Information

  • Inspection

  • Inspection started on

  • Inspected by

  • Temperature (in degrees F)

  • Precipitation

Paperwork Verification

Paperwork Verification

  • Is the previous month's inspection verified complete?

  • Are all actions from previous month inspection assigned?

East

East

Resin Silos

  • Take picture of resin silos

  • No spills or debris on ground beneath silos?

  • Silos in good condition?

  • Roof runoff not discharging near silos?

Trash Roll-off (Cafeteria/Shipping Area)

  • Is the roll-off present?

  • Take picture of trash roll-off

  • Trash roll-off in good condition?

  • Trash roll-off leaking? Any staining observed?

  • Are around roll-off clean and organized?

Spill Kit 26: Cafeteria Grease Container

  • Take picture of spill kit

  • Is the bin clean and in good condition?

  • Is the bin located appropriately and easily accessible?

  • Does the spill kit have a contents list?

  • Is all spill procedure and emergency contact information up to date?

  • Are the contents compatible with materials stored in the area?

  • Is the bin sealed?

  • Pads x 20

  • Socs x 3

  • Box Nitrile Gloves x 1

  • Pair Splash Resistance Googles x 1

  • Disposal Bags x 3

  • Emergency Response Guidebook x 1

South

South

Mold Containment Area

  • Take picture of containment area

  • Discharge valve closed and locked?

  • No liquid accumulated in secondary containment? (Document release on secondary containment structure release form)

  • Liquid waste containers in molding containment area all labeled to indicate contents?

  • Liquid waste containers all stored within containment?

  • Are incompatible wastes stored appropriately?

  • Molding containment area free of cracks and in good condition?

  • Does a waste shipment need to be scheduled?

  • Molding Lab - Discharge records available? Take picture of inspection log

  • CORRECTIVE ACTION REQUIRED. Add follow-up item for this question if the issue cannot be immediately resolved.

Spill Kit 1:: Outside Mold Waste Storage Area

  • Take a picture of the spill kit

  • Is the bin clean and in good condition?

  • Is the bin located appropriately and easily accessible?

  • Does spill kit have a contents list?

  • Is all spill procedure and emergency contact information up to date?

  • Are the contents compatible with materials stored in the area?

  • Does the spill kit have an intact tamper seal?

  • 95 Gallon Lab Pack with Lid x 1

  • Pads 15"x18" x 100

  • Socs 3"x42" x 10

  • Pillows 9"x15 x 6

  • Tyvek Suits x 2

  • Pair Splash Resistance Googles x 2

  • Chemical Resistant Gloves x 4

  • Disposal Bags x 1

  • Caution Tape x 2

  • Emergency Response Guidebook x 1

RIM Exhaust/Wall

  • Take picture of RIM exterior wall

  • No evidence of staining, spills, or releases from RIM presses?

Forklift Repair Area

  • Take picture of forklift repair area

  • Lift repair area covered and area free of staining?

  • Is oil absorbent material present in the stormwater catch basin?

  • Used oil containers labelled and within containment?

Liquid Nitrogen Tank

  • Take picture of Nitrogen Tank

  • No leaks observed?

  • Tank in good condition?

  • Area free of staining and debris?

Paint Cooling Tower(s)

  • Take picture of cooling towers

  • No leaks observed?

  • Equipment in good condition?

  • Equipment operating properly?

AST: Paint Transformer (Nitrogen tank area)

  • Take picture of transformer

  • Foundation in good condition?

West

West

Sludge Roll-Off

  • Take picture of sludge roll-off

  • Roll-off covered and not leaking?

  • Is the roll-off or ground labeled as Non-hazardous Waste, Sludge/Robot Covers/Solidified Clearcoat?

Trash Roll-off

  • Is the roll-off present?

  • Take picture of trash roll-off

  • Trash roll-off in good condition?

  • Trash roll-off leaking? Any staining observed?

  • Area around roll-off clean and organized?

Scrap Metal Roll-Off

  • Is the roll-off present?

  • Take picture of scrap metal roll-off

  • Roll-off in good condition?

  • Roll-off leaking? Any staining observed?

  • Area around roll-off clean and organized?

AST: Emergency Generator Fuel Tank

  • Take picture of emergency generator

  • Is the tank in good condition?

  • Foundation in good condition?

  • Are tanks and interstices free of leaks?

  • Piping and connections leak free?

  • Containment in good condition?

Blasting Booth

  • Take picture of blasting booth

  • Interior of building clean, drains covered and area free of paint chips and debris?

  • Any liquid entering the storm drain?

  • Type of discharge

Solvent Tanks

  • Take picture of Virgin Solvent tank

  • No evidence of leaks

  • Tank in good condition?

  • Containment pad free of debris?

  • Tank labeled with Hazmat information?

  • Take picture of Waste Solvent tank

  • No evidence of leaks

  • Tank in good condition?

  • Containment pad free of debris?

  • Tank labeled with Hazardous Waste and Hazmat information?

RTO

  • No leaks coming from the RTO motor?

  • Take a picture of the leak

North

North

AST: Assembly Building Transformer

  • Take picture of transformer

  • Is the tank in good condition?

  • Foundation in good condition?

Recycling Area

Trash Compactor

  • Compactor in good condition?

  • Any leaks coming from the motor?

  • Area around compactor clean?

Carboard and Plastic Baler

  • Balers in good condition?

  • Any leaks coming from the balers?

Trash Roll-off

  • Is the roll-off present?

  • Take picture of trash roll-off

  • Trash roll-off in good condition?

  • Trash roll-off leaking? Any staining observed?

  • Are around roll-off clean and organized?

Scrap Metal Roll-Off

  • Is the roll-off present?

  • Take picture of scrap metal roll-off

  • Roll-off in good condition?

  • Roll-off leaking? Any staining observed?

  • Are around roll-off clean and organized?

Spill Kit 18: Recycling Area

  • Take a picture of the spill kit

  • Is the spill kit clean and in good condition?

  • Is the spill kit located appropriately and easily accessible?

  • Does the spill kit have a contents list?

  • Is all spill procedure and emergency contact information up to date?

  • Are the contents compatible with materials stored in the area?

  • Does the spill kit have an intact tamper seal?

  • Pads 15"x18" x 40

  • Socks 3"x4" x 15

  • Pillows 9"x15 x 5

  • Pair Splash Resistance Googles x 2

  • Box Inner Nitrile Gloves x 1

  • Disposal Bags x 4

  • Flashlight x 1

  • Emergency Response Guidebook x 1

General Exterior

General Exterior

  • Is the facility fence in place with no openings?

  • Are all building exterior doors locked?

  • Are all exterior motor controls locked?

  • Pavement or concrete (including parking areas) - No large cracks or potholes?

  • Grass in place with no signs of visible disturbance or staining?

  • Do liquid containers have secondary containment?

  • Any containers stored outside (product or waste)?

  • Racks stored outside?

  • General exterior free of contaminants? (Grease, dirt, etc)

  • Any abnormal materials outside?

Environmental Management System

  • Any new aspects identified during the inspection?

  • Aspect
  • Describe the process/equipment/condition that could be a new EMS aspect. Include details, such as frequency of occurrence, regulatory status, potential risk/opportunity to the EMS, etc

  • Add a photo if feasible

  • Notify EMS Rep of new aspect/impact

Storm Water Pollution Prevention

Routine Facility Inspection

  • Any unidentified storm water pollutant discharges in the past 3 years?

  • Any control measures need maintenance or repairs?

  • Any failed control measures that need replacement?

  • Any issues with functionality of rain gauge and gauge monitor?

  • Is there any evidence of or potential for pollutants to enter the drainage system?

  • Is there any evidence of pollutants discharging to receiving waters at any facility outfalls?

  • Describe any discharges occurring at time of inspection

  • Are catch basins free of debris?

  • Is pollution prevention (i.e. oil sorbent pillow, filter cloth, etc.) equipment installed in catch basin(s)?

  • Is the sedimentation pond in need of housekeeping?

  • Are additional control measures needed to comply with stormwater permit requirements?

  • Are any revisions required to SWPPP as a result of inspection?

Action Item Root Cause Analysis

    Action Item
  • Describe

5 Why Analysis

  • Why?

  • Why?

  • Why?

  • Why?

  • Why?

Additional Comments

Additional Comments

  • Comments

Signature(s) of staff

Signature(s) of Staff Completing Inspection

  • Lead Inspector

  • Were there additional Staff that Attended the Inspection?

  • Additional Inspector
  • Inspector

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.