Charlotte-Mecklenburg Risk Management

• Audit Title

• Facility/Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Marshall & Swift Valuation

• Year Built

• Number of Employees:

• Number of floors or stories:

• Story height in feet:

• Occupancy Type:

• Facility square footage:

• Building and Property Value:

• Estimated Contents Value:

• Passenger Elevators / How many?

  Yes

  No

  N/A

• Freight Elevators / How many?

  Yes

  No

  N/A

• Basement / Square Footage

  Yes

  No

  N/A

• Is Basement Finished?

  Yes

  No

  N/A

• Type and location of HVAC system:

• Construction Type

  Select ISO1-Frame ISO 2-Joisted Masonry ISO 3-Pre-engineered metal ISO 4-Masonry Non Combust. ISO 5- Modified Fire Resist. ISO 6- Fire Resistive

  • ISO1-Frame
  • ISO 2-Joisted Masonry
  • ISO 3-Pre-engineered metal
  • ISO 4-Masonry Non Combust.
  • ISO 5- Modified Fire Resist.
  • ISO 6- Fire Resistive

• Wall Construction

  Select Metal Concrete Block Tilt up Precast Concrete Wood/Frame Brick EFIS Unknown Other

  • Metal
  • Concrete Block
  • Tilt up Precast Concrete
  • Wood/Frame
  • Brick
  • EFIS
  • Unknown
  • Other

• Roof Construction

  Select Metal Asphalt Shingle Fiberglass Shingle Wood/Frame Gravel Rubber Unknown Other

  • Metal
  • Asphalt Shingle
  • Fiberglass Shingle
  • Wood/Frame
  • Gravel
  • Rubber
  • Unknown
  • Other

• Roof Support

  Select Unprotected Steel Column Steel Column Masonry Encapsulated Steel Column Sheetrock Encap. Masonry Wood/Frame Unknown Other

  • Unprotected Steel Column
  • Steel Column Masonry Encapsulated
  • Steel Column Sheetrock Encap.
  • Masonry
  • Wood/Frame
  • Unknown
  • Other

• Floor Construction

  Select Dirt Poured Concrete Wood/Frame Block/Brick Unknown Other

  • Dirt
  • Poured Concrete
  • Wood/Frame
  • Block/Brick
  • Unknown
  • Other

• Automatic Fire Alarm System?

  Yes

  No

  N/A

• Sprinkler system?

  Yes

  No

  N/A

• Facility photos

  Media

GENERAL

• OSHA GENERAL DUTY CLAUSE: OSHA ACT 5(a)(1)

OSHA ACT 5(a)(1): OSHA GENERAL DUTY CLAUSE:

• Does the employer furnish his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees?

  Yes

  No

  N/A

• Is the structure, furniture and equipment in the area, in good and safe condition?

  Yes

  No

  N/A

• Are floors clean and free of dirt and liquids?

  Yes

  No

  N/A

• Good lighting available?

  Yes

  No

  N/A

• Are restrooms facilities clean?

  Yes

  No

  N/A

MANAGEMENT

• BEST MANAGEMENT PRACTICES

Best Management Practices:

• Does the location follow Best Management Practices?

  Yes

  No

  N/A

INFORMATIONAL POSTINGS

• Employee OSHA (publication 3165) and U.S. Department of Labor Postings: 29 CFR 1903.2

OSHA publication 3165 & US Dept. of Labor Postings

• Are the OSHA (publication 3165) and US Department of Labor Postings posted and available for the employees to read?

  Yes

  No

  N/A

• Risk Management Information

Risk Mgt. Contact and Medical Clinics Information

• Are Charlotte-Mecklenburg Risk Management Contacts and Medical Clinics information posted?

  Yes

  No

  N/A

HOUSEKEEPING

• Cleanliness and Sanitation

29 CFR 1910(a)(1):

• Are all places of employment kept clean and orderly and in sanitary condition?

  Yes

  No

  N/A

• Isles and passageways.

29 CFR 1910.22(b)

• Are all isles and passageways kept clear with no obstruction across the aisles that could create a hazard.

  Yes

  No

  N/A

• Other "OBSERVED" conditions.

Other observed Housekeeping hazards

• Are all other "OBSERVED" conditions free from Housekeeping hazards?

  Yes

  No

  N/A

ELECTRICAL

• Extension cords and power strips.

29 CFR 1910.303 & 304

• Are extension cords and electrical strips used in accordance with manufacturer's guidelines?

  Yes

  No

  N/A

• Are extension cords used only for immediate use and not as permanent wiring?

  Yes

  No

  N/A

• Are all extension cords free from damage and defects such as damage to the outer jackets (insulation) or missing grounding pins?

  Yes

  No

  N/A

• Are all electrical cords and electrical power strips free from daisy chaining and overloading?

  Yes

  No

  N/A

• Portable cord and plug equipment.

29 CFR 1910.304

• Are all portable cord and plug connected equipment and extension cords free from damage and defects such as damage to the outer jackets (insulation) or missing grounding pins?

  Yes

  No

  N/A

• Are all strain relief points free from exposed electrical wiries?

  Yes

  No

  N/A

• Electrical outlets, boxes, equipment casings, cabinets

29 CFR 1910.305(b)

• Are all unused openings in electrical outlets, boxes, equipment casings, cabinets closed to prevent exposure and accidental entry?

  Yes

  No

  N/A

• Do all boxes, junction boxes, fittings .....outlet fixtures have covers?

  Yes

  No

  N/A

• Is there exposed wiring?

  Yes

  No

  N/A

• GFCI

NFPA 70E 210.8 & 110.4

• Are all electrical outlets installed within 1.8m (6 ft.) of the outside edge of a sink (laundry, utility, and wet bar sinks) GFCI protected?

  Yes

  No

  N/A

• Are all receptacles installed to serve the countertop surfaces in kitchens GFCI protected?

  Yes

  No

  N/A

• Is GFCI protection provided when an employee is outdoors and operating or using cord and plug connected equipment supplied by 125-volt, 15, 20 or 30 amp circuits?

  Yes

  No

  N/A

• Outdoor or other damp locations?

29 CFR 1910.305 & 303

• Are waterproof receptacles installed in outdoor locations or in other damp locations?

  Yes

  No

  N/A

• Are all electrical outlets and enclosures located in damp or wet locations free from visible damage?

  Yes

  No

  N/A

• Panel Labeling

29 CFR 1910.303(e)(1)(ii) NFPA 70E:

• Are labels providing voltage, current and protective clothing requirements posted on outside of electrical panels?

  Yes

  No

  N/A

• Are breakers properly labeled with circuit identification or area served?

  Yes

  No

  N/A

• Overhead lighting

29 CFR 1910.305L(a)(2)(ix):

• Are all lamps used for general illumination protected from accidental contact or breakage by a suitable fixture or guard?

  Yes

  No

  N/A

• Work on electrical equipment.

29 CFR 1910.331-335

• Do facility employees work on electrical circuits?

  Yes

  No

  N/A

• Is there a written Electrical Safe Work Practices policy?

  Yes

  No

  N/A

• Are employees who work with or on electrical circuits properly trained to the required level of their expected job function?

  Yes

  No

  N/A

• Are employees provided with the proper PPE and safeguards for working on electrical circuits.

  Yes

  No

  N/A

• Arcflash

NFPA 70E

• Do employees work on live electrical circuits?

  Yes

  No

  N/A

• Is there an Arcflash and Live Electrical Work policy in place.

  Yes

  No

  N/A

• Are panels and other electrical equipment labeled with the current, voltage, and Arcflash information and required Arcflash PPE?

  Yes

  No

  N/A

• Are employees provided the proper Arcflash PPE for the hazards encountered?

  Yes

  No

  N/A

• Are employees properly trained in Arcflash safety and the proper use of Arcflash PPE?

  Yes

  No

  N/A

• Other "OBSERVED" Electrical hazards?

Other Observed Electrical Hazards

• Are all other "OBSERVED"conditions free from Electrical hazards?

  Yes

  No

  N/A

EMERGENCY EXITS

• Obstructions

29 CFR 1910.37(3):

• Are all exit routes free and unobstructed?

  Yes

  No

  N/A

• Exit Signage

29 CFR 1910.37(b)..

• Are all exits clearly visible and marked by a sign reading "Exit"?

  Yes

  No

  N/A

• Are all "Exit" signs illuminated?

  Yes

  No

  N/A

• Non-exit Doorways

29 CFR 1910.37(b)(5):

• Is each doorway which could be mistaken for and exit marked "Not an Exit"?

  Yes

  No

  N/A

• Emergency Exit Lighting

life Safety Code 101-67 7.9.3.1.1

• Do all emergency lights operate for a minimum of 30 seconds when the test button is pressed?

  Yes

  No

  N/A

• Other "OBSERVED" Emergency Exit hazards?

Other observed Emergency Exit hazards

• Are all other "OBSERVED" conditions free from Emergency Exit hazards?

  Yes

  No

  N/A

EYE WASH STATIONS

• Are eye wash stations unblocked and placed within 10 seconds or 55 feet of the hazard?

ANSI Z358.1 2009: 29 CFR 1910.151:

• Are eye wash stations unblocked and placed within 10 seconds or 55 feet of the hazard?

  Yes

  No

  N/A

• Are all eye wash stations flow tested on a weekly basis and mechanically tested annually?

  Yes

  No

  N/A

• Does the eye wash station deliver tepid (between 60 and 100 degrees F) water for 15 minutes?

  Yes

  No

  N/A

• Are the eyewash solutions for portable eye wash stations being inspected for expiration dates?

  Yes

  No

  N/A

• Other "OBSERVED" Eye Wash Station hazards?

Other Eyewash Station hazards

• Are all other "OBSERVED" conditions free from Eye Wash Station hazards?

  Yes

  No

  N/A

FIRE ALARM & SPRINKLER SYSTEMS

• Fire Alarm System & Testing

NFPA-72, Table 10.4.3 Testing Frequencies

• Is testing of the Fire Alarm System conducted in accordance with National Fire Protection Association (NFPA) testing schedule?

  Yes

  No

  N/A

• How often is the system tested/inspected?

  Yes

  No

  N/A

• Is the documentation available upon request?

  Yes

  No

  N/A

• Sprinkler System & Testing

Is testing of the Fire Alarm System conducted in accordance with National Fire Protection Association (NFPA) testing schedule?

• Has the Fire Pump / Sprinkler System been inspected/tested?

  Yes

  No

  N/A

• How often is the system tested/inspected?

  Yes

  No

  N/A

• Is the documentation available upon request?

  Yes

  No

  N/A

FIRE SAFETY: FIRE EXTINGUISHERS

• Mounting and location.

29 CFR 1910.157(c)

• Are all portable fire extinguishers properly mounted, located and identified so they are readily accessible to employees?

  Yes

  No

  N/A

• Are all portable fire extinguishers kept in their designated places at all times except during use?

  Yes

  No

  N/A

• Inspections

29 CFR 1910.157(e)

• Do all of the fire extinguishers receive a monthly inspection?

  Yes

  No

  N/A

• Do all fire extinguishers receive an annual inspection?

  Yes

  No

  N/A

• Other "OBSERVED" Fire Extinguisher hazards?

Other observed Fire Extinguisher Safety Hazards

• Are all other "OBSERVED" conditions free from Fire Extinguisher hazards?

  Yes

  No

  N/A

FIRE / LIFE SAFETY

• Emergency Action , Evacuation, Fire Prevention Plans

29 CFR 1910.38 & 39

• Are Emergency Action, Evacuation, and Fire Prevention Plans in place?

  Yes

  No

  N/A

• Do Emergency Action Plans address other hazards such as weather emergencies?

  Yes

  No

  N/A

• Are Emergency Evacuation Diagrams or directions posted?

  Yes

  No

  N/A

• Are Emergency Plans communicated to employees and are employees trained on the actions to take during an emergency.

  Yes

  No

  N/A

• Are periodic Emergency and Evacuations Drills Conducted?

  Yes

  No

  N/A

• Combustible Materials

Fire Code 2009 Chapter 3:315.2

• Are combustible materials in buildings separated from heaters or heating devices by distance or shielding so ignition cannot occur?

  Yes

  No

  N/A

• Are combustible materials kept to a minimum and not allowed to accumulate ?

  Yes

  No

  N/A

• Flammable and Combustable Storage

29 CFR 1910.106(d)(3)(ii)

• Are all flammables and combustibles properly stored in flammable cabinets?

  Yes

  No

  N/A

• Are "ONLY" flammables and combustibles stored in flammable cabinets?

  Yes

  No

  N/A

• Ceiling Clearance.

International Fire Code 2009:315.2.1

• Is storage maintained 18" from sprinkler heads in buildings which have fire sprinkler systems?

  Yes

  No

  N/A

• Is storage maintained 24 inches below the ceiling in non-sprinkled buildings?

  Yes

  No

  N/A

• Fire Resistance Rated Components

International Fire Code 2009 703.1

• Is the required fire-resistance rating of fire resistance-rated construction (including ceiling tiles) maintained and properly repaired, restored or replaced for any openings including openings made for passage of pipes, electrical conduit, wires, ducts, air transfer openings and any holes made for any other reason?

  Yes

  No

  N/A

• Other "OBSERVED" Fire Safety hazards?

Other Observed Fire Safety HazardsAre

• Are all other "OBSERVED" conditions free from Fire Safety hazards?

  Yes

  No

  N/A

HAZARD COMMUNICATION

• MSDS / SDS

29 CFR 1910.1200

• Is there a list of hazardous chemicals known to be present and are the appropriate safety data sheet available to employees?

  Yes

  No

  N/A

• Are employees properly trained on the chemical hazards. In the workplace and the facilities Hazard Communication Plan?

  Yes

  No

  N/A

• Are all chemical containers labeled properly?

  Yes

  No

  N/A

• Other "OBSERVED" Hazard Communication hazards?

Other Hazard Communication hazards

• Are all other "OBSERVED" conditions free from Hazard Communication hazards?

  Yes

  No

  N/A

MACHINERY AND MACHINE GUARDING

• Machine Guarding

29 CFR 1910.212(a)(1) :

• Do all tools and machines have the proper machine guarding to protect the operator from hazards at the point of operation? <br>

  Yes

  No

  N/A

• Grinders

29 CFR 1910.215

• Are all GRINDER work rests adjusted closely to the wheel with a maximum opening of one eighth (1/8) of an inch?

  Yes

  No

  N/A

• Are all GRINDER safety guards adjusted so as to never exceed one-fourth (1/4) of an inch between the wheel to the guard?

  Yes

  No

  N/A

• Machine Mounting

29 CFR 1910.305(b)(2)(i)

• Are all machines designed for a fixed location securely anchored to prevent walking or moving?

  Yes

  No

  N/A

• Other "OBSERVED" Machine Guarding hazards?

Other Machine Guarding hazards

• Are all other "OBSERVED" conditions free from Machine Guarding hazards?

  Yes

  No

  N/A

POWERED INDUSTRIAL TRUCKS / SCISSOR LIFTS

• Forklifts

29 CFR 1910.178

• Are forklifts or powered industrial trucks used in the facilit?

  Yes

  No

  N/A

• Have employees operating forklifts or powered industrial trucks been properly trained and certified?

  Yes

  No

  N/A

• Are ther policies and procedures in place for the proper operation of the equipment?

  Yes

  No

  N/A

• Is the forklift or powered industrial truck properly maintained and the correct type for the intended use?

  Yes

  No

  N/A

• Scissor Lifts

ANSI & 29 CFR 1910.29

• Are scissor lifts used in the facility?

  Yes

  No

  N/A

• Are employees properly trained in the use of the scissor lift?

  Yes

  No

  N/A

• Are all guard and side rails in place and no work is performed with the side rails removed?

  Yes

  No

  N/A

• Is the scissor lift properly maintained and inspected?

  Yes

  No

  N/A

• Other "OBSERVED" Powered Industrial Truck hazards?

Other PPE hazards

• Other "OBSERVED" Powered Industrial Truck hazards?

  Yes

  No

  N/A

PPE

• Personal Protective Equipment

29 CFR 1910.132

• Has a JSA (Job Safety Analysis) been performed to determine the correct PPE for the task?

  Yes

  No

  N/A

• Is required PPE provided to the employees and do the employees wear the required PPE?

  Yes

  No

  N/A

• Is the PPE maintained and stored in a sanitary and reliable condition to prevent damage and/or contamination?

  Yes

  No

  N/A

• Other "OBSERVED" PPE hazards?

Other PPE hazards

• Are all other "OBSERVED" conditions free from PPE hazards?

  Yes

  No

  N/A

WALKING WORKING SURFACES

• Ladders

29 CFR 1910.25

• Do the ladders have the ladder manufacturer's information and warning labels in place and are they legible?

  Yes

  No

  N/A

• Are all ladders inspected prior to use and taken out of service if any defects are found?

  Yes

  No

  N/A

• Is the ladder observed in use the correct type of ladder for the job being performed?

  Yes

  No

  N/A

• Are the observed ladders which are not in use stored properly and secured?

  Yes

  No

  N/A

• Aisles, passageways, and floors.

29 CFR 1910.22

• Are all aisles, passageways, and floors clean and free of hazards?

  Yes

  No

  N/A

• Are covers and or guardrails provided to protect employees from floor openings, pits, or other open floor hazards?

  Yes

  No

  N/A

• Are placards indicating the applicable load rating of the floor provided?

  Yes

  No

  N/A

• Are there any areas where the floor safe load rating has been exceeded?

  Yes

  No

  N/A

• Other observed walking working surface safety hazards?

29 CFR 1910.25

• Are all other observed conditions free from any other walking working surface safety hazards?

  Yes

  No

  N/A

WELDING, CUTTING, BRAZING

• Welding Operations

29 CFR 1910.252

• Is the employee properly trained for the task?

  Yes

  No

  N/A

• Is adequate ventilation provided?

  Yes

  No

  N/A

• Is the proper PPE provide to and used by the employee?

  Yes

  No

  N/A

• Hot Work Permit

29 CFR 1910.252

• Does the facility have a Hot Work Permit program?

  Yes

  No

  N/A

• Are contractors required to follow a Hot Work Permit program?

  Yes

  No

  N/A

• Compressed gas cylinders.

29 CFR 1910.253 & 1910.101

• Are all compressed gas cylinders legibly marked for the purpose of identifying the gas content?

  Yes

  No

  N/A

• Are oxygen cylinders in storage separated from fuel-gas cylinders or combustible materials by a minimum of 20 feet or by a noncombustible barrier at least 5 feet high?

  Yes

  No

  N/A

• Are cylinders stored with protective caps in place over valve stems?

  Yes

  No

  N/A

• Are cylinders stored and anchored in such a way to prevent falling?

  Yes

  No

  N/A

• Other "OBSERVED" Welding, Cutting and Brazing hazards?

Other Welding, Cutting and Brazing hazards

• Are all other "OBSERVED" conditions free from Welding, Cutting and Brazing hazards?

  Yes

  No

  N/A

Other Observed Conditions

• Other "Observed" potential hazards to the employees?

OTHER HAZARDS

• Do all other conditions at the location provide a safe workplace free from potential hazards to employees?

  Yes

  No

  N/A

Auditor's Comments

Signatures

• Department / Facility representative:

  Sign

• Participating Risk Management Representative:

  Sign