CNM Annual Facility Inspection/Tool and Equipment Inspection

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

  Joshua Alvarez

  Justin Staley
• Building
  Address

• Yes

  No

  N/A

Hazcom/lab

• SDS <br> Employees have received “right to know” training on hazardous materials and the use of <br> Safety Data Sheets. Employees know where the Safety Data Sheets are kept and how <br> to use them.

  Yes

  No

  N/A

• LABELING - CONTAINER <br> Chemical containers are properly labeled (identity/hazard warnings)

  Yes

  No

  N/A

• SIGNAGE <br> Signs concerning various hazards, such as room capacities, floor loading, biohazards, <br> exposures to x-ray, or other harmful substances posted where appropriate.

  Yes

  No

  N/A

• GAS - EMERGENCY SHUT-OFF <br> Emergency gas shut-offs for all appliances are readily accessible and well marked.

  Yes

  No

  N/A

• EYEWASH/SHOWERS <br> Eyewash/Showers are in areas where corrosives are used and are being inspected and <br> signed off on.

  Yes

  No

  N/A

• FUME HOOD <br> Fume hoods have been inspected within the last year.

  Yes

  No

  N/A

• HAZCOM VIOLATIONS - OTHER:

  Yes

  No

  N/A

• LAB VIOLATIONS - OTHER:

  Yes

  No

  N/A

Confined Space / Lockout Tagout

• CONFINED SPACE - PERMIT <br> All confined spaces in area have been evaluated and verified whether they are permit-required <br> spaces or not.

  Yes

  No

  N/A

• CONFINED SPACE - SIGNAGE <br> Any permit-required confined space has a sign reading "DANGER -- PERMIT-REQUIRED <br> CONFINED SPACE, DO NOT ENTER"

  Yes

  No

  N/A

• LOCKOUT TAGOUT <br> Machine/Task Specific Lockout Tagout Procedures are written and location of documentation <br> are known for LOTO users.

  Yes

  No

  N/A

• GUARDING - POINT OF OPERATION <br> All of the machinery that requires point of operation guarding is adequately guarded against.

  Yes

  No

  N/A

• GUARDING - FAN/BELT <br> All rotating fans, pulleys and belts within 7 feet of the floor or working level are properly guarded.

  Yes

  No

  N/A

• CONFINED SPACE VIOLATIONS - OTHER:

  Yes

  No

  N/A

• LOCKOUT TAGOUT VIOLATIONS OTHER:

  Yes

  No

  N/A

Housekeeping

• WORK AREAS - ORDERLY <br> Work areas are clean and orderly to prevent hidden hazards.

  Yes

  No

  N/A

• TRIP HAZARDS <br> Area is clear of tripping hazards and well lit.

  Yes

  No

  N/A

• DAMAGED EQUIPTMENT <br> Broken/damaged equipment and furniture are absent from the space.

  Yes

  No

  N/A

• EMERGENCY EQUIPTMENT <br> Emergency equipment is clear from all obstacles.

  Yes

  No

  N/A

• HOUSEKEEPING VIOLATIONS - OTHER:

  Yes

  No

  N/A

Floors, aisles, stairs, elevated suface and means of egress

• OCCUPANT LOAD <br> All rooms with a capcity over 50 employees have signage displaying occupany.

  Yes

  No

  N/A

• GUARD RAILS <br> Guards shall be located along open sided walking surfaces that are located more<br> than 30” measured vertically to the floor or grade below at any point (IBC).

  Yes

  No

  N/A

• LOCKED EXIT <br> Exit doors shall be readily accessible and unlocked from the inside at all times.<br>

  Yes

  No

  N/A

• NON-EXITS <br> Doors, passageways or stairways that are neither exits nor access to exits, but could be <br> mistaken for exits, appropriately marked "NOT AN EXIT",

  Yes

  No

  N/A

• EXIT SIGNS AND EMERGENCY ILLUMINATION <br> Exit signs and emergency lights are in working condition and evacuation maps are in all <br> classrooms.

  Yes

  No

  N/A

• STAIR HANDRAILS <br> Standard stair rails or handrails are installed on all stairways have four or more steps.

  Yes

  No

  N/A

• FLOOR SURFACE <br> Floors provide good traction and are free of cracks, bumps and other hazards that could cause <br> trips or falls.

  Yes

  No

  N/A

• STAIRWELL MAINTENANCE <br> Stairs are in good condition with no loose steps, provided with handrails, and well lighted. Area under stairways are clear and not used for storage.

  Yes

  No

  N/A

• STAIR VIOLATIONS - OTHER:

  Yes

  No

  N/A

• MEANS OF EGRESS VIOLATIONS - OTHER:

  Yes

  No

  N/A

• FLOOR, ISLE VIOLATIONS - OTHER:

  Yes

  No

  N/A

Storage

• FLAMABLE LIQUID STORAGE <br> Flammable and combustible liquids are being stored in approved containers and/or storage <br> cabinets.

  Yes

  No

  N/A

• STORAGE HEIGHT <br> Stored materials, products and supplies are set in stable, balanced piles, to a reachable <br> height and not stored above eye level.

  Yes

  No

  N/A

• CEILING CLEARANCE - STORAGE <br> Stored materials have at least 18” clearance from sprinkler deflector or 24” from ceiling.

  Yes

  No

  N/A

• STORAGE VIOLATIONS - OTHER:

  Yes

  No

  N/A

Electrical

• ENERGIZED EQUIPTMENT <br> All electrical equipment and systems treated as energized until tested or otherwise proven to <br> be de-energized.

  Yes

  No

  N/A

• PANEL SECURITY <br> Electrical panels are locked in public areas (Classrooms, Hallways)

  Yes

  No

  N/A

• EXTENSION CORD MAINTENANCE <br> All cords are free of frayed or otherwise exposed wiring.

  Yes

  No

  N/A

• PANEL CLEARANCE <br> Electrical panels maintain 36” clearance and are locked when accessible by public.

  Yes

  No

  N/A

• JUNCTION BOX - OUTLET COVERS <br> Junction box, switches and outlets have covers are present and properly secured.

  Yes

  No

  N/A

• PERMINENT WIRING <br> Extension cords are not used as a permanent electrical source.

  Yes

  No

  N/A

• DAISY CHAINING <br> Power strips and extension cords are plugged directly into outlets and are not daisy chained.

  Yes

  No

  N/A

• ELECTRICAL ROOM STORAGE <br> Electrical rooms shall be clear of all storage.

  Yes

  No

  N/A

• ELECTRICAL VIOLATIONS - OTHER:

  Yes

  No

  N/A

Fire Safety

• ESCUTCHEON PLATE <br> Replace all missing or damaged escutcheon plates.

  Yes

  No

  N/A

• MECHANICAL ROOM STORAGE <br> All Electrical, TR and Mechanical rooms clear of all storage and combustibles.

  Yes

  No

  N/A

• HEAT PRODUCING EQUIPTMENT <br> All office areas are free of hot plates, space heaters, and other heat producing equipment <br> (fans are allowed).

  Yes

  No

  N/A

• FIRE ALARM DEVISE OBSTRUCTIONS <br> Fire alarm pull stations and devises shall visible and unobstructed.

  Yes

  No

  N/A

• FIRE EXTINGUISHER OBSTRUCTION <br> Fire extinguishers shall have an unobstructed clearance of 3ft.

  Yes

  No

  N/A

• FIRE EXTINGUISHER HEIGHT Fire extinguishers have the carrying handle placed 3-1/2 to 5 feet above the floor.

  Yes

  No

  N/A

• CEILING TILES <br> Ceiling tiles are present, not damaged and not painted.

  Yes

  No

  N/A

• HOT WORK LOCATION <br> Hot work is done in a designated hot work area or have utilized a hot work permit system.

  Yes

  No

  N/A

• FIRE RATED DOORS <br> Stationary Fire Doors shall remain closed in closed position.

  Yes

  No

  N/A

• FIRE CODE VIOLATIONS - OTHER:

  Yes

  No

  N/A

PPE

• PPE AVAILIBILITY <br> Personal protective equipment (PPE) is readily available in appropriate work area.

  Yes

  No

  N/A

• HARD HAT PRACTICES <br> Hard hats provided and are worn where danger of falling objects exists.

  Yes

  No

  N/A

• PPE STORAGE <br> PPE stored properly, lanyards and harness are hung up.

  Yes

  No

  N/A

• PPE VIOLATIONS - OTHER:

  Yes

  No

  N/A

Other

• EXTERIOR HAZARDS <br> Free of exterior building safety concerns.

  Yes

  No

  N/A

• SAFETY HAZARDS GENERAL <br> Is the building free of any other safety hazard?

  Yes

  No

  N/A

• ENVIROMENTAL HAZARDS <br> Building is free of any other enviromental hazard (noise, mold, etc.)

  Yes

  No

  N/A

Machines/Equipment/Tools/Guards

• ABRASIVE WHEEL WORK REST <br> Work rests are adjusted with a maximum opening of 1/8" and tongue with a maximum of 1/4" on <br> equipment with and abrasive wheel.

  Yes

  No

  N/A

• POINT OF OPERATION GUARD <br> All of the machinery that requires point of operation guarding is adequately guarded against.

  Yes

  No

  N/A

• FAN, BELTS, PULLEY GUARDING <br> All rotating fans, pulleys and belts within 7 feet of the floor or working level are properly guarded.

  Yes

  No

  N/A

• SAW BLADE MAINTENANCE <br> Saw blades are in good working condition with no cracks, burn marks, missing teeth.

  Yes

  No

  N/A

• SAW BLADE GUARDING <br> Saw blade guards in place.

  Yes

  No

  N/A

• DRILL PRESS CLAMPS <br> Clamps are avaliable for drill press.

  Yes

  No

  N/A

• TABLE SAW PUSH STICK <br> Push Sticks are avaliable for table saw.

  Yes

  No

  N/A

• EQUIPTMENT HOUSEKEEPING <br> Good housekeeping is maintained around machines/equipment with no large accumulation of <br> dusts (wood metal).

  Yes

  No

  N/A

• WOODEN HANDLE MAINTENANCE <br> Wooded handles of tools are kept free of splinters or cracks and are they fixed tightly in the tool.

  Yes

  No

  N/A

• MACHINE/EQUITMENT VIOLATIONS - OTHER:

  Yes

  No

  N/A

Compressed

• SIGNAGE - NFPA 704 <br> Cylinder storage area has proper NFPA 704 sign.

  Yes

  No

  N/A

• WARNING LABELS <br> All warning labels and name of gases are in place and legible.

  Yes

  No

  N/A

• CYLINDER STORAGE <br> All cylinders are stored upright and secured.

  Yes

  No

  N/A

• CYLINDER MAINTENANCE <br> All cylinders are in good condition with no damage, dings, or dents.

  Yes

  No

  N/A

• CYLINDER INSPECTIONS <br> Periodic inspections are completed by department on cylinders.

  Yes

  No

  N/A

• COMPRESSED GAS VIOLATIONS - OTHER:

  Yes

  No

  N/A

Forklift

• ANNUAL MAINTENANCE <br> Annual maintenance services have been completed for the lift.

  Yes

  No

  N/A

• NAME PLATE LOCATION <br> Data/Name plate is in place and legible.

  Yes

  No

  N/A

• DAILY LOG <br> Forklift Operator's Daily Checklist are being completed.

  Yes

  No

  N/A

• FORKLIFT VIOLATIONS - OTHER:

  Yes

  No

  N/A

Crane/Hoist/Automotive lift

• ANNUAL INSPECTION LABEL <br> Annual inspection/service sticker is on the crane/hoist/automotive lift.

  Yes

  No

  N/A

• CRANE, HOIST, LIFT MAINTENANCE <br> Crane/hoist/automotive lift is in good working condition.

  Yes

  No

  N/A

• CRANE VIOLATIONS - OTHER:

  Yes

  No

  N/A

• HOIST VIOLATIONS - OTHER:

  Yes

  No

  N/A

• AUTOMOTIVE LIFT VIOLATIONS OTHER:

  Yes

  No

  N/A

• Building manager name and/or affected supervisor(s) names:

• Signature of Person completing Audit:

  Sign