Title Page

  • Auditor

  • Customer

  • Country

  • Location

  • Date

  • Application name

General comments

  • Overview photo

  • General comments

Chemical Product

    Chemicals
  • Product Name

  • Classification

  • Hazard symbol

Safety Data Sheet / Work Place Safety Card / Labels

  • Are SDS or Workplace Safety Cards available at the application? Indicate current revision date.

  • Is the SDS considered as up to date? (consider max 6 months from latest issue date)

  • Are Primary Containers / Dosing Tanks / IBC properly labelled?

  • REQ/REC

  • Requirement

  • Recommendation

  • Are the dosing pumps and other dosing equipment labelled and/or easily identified?

  • REQ/REC

  • Requirement

  • Recommendation

Chemical Lines & Dosing Pumps

  • Are the product feed/fill lines labelled from the main tank to the injection point, or as far as reasonable practicable?

  • REQ/REC

  • Requirement

  • Recommendation

  • Are all product feed/fill lines properly secured?

  • REQ/REC

  • Requirement

  • Recommendation

  • Are product feed/fill lines doubled walled (hose in hose)?

  • REQ/REC

  • Recommendation

  • Recommendation

  • Are product feed/fill lines exposed to any heat source?

  • REQ/REC

  • Requirement

  • Recommendation

  • Are feed/fill lines running around an electrical control panel? (e.g over, under, on the side)

  • REQ/REC

  • Requirement

  • Recommendation

  • Are feed and fill lines installed/positioned in a way to NOT create a fold or pinch point?

  • REQ/REC

  • Requirement

  • Recommendation

  • Are pumps bunded, contained within the main Bund (Spill/Drip collector) or have suitable drip or leak collection?

  • REQ/REC

  • Recommendation

  • Recommendation

  • Are the dosing pumps in good condition from a visual point of view?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is there any sign of corrosion or leakage on dosing pumps, couplings or fittings?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is there Anti-Splash guarding fitted?

  • REQ/REC

  • Recommendation

  • Recommendation

  • Are all quick connects, camlocks and vent caps secured?

  • REQ/REC

  • Requirement

  • Recommendation

  • Are there any fittings/valves/piping made of obviously incompatible materials?

  • REQ/REC

  • Requirement

  • Recommendation

Storage, Tanks and Chemical Bunding

  • Are the storage/dosing tanks bunded? (Spill/Drip collector)

  • REQ/REC

  • Requirement

  • Recommendation

  • Does the Bund (Spill/Drip collector) have a capacity of 110% or more of the total volume for the biggest tank?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is the bund (spill/drip collector) clean, empty and free from foreign material?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is the product level of the tanks easily identifiable and readily accessible? (Gauge or tube meter in good condition and functional)

  • REQ/REC

  • Requirement

  • Recommendation

  • Are there any signs of storage tank leaks?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is the area surrounding the bund (spill/drip collector) clear and accessible?

  • REQ/REC

  • Requirement

  • Recommendation

  • If the bund includes a grating on which persons may stand on, are there any signs of sagging, corrosion or degradation?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is there a water flushing manifold installed? <br>Products concerned with H-phrase: H290, H300, H301, H310, H311, H314, H317, H318, H330, H331, H334

  • Req/Rec

  • Requirement

  • Recommendation

Chemical Transfer Pumps and Equipment

  • What kind of chemical transfer pump is used?

  • A) Is it free of any visible damage?

  • B) Has it been inspected, tested, and approved by a competent person in accordance with local legal requirements? (Evidence/Proof is required)

  • A) Is it free of any visible damage?

  • B.) Has it been inspected, tested and approved by a competent person in accordance with local legal requirements? (Evidence/Proof is required)

  • Is the transfer done on a platform or with a forklift?

  • Are the associated hoses stored and maintained appropriately?

  • REQ/REC

  • Requirement

  • Recommendation

  • Are there portable hoses dedicated for each product?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is there an electrical label present on the electrical unit?

  • REQ/REC

  • Does the label contain accurate voltage information?

  • REQ/REC

Housekeeping

  • Are redundant feed/fill lines left in place?

  • REQ/REC

  • Requirement

  • Recommendation

  • Does any redundant equipment require removal?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is the floor surface free of Slip, Trip and Fall hazards?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is there a spill-kit available and appropriate according to the product in use?

  • REQ/REC

PPE, First Aid & Emergency Measures

  • Is there any local PPE storage available?

  • REQ/REC

  • Requirement

  • Recommendation

  • Is there a Safety Shower and/or a Emergency Eye Washer available

  • REQ/REC

  • Requirement

  • Recommendation

  • Is there safe access to the Safety Emergency Station?

  • REQ/REC

  • undefined

  • Recommendation

  • How far is the Safety Emergency Station from the application?

  • Are fire extinguishers or other fire fighting devices available (sprinkler, fire hose etc)

  • REQ/REC

  • Are Emergency exits identifiable and easily accessible?

  • REQ/REC

  • Does the Solenis employee know where the evacuation/muster point is?

  • REQ/REC

Bulk unloading

  • Is this considered as bulk unloading

  • Are the primary tanks and pipes identified appropriately?

  • REQ/REC

  • Recommendation/Requirement

  • Recommendation/Requirement

  • Are bulk unloading area lines caped and secured?

  • REQ/REC

  • Recommendation/Requirement

  • Recommendation/Requirement

  • Are bulk unloading area lines identified, labeled and placarded?

  • REQ/REC

  • Recommendation/Requirement

  • Recommendation/Requirement

  • Is the bulk unloading area signage confusing?

  • REQ/REC

  • Recommendation/Requirement

  • Recommendation/Requirement

  • Is the unloading area free of adjacent hazards?

  • REQ/REC

  • Recommendation/Requirement

  • Recommendation/Requirement

Miscellaneous

  • Are Fork Trucks or Elevating Mobile Work Platforms (EMWP) used by Solenis personnel?

  • Who is the owner of the device?

  • Does Solenis employee have the appropriate license and written authorization to operate such equipment?

  • Is there a copy available at the customer site? (copy or ID number required)

Best Practice

  • Is it considered any Best Practice on this application?

  • Best Practice by Category

  • Best Practice Comment

Ending section

  • What are the top main findings by category?

  • Finalizing date

  • Next Review Date for this application

  • Signature

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.