Title Page

  • Company Name:

  • Site Name

  • Line of Business

  • Inspection Location:
  • Date of inspection:

  • Conducted By:

  • Others present:

  • Manager

  • Manager present?

  • Manager Name

  • Site/Plant Manager

  • Announced/Unannounced

Hazardous Materials

  • Hazardous Materials Section Applicable (Is this facility a shop?)

  • No regulatory issues since last coaching opportunity

  • Waste streams properly characterized

  • Things to look for...

  • Waste records available

  • Things to look for...

  • Used oil, batteries, universal waste, and asbestos properly managed

  • Things to look for...

  • Hazardous Materials Comments

Air Quality

  • Air Quality Section Applicable

  • No regulatory issues since last coaching opportunity

  • Air Permit is available, operator familiar

  • Things to look for...

  • Air records available and up-to-date

  • Things to look for...

  • Air permit requirements being met

  • Things to look for...

  • Air Quality Comments

Water Quality

  • Water Quality Section Applicable

  • No regulatory issues since last coaching opportunity

  • SWPPP Available, operator familiar

  • Things to look for...

  • Water records available and up-to-date

  • Things to look for...

  • BMP's Effective and maintained

  • Things to look for...

  • Water Quality Comments

Spill Prevention

  • Spill Prevention Section Applicable (Does this site/plant have a SPCC Plan?)

  • No regulatory inspection since last coaching opportunity

  • SPCC plan available, operator familiar

  • Things to look for...

  • Records available and up-to-date

  • Things to look for...

  • All plan requirement maintained and functional

  • Things to look for...

  • Spill Prevention Comments


  • Trash picked up, properly contained

  • Things to look for...

  • Staining maintained

  • Things to look for...

  • Metal/parts properly managed

  • Things to look for...

  • Drums/containers closed, labeled, and properly stored

  • Things to look for...

  • Plant areas, entrance, and exits swept and free of dirt

  • Things to look for...

  • Tires, lumber, and miscellaneous items properly managed

  • Things to look for...

  • 5S process implemented and documented

  • Things to look for...

  • Housekeeping Comments

Risk Management

  • Risk Management Section Applicable

  • Equipment safety implementation (directional signage, cell phone signage, designated parking, pedestrian crossing, blocks are double stacked or clearly marked)

  • Equipment Safety LSR #2

    Screenshot 2023-04-17 131931.jpg
  • LOTO procedures, and documentation on site

  • LOTO Procedure LSR #3

    Screenshot 2023-04-18 083326.jpg
  • Confined Space signage, procedures and documentation on site.

  • CONSPACE Signage LSR #5

    Screenshot 2023-04-18 083423.jpg
  • Working at heights implementation

  • Working at Heights LSR #6

    Screenshot 2023-04-18 083453.jpg
  • Employee engagement process

  • Employee engagement LSR #13

    Screenshot 2023-04-18 083526.jpg
  • Safety of materials under pressure

  • Explain "Other"

  • Under Pressure LSR #10

    Screenshot 2023-04-18 083606.jpg
  • Presence of a start-up alarm

  • Type of start-up alarm

  • Current arc flash assessment and labels

  • Date Arc Flash Completed

  • Risk Management Comments

Environmental Stewardship (Extra Credit)

  • Stewardship Project Examples

    Screenshot 2023-04-18 083826.jpg
  • Does facility have a current stewarship project that aligns with OpCo or CRH Sustainability Initiatives?

  • Stewardship Project Type

  • Details

  • CRH's Sustainability Goals

    Screenshot 2023-04-24 150826.jpg
  • What sustainability projects would the site/plant like to see in the future

Other Considerations

  • Compliance Hotline

  • Riskonnect

  • Notes

  • Extra Credit: Opacity reader available (Someone on site has attended smoke school every other year.)

  • Extra Credit: Hazardous waste training completed within 12-months of inspection date

  • Extra credit: Health assessment completed

  • Extra credit is being scored differently due to the new inspection format. Your overall score percentage might be less than previous years, but that does not imply the site has not improved.

Overall Impressions

  • Community Perception Score

  • Community Perception Comments:

  • Overall Impression Score

  • Overall Impression Comments:

Overall Results

  • Gold Standard Score = 100% on compliance and 90% or greater overall

  • Category

  • Previous Score

  • Outcome

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.