ClO2 Safety Inspection

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location

• Operator

• Unit

Safety Inspection Checklist

• Totes in good condition

  Yes

  No

  N/A

• Totes in containment

  Yes

  No

  N/A

• Acid in own containment

  Yes

  No

  N/A

• Containment in good condition

  Yes

  No

  N/A

• Problems found

• Brackets in place

  Yes

  No

  N/A

• Lids and caps in place on empties

  Yes

  No

  N/A

• Chem hoses in good condition

  Yes

  No

  N/A

• Camlocks not leaking(Unit & tote)

  Yes

  No

  N/A

• Pins/zipties in place on chem lines

  Yes

  No

  N/A

• Pulling from bottom of tote

  Yes

  No

  N/A

• Chem lines coiled and neat from totes to unit

  Yes

  No

  N/A

• Water hoses in good condition

  Yes

  No

  N/A

• Water camlocks not leaking

  Yes

  No

  N/A

• Pins/zipties in place on water lines

  Yes

  No

  N/A

• Whip checks in place on manifold

  Yes

  No

  N/A

General

• Tools picked up

  Yes

  No

  N/A

• Area free of trash

  Yes

  No

  N/A

• Trip hazards minimized

  Yes

  No

  N/A

• Trucks parked "back in"

  Yes

  No

  N/A

• Spill kit available

  Yes

  No

  N/A

• Fire extinguisher near generator

  Yes

  No

  N/A

• Fire Extinguisher monthly inspection performed

  Yes

  No

  N/A

Generator

• Generator Grounded

  Yes

  No

  N/A

• Generator serviced recently

  Yes

  No

  N/A

• Generator hooked up properly

  Yes

  No

  N/A

• Generator alarms noted and reported

  Yes

  No

  N/A

• Generator wheels chocked

  Yes

  No

  N/A

• Power cord coiled and neat from unit to generator

  Yes

  No

  N/A

Unit

• Wheels chocked

  Yes

  No

  N/A

• Unit leveled

  Yes

  No

  N/A

• Extra hoses coiled and neat

  Yes

  No

  N/A

• Grounded

  Yes

  No

  N/A

• External lights functioning

  Yes

  No

  N/A

Unit:

General

• Unit organized and neat(swept recently; no trash around, no trip hazards)

  Yes

  No

  N/A

• No exposed wires/lights working

  Yes

  No

  N/A

• Eyewash bottles current

  Yes

  No

  N/A

• Food stored properly

  Yes

  No

  N/A

• AC/heat working

  Yes

  No

  N/A

• Drinking water available

  Yes

  No

  N/A

• Refrigerator working

  Yes

  No

  N/A

• SDS available

  Yes

  No

  N/A

• Daily JSA completed

  Yes

  No

  N/A

Lab Area

• Neat and organized

  Yes

  No

  N/A

• No food in lab area

  Yes

  No

  N/A

• Items properly labeled(bottles, pipettes, etc.)

  Yes

  No

  N/A

• No spills

  Yes

  No

  N/A

Safety Equipment Present

• Apron

  Yes

  No

  N/A

• Faceshield

  Yes

  No

  N/A

• First Aid kit

  Yes

  No

  N/A

• First Aid Kit properly stocked?

  Yes

  No

  N/A

• Bloodborne Pathogen Kit

  Yes

  No

  N/A

• Bloodborne Pathogen Kit propery stocked?

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Earplugs

  Yes

  No

  N/A

• Disposable Mask

  Yes

  No

  N/A

• Eyewash Keg Pressurized

  Yes

  No

  N/A

Generation Room

• Neat and organized(No: hoses in area, tools laying around, general clutter)

  Yes

  No

  N/A

• No exposed wires

  Yes

  No

  N/A

• No leaks

  Yes

  No

  N/A

• Chemical lines

  Yes

  No

  N/A

• Water line

  Yes

  No

  N/A

• Eyewash bottles present

  Yes

  No

  N/A

Operator

• Wearing FR

  Yes

  No

  N/A

• PPE present: H2S monitor, safety glasses, hard hat

  Yes

  No

  N/A

• Training cards: H2S, SafeLand(PEC or Rig ID), Forklift

  Yes

  No

  N/A

Problems Fixed:

• Location Needs:

• Problems fixed