Checklist

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

GENERAL WORK ENVIRONMENT

• Are all worksites clean and orderly?

  Yes

  No

  N/A

• Are all spilled materials or liquids cleaned up immediately?

  Yes

  No

  N/A

• Are combustible scrap, debris, and waste stored safely and removed from the worksite promptly?

  Yes

  No

  N/A

• Are all oil and gas fired devices equipped with flame failure controls that will prevent the flow of fuel if pilots or main burners are not working?

  Yes

  No

  N/A

• Are paint spray booths, dip tanks and the like cleaned regularly?

  Yes

  No

  N/A

EXIT DOORS

• Are doors that are required to serve as exits designed and constructed so that the way of exit travel is obvious and direct?

  Yes

  No

  N/A

• Are windows that could be mistaken for exit doors, made inaccessible by means of barriers or railings?

  Yes

  No

  N/A

• Are exit doors openable from the direction of exit travel without the use of a key or any special knowledge or effort, when the building is occupied?

  Yes

  No

  N/A

• Is a revolving, sliding or overhead door prohibited from serving as a required exit door?

  Yes

  No

  N/A

• Where panic hardware is installed on a required exit door, will it allow the door to open by applying a force of 15 pounds or less in the direction of the exit traffic?

  Yes

  No

  N/A

• Are doors on cold storage rooms provided with an inside release mechanism that will release the latch and open the door even if it's padlocked or otherwise locked on the outside?

  Yes

  No

  N/A

• Where exit doors open directly onto any street, alley or other areas where vehicles may be operated, are adequate barriers and warnings provided to prevent employees stepping into the path of traffic?

  Yes

  No

  N/A

• Are doors that swing in both directions and are located between rooms where there is frequent traffic, provided with viewing panels in each door?

  Yes

  No

  N/A

SPRAYING OPERATIONS

• Is adequate ventilation assured before spray operations are started?

  Yes

  No

  N/A

• Is mechanical ventilation provided when spraying operation is done in enclosed areas?

  Yes

  No

  N/A

• When mechanical ventilation is provided during spraying operations, is it so arranged that it will not circulate the contaminated air?

  Yes

  No

  N/A

• Is the spray area free of hot surfaces?

  Yes

  No

  N/A

• Is the spray area at least 20 feet from flames, sparks, operating electrical motors and other ignition sources?

  Yes

  No

  N/A

• Are portable lamps used to illuminate spray areas suitable for use in a hazardous location?

  Yes

  No

  N/A

• Is approved respiratory equipment provided and used when appropriate during spraying operations?

  Yes

  No

  N/A

• Do solvents used for cleaning have a flash point of 100E F or more?

  Yes

  No

  N/A

• Are fire control sprinkler heads kept clean?

  Yes

  No

  N/A

• Are "NO SMOKING" signs posted in spray areas, paint rooms, paint booths, and paint storage areas?

  Yes

  No

  N/A

• Is the spray area kept clean of combustible residue?

  Yes

  No

  N/A

• Are spray booths constructed of metal, masonry, or other substantial noncombustible material?

  Yes

  No

  N/A

• Are spray booth floors and baffles noncombustible and easily cleaned?

  Yes

  No

  N/A

• Is infrared drying apparatus kept out of the spray area during spraying operations?

  Yes

  No

  N/A

• Is the spray booth completely ventilated before using the drying apparatus?

  Yes

  No

  N/A

• Is the electric drying apparatus properly grounded?

  Yes

  No

  N/A

• Are lighting fixtures for spray booths located outside of the booth and the interior lighted through sealed clear panels?

  Yes

  No

  N/A

• Are the electric motors for exhaust fans placed outside booths or ducts?

  Yes

  No

  N/A

• Are belts and pulleys inside the booth fully enclosed?

  Yes

  No

  N/A

• Do ducts have access doors to allow cleaning?

  Yes

  No

  N/A

• Do all drying spaces have adequate ventilation?

  Yes

  No

  N/A

FLAMMABLE & COMBUSTIBLE MATERIALS

• Are combustible scrap, debris and waste materials (i.e. oily rags) stored in covered metal receptacles and removed from the worksite promptly?

  Yes

  No

  N/A

• Is proper storage practiced to minimize the risk of fire including spontaneous combustion?

  Yes

  No

  N/A

• Are approved containers and tanks used for the storage and handling of flammable and combustible liquids?

  Yes

  No

  N/A

• Are all connections on drums and combustible liquid piping, vapor and liquid tight?

  Yes

  No

  N/A

• Are all flammable liquids kept in closed containers when not in use (e.g. parts cleaning tanks, pans)?

  Yes

  No

  N/A

• Are bulk drums of flammable liquids grounded and bonded to containers during dispensing?

  Yes

  No

  N/A

• Do storage rooms for flammable and combustible liquids have explosion-proof lights?

  Yes

  No

  N/A

• Do storage rooms for flammable and combustible liquids have mechanical or gravity ventilation?

  Yes

  No

  N/A

• Is liquefied petroleum gas stored, handled, and used in accordance with safe practices and standards?

  Yes

  No

  N/A

• Are liquefied petroleum storage tanks guarded to prevent damage from vehicles?

  Yes

  No

  N/A

• Are all solvent wastes and flammable liquids kept in fire-resistant covered containers until they are removed from the worksite?

  Yes

  No

  N/A

• Is vacuuming used whenever possible rather than blowing or sweeping combustible dust?

  Yes

  No

  N/A

• Are fire separators placed between containers of combustibles or flammables, when stacked one upon another, to assure their support and stability?

  Yes

  No

  N/A

• Are fuel gas cylinders and oxygen cylinders separated by distance, fire resistant barriers or other means while in storage?

  Yes

  No

  N/A

• Are fire extinguishers selected and provided for the types of materials in areas where they are to be used?

  Yes

  No

  N/A

• Class A: Ordinary combustible material fires.

  Yes

  No

  N/A

• Class B: Flammable liquid, gas or grease fires.

  Yes

  No

  N/A

• Class C: Energized-electrical equipment fires.

  Yes

  No

  N/A

• If a Halon 1301 fire extinguisher is used, can employees evacuate within the specified time for that extinguisher?

  Yes

  No

  N/A

• Are appropriate fire extinguishers mounted within 75 feet of outside areas containing flammable liquids, and within 10 feet of any inside storage area for such materials?

  Yes

  No

  N/A

• Is the transfer/withdrawal of flammable or combustible liquids performed by trained personnel?

  Yes

  No

  N/A

• Are fire extinguishers mounted so that employees do not have to travel more than 75 feet for a class "A" fire or 50 feet for a class "B" fire?

  Yes

  No

  N/A

• Are employees trained in the use of fire extinguishers?

  Yes

  No

  N/A

• Are extinguishers free from obstructions or blockage?

  Yes

  No

  N/A

• Are all extinguishers serviced, maintained and tagged at intervals not to exceed one year?

  Yes

  No

  N/A

• Are all extinguishers fully charged and in their designated places?

  Yes

  No

  N/A

• Is a record maintained of required monthly checks of extinguishers?

  Yes

  No

  N/A

• Where sprinkler systems are permanently installed, are the nozzle heads directed or arranged so that water will not be sprayed into operating electrical switchboards and equipment?

  Yes

  No

  N/A

• Are "NO SMOKING" signs posted where appropriate in areas where flammable or combustible materials are used or stored?

  Yes

  No

  N/A

• Are "NO SMOKING" signs posted on liquefied petroleum gas tanks?

  Yes

  No

  N/A

• Are "NO SMOKING" rules enforced in areas involving storage and use of flammable materials?

  Yes

  No

  N/A

• Are safety cans used for dispensing flammable or combustible liquids at a point of use?

  Yes

  No

  N/A

• Are all spills of flammable or combustible liquids cleaned up promptly?

  Yes

  No

  N/A

• Are storage tanks adequately vented to prevent the development of excessive vacuum or pressure as a result of filling, emptying, or atmosphere temperature changes?

  Yes

  No

  N/A

• Are storage tanks equipped with emergency venting that will relieve excessive internal pressure caused by fire exposure?

  Yes

  No

  N/A

• Are spare portable or butane tanks, which are sued by industrial trucks stored in accord with regulations?

  Yes

  No

  N/A

FIRE PROTECTION

• Do you have a fire prevention plan?

  Yes

  No

  N/A

• Does your plan describe the type of fire protection equipment and/or systems?

  Yes

  No

  N/A

• Have you established practices and procedures to control potential fire hazards and ignition sources?

  Yes

  No

  N/A

• Are employees aware of the fire hazards of the material and processes to which they are exposed?

  Yes

  No

  N/A

• Is your local fire department well acquainted with your facilities, location and specific hazards?

  Yes

  No

  N/A

• If you have a fire alarm system, is it tested at least annually?

  Yes

  No

  N/A

• If you have a fire alarm system, is it certified as required?

  Yes

  No

  N/A

• If you have interior standpipes and valves, are they inspected regularly?

  Yes

  No

  N/A

• If you have outside private fire hydrants, are they flushed at least once a year and on a routine preventive maintenance schedule?

  Yes

  No

  N/A

• Are fire doors and shutters in good operating condition?

  Yes

  No

  N/A

• Are fire doors and shutters unobstructed and protected against obstructions, including their counterweights?

  Yes

  No

  N/A

• Are fire door and shutter fusible links in place?

  Yes

  No

  N/A

• Are automatic sprinkler system water control valves, air and water pressures checked weekly/periodically as required?

  Yes

  No

  N/A

• Is maintenance of automatic sprinkler system assigned to responsible persons or to a sprinkler contractor?

  Yes

  No

  N/A

• Are sprinkler heads protected by metal guards, when exposed to physical damage?

  Yes

  No

  N/A

• Is proper clearance maintained below sprinkler heads?

  Yes

  No

  N/A

• Are portable fire extinguishers provided in adequate number and type?

  Yes

  No

  N/A

• Are fire extinguishers mounted in readily accessible locations?

  Yes

  No

  N/A

• Are fire extinguishers recharged regularly and noted on the inspection tag?

  Yes

  No

  N/A

• Are employees periodically instructed in the use of extinguishers and fire protection procedures?

  Yes

  No

  N/A

HAZARDOUS CHEMICAL EXPOSURE

• Are employees trained in the safe handling practices of hazardous chemicals such as acids, caustics, and the like?

  Yes

  No

  N/A

• Are employees aware of the potential hazards involving various chemicals stored or used in the workplace-- such as acids, bases, caustics, epoxies, and phenols?

  Yes

  No

  N/A

• Is employee exposure to chemicals kept within acceptable levels?

  Yes

  No

  N/A

• Are eye wash fountains and safety showers provided in areas where corrosive chemicals are handled?

  Yes

  No

  N/A

• Are all employees required to use personal protective clothing and equipment when handling chemicals (i.e. gloves, eye protection, and respirators)?

  Yes

  No

  N/A

• Are flammable or toxic chemicals kept in closed containers when not in use?

  Yes

  No

  N/A

• Are chemical piping systems clearly marked as to their content?

  Yes

  No

  N/A

• Where corrosive liquids are frequently handled in open containers or drawn from storage vessels or pipelines,

  Yes

  No

  N/A

• are adequate means readily available for neutralizing or disposing of spills or overflows properly and safely?

  Yes

  No

  N/A

• Have standard operating procedures been established and are they being followed when cleaning up chemical spills?

  Yes

  No

  N/A

• Where needed for emergency use, are respirators stored in a convenient, clean and sanitary location?

  Yes

  No

  N/A

• Are respirators intended for emergency use adequate for the various uses for which they may be needed?

  Yes

  No

  N/A

• Are employees prohibited from eating in areas where hazardous chemicals are present?

  Yes

  No

  N/A

• Is personal protective equipment provided, used and maintained whenever necessary?

  Yes

  No

  N/A

• Are there written standard operating procedures for the selection and use of respirators where needed?

  Yes

  No

  N/A

• If you have a respirator protection program, are your employees instructed on the correct usage and limitations of the respirators?

  Yes

  No

  N/A

• Are the respirators NIOSH approved for this particular application?

  Yes

  No

  N/A

• Are they regularly inspected and cleaned sanitized and maintained?

  Yes

  No

  N/A

• If hazardous substances are used in your processes, do you have a medical or biological monitoring system in operation?

  Yes

  No

  N/A

• Are you familiar with the Threshold Limit Values or Permissible Exposure Limits of airborne contaminants and physical agents used in your workplace?

  Yes

  No

  N/A

• Have control procedures been instituted for hazardous materials, where appropriate, such as respirators, ventilation systems, handling practices, and the like?

  Yes

  No

  N/A

• Whenever possible, are hazardous substances handled in properly designed and exhausted booths or similar locations?

  Yes

  No

  N/A

• Do you use general dilution or local exhaust ventilation systems to control dusts, vapors, gases, fumes, smoke, solvents or mists which may be generated in your workplace?

  Yes

  No

  N/A

• Is ventilation equipment provided for removal of contaminants from such operations as production grinding, buffing, spray painting, and/or vapor decreasing, and is it operating properly?

  Yes

  No

  N/A

• Do employees complain about dizziness, headaches, nausea, irritation, or other factors of discomfort when they use solvents or other chemicals?

  Yes

  No

  N/A

• Is there a dermatitis problem--do employees complain about skin dryness, irritation, or sensitization?

  Yes

  No

  N/A

• Have you considered the use of an industrial hygienist or environmental health specialist to evaluate your operation?

  Yes

  No

  N/A

• If internal combustion engines are used, is carbon monoxide kept within acceptable levels?

  Yes

  No

  N/A

• Is vacuuming used, rather than blowing or sweeping dusts whenever possible for clean up?

  Yes

  No

  N/A

• Are materials, which give off toxic asphyxiant, suffocating or anesthetic fumes, stored in remote or isolated locations when not in use?

  Yes

  No

  N/A

HAZARDOUS SUBSTANCES COMMUNICATION

• Is there a list of hazardous substances used in your workplace?

  Yes

  No

  N/A

• Is there a written hazard communication program dealing with Material Safety Data Sheets (MSDS) labeling, and employee training?

  Yes

  No

  N/A

• Is each container for a hazardous substance (i.e. vats, bottles, storage tanks,) labeled with product identity and a hazard warning (communication of the specific health hazards and physical hazards)?

  Yes

  No

  N/A

• Is there a Material Safety Data Sheet readily available for each hazardous substance used?

  Yes

  No

  N/A

• How will you inform other employers whose employees share the same work area where the hazardous substances are used?

  Yes

  No

  N/A

• Is there an employee training program for hazardous substances?

  Yes

  No

  N/A

• Does this program include:

• An explanation of what an MSDS is and how to use and obtain one?

  Yes

  No

  N/A

• MSDS contents for each hazardous substance or class of substances?

  Yes

  No

  N/A

• Explanation of "Right to Know"?

  Yes

  No

  N/A

• Identification of where employees can see the employer's written hazard communication program and where hazardous substances are present in their work area?

  Yes

  No

  N/A

• The physical and health hazards of substances in the work area, how to detect their presence, and specific protective measures to be used?

  Yes

  No

  N/A

• Details of the hazard communication program, including how to use the labeling system and MSDSs?

  Yes

  No

  N/A

• How employees will be informed of hazards of non-routine tasks, and hazards of unlabeled pipes?

  Yes

  No

  N/A

CONTROL OF HARMFUL SUBSTANCES BY VENTILATION

• Is the volume and velocity of air in each exhaust system sufficient to gather the dusts, fumes, mists, vapors or gases to be controlled, and to convey them to a suitable point of disposal?

  Yes

  No

  N/A

• Are exhaust inlets, ducts and plenums designed, constructed, and supported to prevent collapse or failure of any part of the system?

  Yes

  No

  N/A

• Are clean-out ports or doors provided at intervals not to exceed 12 feet in all horizontal runs of exhaust ducts?

  Yes

  No

  N/A

• Where two or more different type of operations are being controlled through the same exhaust system, will the combination of substances being controlled, constitute a fire, explosion or chemical reaction hazard in the duct?

  Yes

  No

  N/A

• Is adequate makeup air provided to areas where exhaust systems are operating?

  Yes

  No

  N/A

• Is the intake for makeup air located so that only clean, fresh air, which is free of contaminates, will enter the work environment?

  Yes

  No

  N/A

• Where two or more ventilation systems are serving a work area, is their operation such that one will not offset the functions of the other?

  Yes

  No

  N/A

EMERGENCY ACTION PLAN

• Are you required to have an emergency action plan?

  Yes

  No

  N/A

• Have emergency escape procedures and routes been developed and communicated to all employers?

  Yes

  No

  N/A

• Do employees, who remain to operate critical plant operations before they evacuate, know the proper procedures?

  Yes

  No

  N/A

• Is the employee alarm system that provides a warning for emergency action recognizable and perceptible above ambient conditions?

  Yes

  No

  N/A

• Are alarm systems properly maintained and tested regularly?

  Yes

  No

  N/A

• Is the emergency action plan reviewed and revised periodically?

  Yes

  No

  N/A

• Do employees:

• Know their responsibilities for reporting emergencies?

  Yes

  No

  N/A

• Know their responsibilities during an emergency?

  Yes

  No

  N/A

• Know their responsibilities for conducting rescue and medical duties?

  Yes

  No

  N/A

RECOMMENDATION

• Enter recommendations here

COMPLETION

• Full Name and Signature of the Inspector

  Sign