COURTESY ALL-IN INSPECTION

• Site

  Select

• Conducted on

  Date

• Prepared by

• Audit

  1st Audit

  2nd Audit

• AUDIT HAZARD LEVEL RATING

  Severe Risk

  High Risks

  Moderate Risks

  Low Risks

• SEVERE RISK! - EXTREMELY HIGH INCIDENT POTENTIAL OR EXPOSURE TO SEVERE INJURY OR DEATH - STOP WORK IMMEDIATELY and TAKE IMMEDIATE ACTION TO CORRECT UNSAFE CONDITIONS.

• HIGH RISK! - High incident potential or exposure to serious injury - Take corrective actions immediately!

• MODERATE RISK! - Moderate Incident potential and/or moderate exposure to less than serious injury - Corrective actions must be scheduled and completed promptly.

• LOW RISK - Low incident potential or severity. Incidents or injuries are not likely. Address any non-compliant conditions listed in this report.

• AUDIT COMMENTS

• (x3) - ENGAGE / MONTHLY SAFETY TRAINING completed and documented each month since last All-In audit?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• (X3) - ENGAGE / Documentation is consistent with observations during audit (No evidence of pencil whipping required compliance documentation)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

Employees Interviewed

• Employee Name

Interviews

• PPE

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• EAP

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• HAZCOM

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• LOTO

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• GRAIN SAFETY

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• NEAR MISS

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PRCS

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FORKLIFT

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• ANHYDROUS AMMONIA

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

EMERGENCY ACTION PROGRAM

• EAP / Initial and annual training documented for EAP?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• EAP / Visitor log used for all visitor except customers?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• EAP / Updated when changes are made and reviewed for changes at once least annually?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• EAP / Exit routes posted for offices with 10 or more employees?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

NEAR MISS / UNSAFE CONDITION REPORTING PROGRAM

• NEAR MISS / Initial and annual training documented for NEAR MISS REPORTING PROGRAM?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• NEAR MISS / Forms are readily available for employee use?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• NEAR MISS / Proper follow-up on reports?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• NEAR MISS / Posters Displayed in Workplace

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

LOTO PROGRAM

• LOTO / Initial and annual training documented for LOTO program?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• LOTO / Written procedures are complete?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• LOTO / Energy control forms are completed properly and maintained for at least 12 months?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• LOTO / Annual LOTO review current?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

HAZ-COM SAFETY PROGRAM

• HAZCOM / Initial and annual TRAINING documented for HAZCOM PROGRAM?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• HAZCOM / Employees are TRAINED on the safe handling of the CATEGORIES OF HAZARDOUS MATERIALS they come into contact with?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• HAZCOM / EPA WPS Pesticide Handler Training current for all pesticide handlers (required annually for any employee that mixes, loads, or applies agronomy chemicals even around CVA facilities).

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• HAZCOM / Written program includes a LIST of all onsite chemicals (except consumer products)?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• HAZCOM / All employees have completed GHS HAZCOM training on the LMS?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• HAZCOM / CDMS website readily available on computers at agronomy locations? (www.cdms.net/labelsmsds/lmdefault.aspx)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

GRAIN SAFETY PROGRAM

• Check box if this section is applicable.

• GRAIN / initial and annual training documented for GRAIN SAFETY PROGRAM.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• GRAIN / Each employee has completed annual grain safety course on LMS

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• GRAIN / HOUSEKEEPING documentation complete and certified by location manager.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• GRAIN / MAINTENANCE & INSPECTION documentation complete and verified by location manager.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• GRAIN / LUBRICATION completed according to schedule with proper documentation.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• GRAIN / BIN ENTRY PERMITS completed correctly and maintain for at least 12 months?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• GRAIN / HOTWORK permits completed properly and maintained for at least 12 months?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

ANHYDROUS AMMONIA SAFETY PROGRAM

• Check box if this section is applicable.

• NH3 / Employees who fill NH3 nurse tanks are current on CVA's 3 year NH3 Handler Certification (LMS + Hand On Observations)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• NH3 / Anhydrous Ammonia Bulk Plants and Nurse Tanks maintenance and repair records

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• NH3 / Monthly Anhydrous Ammonia Bulk Plant Inspections completed and documented

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

RESPIRATORY PROGRAM

• Check box if this section is applicable.

• RESPIRATORY / Initial and annual training for all effected employees is documented for Respiratory PROGRAM?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• RESPIRATORY / All respirators are properly maintained and stored?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• RESPIRATORY / All employees are current on annual fit testing?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

FERTILIZER TANK, SHUTTLE, AND CONTAINMENT INSPECTION PROGRAM

• Check box if this section is applicable.

• TANK INSPECTION / Monthly Tank Inventory and Containment Inspection Forms completed properly and maintained for at least 2 years?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• TANK INSPECTION / Nitrogen testing completed and documented before pumping rain water from dikes?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• SHUTTLE COMPLIANCE / Repackaging facilities compliant on shuttle inspection/testing/documentation?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

PERMIT REQUIRED CONFINED SPACE PROGRAM

• Check box if this section is applicable.

• PRCS / Initial and annual training for all effected employees is documented for PRCS PROGRAM?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PRCS / All PRCS forms are completed properly and when required?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PRCS / Fire Department tour of all PRCS at facility completed?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PRCS / Annual rescue training complete when required (Including use of rope retrieval kit)?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

PPE / FALL PROTECTION PROGRAM

• Check box if this section is applicable.

• PPE / Initial and annual training for all effected employees is documented for PPE PROGRAM?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PPE / Railcar Fall Protection LMS Course complete for all employees assigned to use trolly system (required annually)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PPE / FEED TRUCK Tram system training and proper use of system?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PPE / Cable Grab Ladder Safety System training and proper use of system?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PPE / All PPE & FALL PROTECTION equipment properly stored and cared for?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

DOT Hazmat Shipper Training

• All affected employees are current on DOT hazmat Shipper Training

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• DOT / Required HAZMAT Shipping documents are retained in files for 2 years.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

Supervisor Drug and Alcohol Training

• Supervisor has completed DOT Drug and Alcohol Training

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

VEHICLE / DOT COMPLIANCE

• Check box if category is applicable.

• (X2) DOT / Daily truck inspections completed and filed in office at the end of each day. (Retain 90 days)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• (X3) DOT / Unattended vehicles properly secured (keys left in vehicles with doors unlocked)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• DOT / All trucks and pickups compliant with FMCSA rules and regulations.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• (X2) DOT / All commercial trucks and trailers current on annual inspections with inspection report and sticker with the vehicle?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• (X2) DOT / All electric brake trailers have proper break-away systems compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• (X2) DOT / All loads are properly secured (Including load straps and chemical containers protected from shifting)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• (X2) DOT / Tram Fall Protection System in Proper Working Condition

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
ADD Vehicle / DOT Issue

• Unit Number / Description

• Free of Safety/Compliance Issues

  YES

  NO

  NO - not scored

  REPEAT

FACILITY GENERAL

• (X2) FACILITY GEN / Poor Facility Image (mowing/weed control, rotten grain piles, loose bunker tarps, clutter and rubbish, poor condition of structures/offices, other facility image issues)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FACILITY GEN / Company Signage (Good Condition)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FACILITY GEN / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FACILITY GEN / ELECTRICAL compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FACILITY GEN / PROPANE STORAGE compliant with NFPA standards?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FACILITY GEN / FUELING AREAS free of leaks and ground contamination?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FACILITY GEN / ROLLING STOCK & PORTABLE EQUIPMENT in safe condition (skid steers, loaders, trailers, yard trucks, conveyors, augers, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Add Facility General Hazard

• Free of Additional Hazards?

  YES

  NO

  NO - not scored

  REPEAT

Structural Hazards/Issues

Add Structural Hazard/Issue

• FACILITY GEN / Structural Issues (ie; rusting tower support, cracked concrete elevators, etc.)

FORKLIFT

• FORKLIFT (Check if Applicable)

• Employees are properly trained and hold valid certification for the types of forklifts used at this facility?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
ADD FORKLIFT

• FORKLIFT DESCRIPTION (Make/Model)

• FORKLIFT / INSPECTIONS are completed and documented at the beginning of each shift, (If defects are listed the report must be turned in to the supervisor).

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FORKLIFT / Free of HYDRAULIC LEAKS OR OIL LEAKS

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FORKLIFT / COMPONENTS AND ATTACHMENTS are maintained in safe condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• FORKLIFT / LOAD CAPACITY DATA PLATE is properly attached, legible in English, and maintained in clean condition.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
ADD MOTORIZED PALLET JACK

• PALLET JACK DESCRIPTION (Make/Model)

• PALLET JACK / INSPECTIONS are completed and documented at the beginning of each shift, (If defects are listed the report must be turned in to the supervisor).

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PALLET JACK / Free of HYDRAULIC LEAKS OR OIL LEAKS

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PALLET JACK / COMPONENTS AND ATTACHMENTS are maintained in safe condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• PALLET JACK / LOAD CAPACITY DATA PLATE is properly attached, legible in English, and maintained in clean condition.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
ADD FORKLIFT MAN BASKET

• MAN BASKET / (Make/Serial Number)

• MAN BASKET / Safe Condition and Proper Storage (stored inside out of the elements)?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• MAN BASKET / Inspection Tag attached to basket

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

SKID STEER / WRANGLER LOADER

• SKID STEER / WRANGLER LOADER (Check if Applicable)

• Employees are properly trained and hold valid certification for the types of Skid Steer/Wranger Loader used at this facility?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
ADD SKID STEER / WRANGLER LOADER

• SKID STEER-LOADER DESCRIPTION (Make/Model)

• SKID STEER-LOADER / Free of HYDRAULIC or OIL LEAKS

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• SKID STEER-LOADER / INSPECTIONS are completed and documented at the beginning of each shift (using inspection tags)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• SKID STEER-LOADER / Skid steer machines and attachments are maintained in safe condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• SKID STEER-LOADER / USER'S MANUAL is available in the machine?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• SKID STEER-LOADER / All operator warning labels are legible and in good condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

JLG / BUCKET TRUCK / SCISSORS LIFT

• JLG / BUCKET TRUCKS/ SCISSOR LIFTS (Check if Applicable)

• Employees are properly trained and hold valid certification for the types of Equipment used at this facility?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
ADD JLG / BUCKET TRUCK / SCISSORS LIFT

• JLG DESCRIPTION (Make/Model)

• JLG / INSPECTIONS are completed and documented at the beginning of each shift.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• JLG / Free of HYDRAULIC or OIL LEAKS?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• JLG / Machines are maintained in safe condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• JLG / Annual Inspection Completed on Machine?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• JLG / USER'S MANUAL is available in the machine?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• JLG / All operator warning labels are legible and in good condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

TELEHANDLER

• TELEHANDLERS (Check if Applicable)

• Employees are properly trained and hold valid certification for the type of Telehandler they operate?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
ADD TELEHANDLER

• TELEHANDLER DESCRIPTION (Make/Model)

• TELEHANDLERS / INSPECTIONS are completed and documented at the beginning of each shift.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• TELEHANDLERS / Machines are maintained in safe condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• TELEHANDLERS / Free of HYDRAULIC or OIL LEAKS?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• TELEHANDLERS / Annual Inspection Completed on Machine?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• TELEHANDLERS / USER'S MANUAL is available in the machine?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• TELEHANDLERS / All operator warning labels are legible and in good condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

OFFICE

• Check box if section is applicable.

• OFFICE / FIRE EXTINGUISHERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Fire Extinguisher

• Fire Extinguisher Compliant

  YES

  NO

  NO - not scored

  REPEAT

• OFFICE / FIRST AID / AED compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / First Aid & AED

• First Aid & AED Compliant

  YES

  NO

  NO - not scored

  REPEAT

• OFFICE / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Working and Walking Areas

• Working and Walking Areas Safe?

  YES

  NO

  NO - not scored

  REPEAT

• OFFICE / STAIRWAYS have proper handrails where required?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Stairway Area

• Stairway Safe?

  YES

  NO

  NO - not scored

  REPEAT

• OFFICE / EGRESS routes kept clear of obstacles?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Egress

• Egress clear?

  YES

  NO

  NO - not scored

  REPEAT

• OFFICE / ELECTRICAL SYSTEMS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Electrical

• Electrical compliant

  YES

  NO

  NO - not scored

  REPEAT

• OFFICE / Facility SIGNAGE compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Signage

• Additional Signage

  YES

  NO

  NO - not scored

  REPEAT

• OFFICE / INFOTRAC contact signs/stickers are displayed.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• OFFICE / Employee LABOR LAW POSTERS and OSHA 300 posted?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• OFFICE / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Chemical Containers

• Chemical Containers Compliant

  YES

  NO

  NO - not scored

  REPEAT
ADD OTHER OFFICE HAZARD

• Free of Additional Hazards?

  YES

  NO

  NO - not scored

  REPEAT

GRAIN & FEED AREAS

• Check box if section is applicable.

• GRAIN & FEED / Is the facility free of combustible dust accumulations?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A

• (Severity Level 1) if dust is greater than 1/8" anywhere within a priority housekeeping area, (Severity Level 2) if dust is greater than 1/8" anywhere in a non-priority housekeeping area, (Severity Level 3) if dust is not greater than 1/8" but covers floor and most other surfaces, (Severity Level 4) if dust is not greater than 1/8" only on pipes, ledges, or walls.

• Describe the area (include pictures) then add risk assessment with the slider. Combustible Dust Risk Level (Severity Level 1 = highest Risk / Severity Level 4 = lowest Risk)

  Severity 1

  Severity 2

  Severity 3

  Severity 4

  No Dust Present
Additional / Area With Combustible Dust Accumulations

• Other areas free of combustible dust?

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / SPILLED GRAIN or Feed PICKED UP?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Spilled Grain or Feed

• Spilled Grain or Feed

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / ORGANIZED and free of clutter and rubbish?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Clutter & Rubbish

• Clutter & Rubbish

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / FIRE EXTINGUISHERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Fire Extinguisher

• Fire extinguisher compliant?

  YES

  NO

  NO - not scored

  REPEAT

• Grain & Feed / Only non-steel hammers used on feed mill bins or in other combustible dust areas.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Metal Hammers on Bins

• Grain & Feed / Metal Hammers used on feed mill bins or in other combustible dust areas.

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & Feed / EGRESS routes kept clear of obstacles?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Egress Routes

• Egress Route kept clear

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / ELECTRICAL SYSTEMS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Electrical

• Electrical system compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / RAILINGS AND HOLE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Railings and Hole Guarding

• Railings and hole guarding compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / MACHINE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Machine Guarding

• Machine Guarding Compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Working Walking Areas

• Working walking areas free of hazards?

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / LADDERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Ladders

• Ladders compliant?

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / PERMIT SPACES properly marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / PRCS Marking

• Permit Spaces properly marked

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / MAINTENANCE (Equipment is in proper working condition)?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Maintenance

• Grain Maintenance (equipment in proper working order)

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / DUST COLLECTION system is compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Dust Systems

• Dust collection system compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / OILER SYSTEM(S) in proper working condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Oiler Systems

• Oiler system compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / EMERGENCY RESCUE EQUIPMENT on site and stored properly? (Rope retrieval kit, plywood coffer dams, proper harness, and lifelines)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Rescue Equipment

• Rescue Equipment properly stored

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / DUMP PIT GRATES compliant (less than 2 1/2")?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Dump Pit Grates

• Dump Pit Grates Compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / Grain processing equipment MAGNETS are properly maintained? (Cleaned at least monthly)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Magnets

• Magnets properly maintained?

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Chemical Containers

• Chemical Containers compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / Facility SIGNAGE compliant (Including NO SMOKING WITHIN 50 FEET)?<br><br>

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Signage

• Grain Facility Signage Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / LOTO Markings

• Grain LOTO Markings Compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Extension Cords

• Extension Cords Compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / Adequate SECURITY at facility? (Ladders, doors, electrical, overheads, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Security

• Grain Facility Security

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / FALL PROTECTION SYSTEMS safe condition (including rails, trolleys, and SRLs)?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Fall Protection Systems

• Fall Protection System Compliant

  YES

  NO

  NO - not scored

  REPEAT

• GRAIN & FEED / MAN-LIFTS are current on annual inspections and in safe operating condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Manlifts

• Manlift compliant

  YES

  NO

  NO - not scored

  REPEAT
ADD OTHER GRAIN & FEED AREA HAZARD

• Free of Additional Hazards?

  YES

  NO

  NO - not scored

  REPEAT

SHOP AREAS

• Check this box if this section is applicable.

• SHOP / FIRE EXTINGUISHERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Fire Extinguisher

• Fire Extinguisher Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / EGRESS routes kept clear of obstacles?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Egress Routes

• Egress Routes kept clear?

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / ELECTRICAL SYSTEMS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Electrical

• Shop Electrical Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Extension Cords

• Extension Cords Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / MACHINE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Machine Guarding

• Machine Guarding Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / ORGANIZED and free of clutter and rubbish?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Clutter and Rubbish

• Free of Clutter and Rubbish

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Working and Walking Areas

• Working and Walking Areas Safe

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / RAILINGS and HOLE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Railings and Hole Guarding

• Railings and Hole Guarding Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / LADDERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Ladders

• Ladders Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / OILY RAGS and MATERIALS are placed in covered metal containers?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Oily Material Disposal

• Oily Material Disposal Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / TOOLS are kept picked up and put away when not in use?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Tools Put Away

• Tools Put Away

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / TOOLS and equipment are all OSHA compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Tools Compliant

• Shop Tools Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / All JACKS and HOISTS are marked with lifting capacities?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Jacks

• Shop jacks Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / Proper PPE is available? (Welding Equipment, Face Shields, Hearing Protection, Eye Protection, Hand Protection, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / PPE

• PPE Available and Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / BATTERY CHARGING stations have flushing water near by?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Battery Charging Stations

• Battery Charging Stations Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / LOTO Markings

• Loto Markings Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Chemical Containers

• Chemical Containers Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / FLAMMABLES and AEROSOLS stored to protect them from Hot Work? (sparks, slag, flying debris, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Flammables and Aerosols

• Shop flammables and Aerosols properly stored?

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / ALL FUELS are stored in OSHA compliant containers?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / fuel containers

• Fuel Containers Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / FLAMMABLES not stored in access or egress routes?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Flammables in Egress

• Flammables kept out of egress routes

  YES

  NO

  NO - not scored

  REPEAT

• Flash Back Spark Arrester on cutting torches

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Flash Back Spark Arrester's on cutting torches

• Flash Back Spark Arrestor's on cutting torches?

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / OXYGEN CYLINDERS stored properly? (Greater than 20 feet from combustibles/Flammables)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Oxygen Storage

• Oxygen Storage Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / STORED CYLINDERS are capped and secured from falling over?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Cylinder Storage

• Cylinder Storage is compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / PROPANE BOTTLES are not stored inside? (Gas grills stored indoors must have grill bottles removed)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Propane Storage

• Propane Storage is Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / USED OIL is placed in covered containers that are marked as "USED OIL"?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Used Oil Storage

• Used Oil Storage is Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / OVERHEAD STORAGE areas are marked with max load ratings.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Overhead Storage

• Overhead Storage Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / STORAGE RACKS are secured and in good condition.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Storage Racks

• Storage Racks Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / All WEED SPRAYERS are emptied and rinsed before placing or storing inside shops?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Weed Sprayers

• Weed Sprayers Properly Stored

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / Facility SIGNAGE compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Signage

• Shop Signage Compliant

  YES

  NO

  NO - not scored

  REPEAT

• SHOP / Eye Wash Station has an inspection tag and inspected monthly.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Eye Wash Station

• Eye Wash Station Compliant

  YES

  NO

  NO - not scored

  REPEAT
ADD OTHER SHOP HAZARD

• Free of Additional Hazards?

  YES

  NO

  NO - not scored

  REPEAT

Warehouse Areas

• Check this box if this section is applicable.

• WAREHOUSE / FIRE EXTINGUISHERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Fire Extinguishers

• Fire Extinguisher Compliant

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / EGRESS routes kept clear of obstacles?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Egress Routes

• Egress Routes Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / ELECTRICAL SYSTEMS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Electrical

• Electrical Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / MACHINE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Machine Guarding

• Machine Guarding Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / ORGANIZED and free of clutter and rubbish?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Organized & Free of Clutter & Rubbish

• Free of Clutter and Rubbish

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Working and Walking Areas

• Working and Walking Areas Safe

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / RAILINGS and HOLE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Railings and Hole Guarding

• Railings and hole guarding compliant?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / LADDERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Ladders

• Ladders Compliant

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Extension Cords

• Extension Cords Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / STORAGE RACKS are secured and in good condition?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Storage Racks

• Storage Racks Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / STORAGE RACKS and STORAGE AREAS are not unsafely loaded or stacked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Storage Rack Safe Loading

• Storage Racks Safely Loaded?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / OVERHEAD STORAGE areas are marked with max load ratings?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Overhead Storage

• Overhead Storage Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / CHEMICAL CONTAINERS are free of leaks, properly stored, and labeled?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Chemical Containers

• Chemical Containers Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / LOTO Markings

• LOTO Markings Compliant

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / Facility SIGNAGE compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Signage

• Signage Compliant

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / Adequate SECURITY at facility? (Ladders, doors, chemicals)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Security

• Security Adequate

  YES

  NO

  NO - not scored

  REPEAT

• WAREHOUSE / Eye Wash Station has an inspection tag and inspected monthly.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Eyewash Stations

• Eyewash Station Compliant

  YES

  NO

  NO - not scored

  REPEAT
ADD OTHER WAREHOUSE HAZARD

• Free of Additional Hazards?

  YES

  NO

  NO - not scored

  REPEAT

LIQUID FERTILIZER AND CHEMICAL STORAGE AREAS

• Check this box if this section is applicable

• LIQ FERT / FIRE EXTINGUISHERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Fire Extinguishers

• Fire Extinguishers Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / EGRESS routes kept clear of obstacles?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Egress Routes

• Egress Routes Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / ELECTRICAL SYSTEMS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Electrical

• Electrical System Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / MACHINE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Machine Guarding

• Machine Guarding Compliant

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / ORGANIZED and free of clutter and rubbish?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Organized and Free of Clutter and Rubbish

• Organized and Free of Clutter and Rubbish

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Working and Walking Areas

• Working and Walking Areas Safe?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / RAILINGS and HOLE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Railings and Hole Guarding

• Railings and Hole Guarding Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / LADDERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Ladders

• Ladders Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Extension Cords

• Extension Cords Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / Proper PPE including chemical goggles and appropriate chemical gloves readily available in shuttle filling and truck loading areas?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / PPE

• PPE Available and Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / STORAGE RACKS are secured, in good condition, and safely loaded?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Storage Racks

• Storage Racks Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / OVERHEAD STORAGE areas are marked with max load ratings?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Overhead Storage

• Overhead Storage Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Chemical Containers

• Chemical Containers Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / LOTO Isolation Points

• LOTO Isolation Points properly marked

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / Facility SIGNAGE compliant (including "NO SMOKING")?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Facility Signage

• Facility Signage Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / INFOTRAC signs posted?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / InfoTrac Signs Posted

• Info Trac Signs Properly Displayed?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / PERMIT REQUIRED SPACES marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Permit Required Space Markings

• Permit Required Spaces Properly Marked

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / EYEWASH-SHOWER STATION clear of obstacles and inspected monthly with inspection tag?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Eyewash-Shower Station

• Eyewash Station Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / CHEMICAL CONTAINMENT SYSTEM free of defects or damage?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / ChemIcal Containment

• Chemical Containment Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / Adequate SECURITY at facility? (Ladders, doors, chemicals, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Security

• Security Adequate?

  YES

  NO

  NO - not scored

  REPEAT

• LIQ FERT / Bulk chemical tanks have SDS's readily available?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Safety Data Sheets

• Safety Data Sheets Available for Bulk Storage Chemicals?

  YES

  NO

  NO - not scored

  REPEAT
ADD OTHER LIQUID FERT HAZARD

• Free of Additional Hazards?

  YES

  NO

  NO - not scored

  REPEAT

DRY FERTILIZER STORAGE AREAS

• Check box if this section is applicable

• DRY FERT / FIRE EXTINGUISHERS compliant.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Fire Extinguishers

• Fire Extinguishers Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / EGRESS routes kept clear of obstacles?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Egress Routes

• Egress Routes Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / ELECTRICAL SYSTEMS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Electrical

• Electrical Systems Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / MACHINE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Machine Guarding

• Machine Guarding Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / ORGANIZED and free of clutter, rubbish, and spilled fertilizers?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Organized and Free of Clutter & Rubbish

• Free of Clutter and Rubbish

  YES

  NO

  NO - not scored

  REPEAT

• Dry Fert / Free of Excessive Spilled Fertilizer

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Excessive Spilled Fertilizer

• Free of Excessive Fertilizer Spills

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Working and Walking Areas

• Working and walking areas compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / RAILINGS and HOLE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Railings and Hole Guarding

• Railings and Hole Guarding Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / LADDERS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Ladders

• Ladders Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / EXTENSION CORDS are OSHA compliant including GFCI where required?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Extension Cords

• Extension Cords Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / OVERHEAD STORAGE areas are marked with max load ratings?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Overhead Storage Areas

• Overhead Storage Areas Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / CHEMICAL CONTAINERS free of leaks, properly stored, and labeled?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Chemical Containers

• Chemical Containers Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / Proper PPE available?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / PPE

• PPE Available and Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / LOTO Energy Isolation Points

• LOTO Energy Isolation Points properly marked

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / PERMIT REQUIRED SPACES marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Permit Required Space Markings

• Permit Required Space Markings Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / Facility SIGNAGE compliant (including "NO SMOKING")?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Facility Signage

• Facility Signage Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / INFOTRAC signs posted.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Info Trac Signs

• Info Trac Signs properly displayed?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / Adequate SECURITY at facility? (Ladders, doors, chemicals, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Security

• Facility Security Adequate?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / Eye Wash Station has an inspection tag and inspected monthly.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Eye Wash Station

• Eye wash stations compliant?

  YES

  NO

  NO - not scored

  REPEAT

• DRY FERT / FALL PROTECTION SYSTEMS safe condition (including rails, trolleys, and SRLs)?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Fall Protection Systems

• Fall Protection System Compliant?

  YES

  NO

  NO - not scored

  REPEAT
ADD OTHER DRY FERT HAZARD

• Free of Additional Hazards?

  YES

  NO

  NO - not scored

  REPEAT

ANHYDROUS AMMONIA

• Check this box if this section is applicable.

• NH3 / system free of LEAKS? (X3)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / NH3 Leaks

• Free of Leaks?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / Area within 10 feet of TANKS and PIPING kept clear of vegetation and other combustible items.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Combustibles within 10 feet

• Free of Combustible vegetiation and items with 10 feet?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / Required PPE available and properly maintained? (protective boots, protective slicker, non-vented goggles, NH3 gloves)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / PPE

• Required PPE available and properly maintained?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / Free of clutter and rubbish.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Clutter and Rubbish

• Free of Clutter and Rubbish?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / WORKING and WALKING AREAS safe? (Slip and Trip Hazards, Impalement hazards, sharp edges, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Working Walking Areas safe

• Working Walking Areas Safe?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / LOAD-OUT STANDS maintained and in safe condition.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Load-out stands safe

• Load-out Stands Safe?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / Adequate EMERGENCY WATER TANKS, Tank Placement, Full, and Clean Water?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Emergency Water Tanks

• Emergency Water Tanks Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / MACHINE GUARDING compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Machine Guarding

• Machine Guarding Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / ELECTRICAL SYSTEMS compliant?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Electrical

• Electrical Systems Compliant?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / LOTO ENERGY ISOLATION POINTS properly marked?

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / LOTO Markings

• LOTO Points properly marked?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / Proper SECURITY of plant

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Security

• Proper Security of Plant?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / Adequate MAINTENANCE of plant and tanks. (Paint, repair, tank markings, pop off valve covers, etc.)

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Maintenance

• Adequate Maintenance of plant?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / CHOCK BLOCKS are available and adequate for loading and unloading.

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Chock Blocks

• Chock Blocks Adequate?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / WINDSOCK properly located on or in close proximity to NH3 risers and in good condition

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Windsock

• Windsocks Adequate?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / Facility SIGNAGE compliant (Including Emergency Contact Sign and "DANGER Only authorized CVA employees allowed within 25 feet of risers during loading"

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Signage

• Facility SIGNAGE compliant?

  YES

  NO

  NO - not scored

  REPEAT

• NH3 / HOSES in safe condition

  YES

  Y-NOTES

  NO

  REPEAT

  N/A
Additional / Hoses

• Hoses in safe condition?

  YES

  NO

  NO - not scored

  REPEAT
ADD OTHER NH3 FACILITY HAZARDS

• Free of Additional Hazards?

  YES

  NO

  NO - not scored

  REPEAT

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• Auditor's signature

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