Information
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Facility:
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Date:
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Prepared By:
1. FIRE PROTECTION
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Extinguisher locations marked?
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Extinguishers fully charged and inspected?
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Free access to extinguishers?
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Exits marked and clear of obstructions?
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No stock within 36" of sprinkler heads?
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Flammables stored in proper containers?
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All containers clearly marked with contents?
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No ignition sources
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Paint Booth
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Booth free of excessive paint buildup?
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Filters changed/cleaned?
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Sprinkler heads free of paint and covered?
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Three foot clearance around booth is maintained?
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All equipment /drums/buckets properly grounded?
2. PERSONAL PROTECTION EQUIPMENT
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Safety glasses with side shields worn?
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Full face shields worn when grinding?
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Welding hoods worn when welding?
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Hearing protection worn when required?
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Respirators worn when sanding/painting/blasting?
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Steel toed shoes worn in all work areas?
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Gloves worn when handling hot/sharp materials?
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Safety PPE placards in place?
3. HOUSEKEEPING
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No materials in aisle ways?
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No Trash, Debris, Tooling on Floor?
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Tools and Supplies are stored in visibly marked locations?
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Work/break areas are clean. Key items to check are identified
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Cords/hoses are coiled and don't represent a trip hazard?
4. ELECTRICAL
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Three foot clearance in front of electrical panels?
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Electrical panels/disconnects marked?
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Junction boxes covered with no exposed wiring?
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No visible frayed or defective cords?
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No damaged outlets or connection boxes?
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Machinery and tools grounded with 3 prong plugs?
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Unused opening in panel boxes?
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No extension cords/power strips permanently mounted?
5. HAND TOOLS
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Impact tools free of mushroomed/chipped heads?
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No wrenches in use with sprung or worn jaws?
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No cracked or loose handles on tools?
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Air guns regulated to 30 psi Maximus pressure?
6. FIRST AID
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First Aid cabinets accessible and stocked?
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Eye wash stations accessible and maintained?
7. HAZARDOUS MATERIALS
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Current Hazardous Materials inventory List?
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Material Safety Data Sheets readily available?
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Hazardous materials properly labeled and stored?
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Designated Personnel maintaining MSDS?
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Designated person had CHK 3E MSDS training?
8. MATERIAL HANDLING
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Forklift Trucks
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Operated by authorized personnel?
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Daily inspections documented?
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Seat belts worn when operating?
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Fall protection used on man lifts/order picker lifts?
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Unattended trucks with forks down/controls in neutral/brakes set?
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Pallet Loading and Storage
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Pallets in good condition?
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No pallets improperly stacked/secured/loaded?
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No damaged legs/braces on storage racks?
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Portable and Roll Around Ladders
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No damaged or missing rungs/steps/side rails?
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Secure base footings and casters?
9. MACHINERY
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Points of operation guarded?
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Belts/pulleys/gears/shafts/electrical terminals within 7' of floor guarded?
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Hand grinders have 180* guards?
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Work rests within 1/8" of grinding wheels?
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Metal chips/shavings contained within work area?
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Lockout/Tagout used during servicing?
10. WELDING AND CUTTING
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Cylinders capped/chained when stored?
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Cylinders chained when in use?
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Valves closed or unattended cylinders?
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Cylinders free of grease and oil?
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Pressure regulators in working order?
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Wrench left in place on valve stem of acetylene?
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No leaks/burns/defects in torch guns or hoses?
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No acetylene used in access of 15 psig?
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No welding lead cables damaged?
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No defective positioners used?
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Weld curtains in place around operations?
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No leads/guns/hoses left in confined spaces?
11. CRANES AND HOISTS
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No damaged lifting chains/cables/slings?
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Control functions legible/working?
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Control cable pull back/trolley in place?
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Inspection of Slings/Chokers?
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Load hooks not worn/sprung/cracked?
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Load limits posted on cranes/controls?
12. GENERAL SAFE PRACTICES
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Local exhaust systems used when provided?
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No misuse of tools or equipment?
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Manual operations performed in strike zone?
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No horseplay?
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Emergency phone numbers posted by telephone?
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All permanent equipment mounted to floor?
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1. Used Oil
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Used oil is not mixed with any other materials?
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It is properly labeled as used oil?
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It is being transported off site and recycled?
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Bills of lading are being kept on file?
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2. Non-Hazardous Waste
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Scrap metals being recycled?
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Anti-Freeze being recycled?
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Used oil filters disposed of properly?
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Trash being shipped to an approved landfill?
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NHIW filed with state for each non-haz waste stream going to landfill?
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3. Hazardous Waste
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Hazardous Wastes Identified?
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Certified HazWaste transporter picking up waste?
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Land Restriction Notifications being sent with each shipment of hazardous waste?
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Manifests being retained?
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Waste being stored properly?
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Appropriate state/fed permits for site?
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No more than 2,200 lbs generated in one year and less than 220 lbs accumulated in one month?
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4. Above Ground Storage Tank
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Storage tanks identified?
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AST state notification has been sent?
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AST design and construction documents available at site?
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Release detection system?
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Tank tightness tests being conducted?
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Spills/overflows documented?
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Conducting sampling/testing/monitoring?
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5. SARA Tier 2 Reporting
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Submitting Tier 2 reports?
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Submitted for last 3 consecutive years?
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Have 10,000 lbs. or more of chemicals on site?
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6. Air Quality
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Painting operations?
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Bulk propane storage?
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Bulk diesel storage?
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Bulk gasoline storage?
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Abrasive blasting?
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Applicable air permits filed with the state?
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Air emissions inventory properly prepared and submitted?
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Any modifications to facility have modifications to permit?
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Emissions tracked throughout the year?
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Welding operations?
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7. Storm Water
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SIC falls under NPDES?
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Have a SWPPP?
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Outside waste bins are covered?
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Outside barrels of liquids have bungs securely in place and are elevated?
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Outfalls identified?
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Conducting quarterly outfall checks?
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Conducting annual inspection?
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Conducting analyticals?
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8. SPCC
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Storing 1,320 gallons of petroleum product on site?
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Specific release containment procedures?
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Secondary containment 150%?
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9. Universal Waste
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Fluorescent bulbs stored in boxes from transporter or manufacturer?
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Fluorescent bulbs labeled "waste bulbs"?
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Batteries labeled "waste batteries"?
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Batteries stored in sturdy leak proof container?
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Computer waste stored Ina sturdy leak proof container?
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No more than 11,000 lbs. accumulated at any given time?
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Computer waste labeled "computer waste"?
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10. Underground Storage Tank
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If exists, contact EH&S Dept.
