• How do we know?

  Yes

  No

  N/A

• Is IDrive operating in every vehicle?

  Yes

  No

  N/A

• Who doesn't have IDrive?

  Yes

  No

  N/A

• Does management coach employees using IDrive?

  Yes

  No

  N/A

• Where is it documented?

  Yes

  No

  N/A

Auto Shops

• Where is the right to know center for the auto shop (MSDS, SDS)?

  Yes

  No

  N/A

• What equipment is being used in the shop?

• Are the guards and safeties on the machines?

  Yes

  No

  N/A

• Are chemicals being stored properly?

  Yes

  No

  N/A

• Is the new oil stored properly?

  Yes

  No

  N/A

• Is the used oil stored properly?

  Yes

  No

  N/A

• Is the hazardous waste picked up within 180 days?

  Yes

  No

  N/A

• Is there a welder or torch in the shop?

  Yes

  No

  N/A

• Is there an air compressor?

  Yes

  No

  N/A

• Are permanently mounted air tanks permitted?

  Yes

  No

  N/A

• Is there any other shop hazards?

  Yes

  No

  None

• Is the nitrogen securely stored?

  Yes

  No

  N/A

WDO Storage

• Is the building material stored properly?

  Yes

  No

  N/A

• What chemicals are stored?

  Yes

  No

  N/A

• Where is the right to know center for the WDO products? (Non-pesticide)

  Yes

  No

  N/A

Documents and Training

• Is a city or county business license posted?

  Yes

  No

  N/A

• Is the branch registered in each county they apply pesticides?

  Yes

  No

  N/A

• Which counties?

• Does the branch have a restricted use permit?

  Yes

  No

• Is there a pesticide use report for each county pesticides where applied and for each month? Which material?

  Yes

  No

  N/A

• Are the pesticide use reports filled out properly?

  Yes

  No

  N/A

• Are all DPR records kept for a minimum of 3 months?

  Yes

  No

  N/A

• Has each employee handling pesticides been trained? ( annual pesticide training)

  Yes

  No

  N/A

• Has each employee received spill training?

  Yes

  No

  N/A

• Has WDO personal received tool training?

  Yes

  No

  N/A

• Has any speciality training been given? (Fall protection, Boom lifts, etc)

  Yes

  No

  N/A

Respiratory Protection Program

• Have the employees had a medical evaluation?

  Yes

  No

  N/A

• Have all field employees been fit tested?

  Yes

  No

  N/A

• Have employees signed the policy?

  Yes

  No

  N/A

• Does the branch use the monthly respirator issue form?

  Yes

  No

  N/A

• Has the employees filled out the Respirator Program Evaluation form in the past year?

  Yes

  No

  N/A

Branch Safety Record

• Does the branch document a monthly safety committee safety meeting?

  Yes

  No

  N/A

• Does the branch have monthly safety meetings for each department?

  Yes

  No

  N/A

• Does the branch have weekly tailgate meeting for the WDO department?

  Yes

  No

  N/A

Vehicle training and records

• Do employees that drive Clark vehicles trained annually?

  Yes

  No

  N/A

• Are weekly truck inspection forms used?

  Yes

  No

  N/A

• Where are the vehicle maintenance logs kept?

  Yes

  No

  N/A

LMS Training

• Is the Branch up to date?

  Yes

  No

  N/A