Title Page
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Audit Title
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Location
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Conducted on
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Prepared by
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Location
Audit Section 1
Section 1: Sources
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1a. Does the facility operate liquid propane (LP) powered industrial trucks (including forklifts, high-lows, etc. ) indoors? <br> <br>
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1b. Does the facility operate any indoor natural-gas or propane powered packaging equipment? <br> <br>
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1c. Does the facility have any digestion tanks into which any liquids (process waste, wastewater, sanitation effluent, etc.) may potentially flow? <br> <br>
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1d. Does the facility have engines which may operate indoors? Examples include trucks pulling inside to be loaded, indoor loading docks, railcars, emergency generators, or other gasoline/diesel exhaust source. <br> <br> <br>
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1e. Does the facility operate any indoor industrial personnel heaters, such as wall mounted heaters, which are not powered only by electricity? <br> <br>
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1f. Does the facility operate any propane or natural gas furnaces, bioreactors, industrial production heating equipment, flame boxes or any other equipment which uses liquid propane or natural gas fuel indoors? <br> <br> <br>
Note: If you answered "No" to all of the above, no further use of this checklist is required because no potential sources of carbon monoxide have been identified. Repeat when site conditions change, or every two years. If any sources were identified, continue to Section 2.
Audit Section 2
Section 2: Facility Conditions
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2a. Is there a noticeable odor associated with propane or natural gas powered equipment(other than inside tractor trailers)? <br> <br>
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Note: Carbon monoxide is odorless, but will often be accompanied by other exhaust components for which odor may be detectable.
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2b. Is the facility in a climate that requires doors and windows to remain shut during months with cold ambient weather? <br> <br>
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2c. Is this facility located in Minnesota? <br>
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Note: Minnesota has state-specific regulations for carbon monoxide.
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2d. Is this facility located in a high altitude area, such as Denver, Colorado?<br>
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"Note: High altitude is defined as >1000 meters above sea level.
Higher partial pressure of carbon monoxide presents higher risk."
Continue to Section 3. Respond to All Relevant Sections.
Audit Section 3
Section 3: Review of Specific Sources
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Propane-powered Industrial Trucks
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3a. Are propane-powered industrial trucks operated inside tractor trailers?<br>
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3b. Are propane-powered industrial trucks operated indoors in enclosed areas (other than inside tractor trailers)? <br> <br>
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3c. Are propane-powered industrial trucks operated indoors in areas with limited ventilation (other than inside tractor trailers)? <br> <br>
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3d. Are employees driving propane-powered industrial trucks permitted to carry personal electronic devices which they can access while driving? <br> <br>
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3e. Does the facility have a policy requiring that the engines of propane-powered industrial trucks be turned off when the equipment is stopped for more than a certain time frame (usually 30-60 seconds)? <br> <br> <br>
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3f. Have employees driving propane-powered industrial trucks been observed in non-compliance with this policy? <br> <br>
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Propane or Natural Gas Packaging Equipment and Personnel Heaters
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3g. Does the facility operate a Leak Detection and Repair (LDAR) process to routinely inspect heating equipment? <br> <br>
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3h. Are manufacturer maintenance and inspection processes followed for heating equipment? <br> <br>
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3i. Are there any integrated alarms or sensors which may detect a poor flame, flameout, or other gas-related mechanical issue? <br> <br>
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Digestion Tanks
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3j. Are digestion tanks sealed so as to prevent gas exchange between indoor air and tank atmosphere? <br> <br>
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3k. Is there any air-moving equipment in the vicinity of digestion tanks?<br>
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Indoor Engine Use or Exhaust Exposure
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3k. Does the facility have a policy identifying a maximum idling time for gasoline or diesel vehicles operated indoors or docking with the facility? <br> <br>
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3l. Does the facility have posted signage identifying a maximum idling time or otherwise communicating an idling policy? <br> <br>
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3m. Have there been observations of non-compliance with idling rules?<br>
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3o. For locations such as fleet shops where tractor trailers may be operated indoors, is there a fume extractor near the point of exhaust emission? <br> <br>
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Continue to Section 4. Respond to All Relevant Sections.
Audit Section 4
Section 4: Exposure Controls
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Propane-powered Industrial Truck Tuning
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4a. Are propane-powered industrial trucks subject to regular emissions testing by PepsiCo fleet services or a vendor? <br> <br>
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4a1. Is emissions testing conducted annually or more often?<br>
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4a2. Are these emissions tests subject to a 1.0% passing rate for carbon monoxide concentration in exhaust? <br> <br>
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4a3. Are these emissions tests subject to a 0.5% passing rate for carbon monoxide concentration in exhaust? <br> <br>
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4a4. Are records of these emissions tests kept for later review, if necessary? Note: These records may be printouts on carbon paper and should be kept in a cool place away from sunlight. <br> <br> <br>
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4a5. Is the instrument used to conduct carbon monoxide emissions testing regularly calibrated using a canister of test gas? <br> <br>
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4a6. Is emissions tester calibration conducted at least annually?<br>
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4a7. Are records of these calibrations kept for later review?<br>
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4a8. When a powered industrial truck is tested for exhaust content and found to be above an acceptable level, is the equipment removed from service until repairs can be completed? <br> <br> <br>
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4a9. Is this removal from service documented, including an identification number for the piece of equipment, and the cause for removal? <br> <br> <br>
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4a10. After removal from service and subsequent repair, are powered industrial trucks tested for acceptable emissions before being returned to service? <br> <br> <br>
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Stationary Sensors
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4b. Does the facility have any stationary carbon monoxide sensors (such as Drager or Sensidyne)? <br> <br>
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4b1. Have these sensors been calibrated within the past year or according to manufacturer reccomendations? <br> <br>
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4b2. Do these sensors have an alarm function?<br>
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4b3. Does the facility have a policy indicating what employee actions are required when stationary sensor alarms sound? This may include conditional requirements based on the alarm type. <br> <br> <br>
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4b4. Have there been observations of non-compliance with required actions? <br> <br>
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4b5. Are these sensors interfaced with ventilation equipment?<br>
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Ventilation Equipment
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4c. Does the facility have any ventilation equipment, including fans, which are designed to control carbon monoxide exposures? <br> <br>
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If you answered YES to 4c, describe that equipment here.
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Exposure Monitoring
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4d. Has the facility performed carbon monoxide exposure monitoring using personal electrochemical samplers? <br> <br>
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4d1. Has personal exposure monitoring indicated employee exposures above 50% of the TLV ("action level")? <br> <br>
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4d1a. Is this position still in place at the facility?<br>
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4d1b. Has follow-up monitoring conducted on this position indicated two consecutive measurements below the action level? <br> <br>
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4d1c. Have exposure controls been implemented for the position identified to be above the action level? <br> <br>
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4d1d. Is exposure monitoring for this position conducted annually?<br>
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Exposure Screening
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4e. Does the facility perform handheld carbon monoxide area screening?<br>
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4e1. Is this screening performed at least monthly?<br>
Audit Section 5
Section 5: Employee Concerns and Health Effects
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5a. Have any employee concerns been received which reference any of the following conditions?
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Headache, nausea/vomiting, dizziness or blurred vision<br>
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Weariness or rapid loss of stamina<br>
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Heart trouble, including irregular heartbeat<br>
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5b. Have any employees which are confirmed or suspected of being exposed to carbon monoxide communicated to PepsiCo any heart conditions, such as coronary artery disease? <br> <br> <br>
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5c. Have any employees which are confirmed or suspected of being exposed to carbon monoxide communicated to PepsiCo any conditions associated with asthma? <br> <br> <br>
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Note: Employees who smoke are at higher risk for carbon monoxide health effects due to a higher baseline of carboxyhemoglobin.
Audit Section 6
Section 6: Hazard Communication
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6a. Have employees which are confirmed or suspected of being exposed to carbon monoxide received appropriate hazard communication training? <br> <br>
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"This completes the Carbon Monoxide Risk Management Checklist.
This document constitutes an employee exposure record. Retain a completed copy of this checklist at your facility (paper or electronic) for a minimum of thirty (30) years.
Inform employees annually of the presence and location of this and all other exposure records."
