CVA NH3 SAFETY EMPHASIS AUDIT - duplicate

• Site conducted

  Select

• Location

• Conducted On

  Date

• Prepared By

EMPLOYEE TRAINING & CERTIFICATIONS

• Employees engaged in ammonia transfer operations are current on (3 year) CVA Ammonia Handler Certification?

  Yes

  Y-Notes

  No

  N/A

• Employees engaged in pulling ammonia trailers hold appropriate CDL and Endorsements?

  Yes

  Y-Notes

  No

  N/A

RESPIRATORY PROGRAM COMPLIANCE

• Employees engaged in ammonia transfers have completed a medical evaluation and are current on fit testing?

  Yes

  Y-Notes

  No

  N/A

BULK PLANT COMPLIANCE

• EMERGENCY WATER - adequate clean water in tanks that provide immediate access for first aid?

  Safe x3

  At Risk

  N/A

  Y-Notes

• WORKING WALKING SURFACES - All working walking areas are maintained in safe condition?

  Safe

  Y-Notes

  At Risk

  N/A

• COMBUSTIBLES - Areas within 10' of storage tanks and piping are free of vegetation and combustible items?

  Safe

  Y-Notes

  At Risk

  N/A

• RISER STANDS - free of defects and provide adequate access to fill nurse tanks (without standing on tires)?

  Safe

  Y-Notes

  At Risk

  N/A

• WIND SOCKS - free of defects and in the immediate area of the ammonia bulk plant?

  Safe

  Y-Notes

  At Risk

  N/A

• LEAKS - ammonia storage and transfer systems are free of leaks?

  Safe

  Y-Notes

  At Risk

  N/A

• HOSES - NH3 transfer hoses are in good condition and within the marked replace-by dates?

  Safe

  Y-Notes

  At Risk

  N/A

• MAINTENANCE & REPAIR - ALL tanks, piping, pipe fittings, valves, and safety devices are in proper working order and maintained in a manner to prevent rust and deterioration?

  Safe

  Y-Notes

  At Risk

  N/A

• MARKINGS & SIGNS - All required signs and markings are properly placed, free of damage, and legible?

  Safe

  Y-Notes

  At Risk

  N/A

• SAFETY EQUIPMENT - chemical gloves, respirators with (min. of 2) extra sets of NH3 respirator filter cartridges, rain coats, and rubber boots are available at bulk plant during filling operations?

  Safe

  Y-Notes

  At Risk

  N/A

• SECURITY - bulk plant and fill hoses are properly secured when plant is unattended?

  Safe

  Y-Notes

  At Risk

  N/A

NURSE TANK SAFETY

• All nurse tanks are safe before sending out to customer (emergency water saddle tanks, safety chains, free of leaks, proper markings, etc.)

  Yes

  Y-Notes

  No

  N/A
NURSE TANK INSPECTIONS

• TANK UNIT NUMBER

• LIST OF DEFECTS - Inspect for damage, maintenance & repair issues, SMV Emblem, safety chains, plumbing, emergency water tanks.

• PHOTOS

  Media

OBSERVATIONS

• PPE - Proper use of PPE (Gloves, Respirator, Long Sleeves) with 25 feet of loading platform?

  Safe x3

  At Risk

  N/A

  Y-Notes

• WHEEL CHOCKS - Proper use of wheel chocks when filling tanks?

  Safe x3

  At Risk

  N/A

  Y-Notes

• HITCH PIN / KEYS - Hitch pin or keys removed before filling nurse tanks?

  Safe x3

  At Risk

  N/A

  Y-Notes

• FILLING PROCESS / SEQUENCE - Employees follow proper processes and sequence when filling nurse tanks?

  Safe x3

  At Risk

  N/A

  Y-Notes

• HOSE END VALVES - Proper handling of hose end valves and storage of hose end valves when filling nurse tanks?

  Safe x3

  At Risk

  N/A

  Y-Notes

• OTHER OBSERVATIONS

• Auditor Signature

  Sign

• Facility Representative

  Sign