Forterra Safety & Health Site Visit

• Facility Name:

• Facility Name: (Can be same name as above-This name will show up in the title line of the written report)

• Conducted on:

  Date

• Prepared by:

• Plant Personnel Assisting:

Revision Date: June 10, 2016

• Is the plant utilizing the Hazard Training & Recognition Checklist for visitors and is it in the correct format? Is the Visitor Sign in sheet being utilized and in the correct format as well?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 1904.33 Are the OSHA 300 and 300A logs on file for current year and past five years with the First Report of Injuries or equivalent?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before"

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Confined Spaces?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 146(c)(4) Is there a written confined-space entry program?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 146(c)(4) Is the written confined-space entry program easily accessible to employees?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 146(c)(1) Has a Hazard Evaluation been conducted to identify confined spaces in the facility?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 146(c)(2) Are permit-required confined spaces marked with proper signage?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 146(c)(3) Are effective measures taken to prevent employees from entering permit-required confined spaces, through training, signage etc.?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 146(c)(7) If any permit-required spaces have been re-classified as non-permit confined spaces, is there proper documentation and certification?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 146(c)(5) If any permit-required spaces have been entered via alernate procedures, is there proper documentation and certification?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 146(c)(8) If contractors are used to enter confined spaces, is there a written program detailing responsibilities and actions of each party?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 146(d) - (l) If permit-required confined spaces are entered, is there a permit space program as outlined in 1910.146 (d) - (l)

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 146(f) If permit-required confined spaces are entered, is there a documented permit on file.

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 11. 146(d) (4) Is there appropriate equipment for confined space entry readily available & maintained?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 12. 146(g) If permit-required confined spaces are entered, is there a record of training for confined space participants?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Crane Safety?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 179(b)(5) Do all cranes have rated capacity on them?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 179(b)(8) Do all crane operators have a certificate of training?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 179(e)(6) Are all guards in place and adequately protect employees?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 179(h)(2)(v) Are all rope and cable clamps attached correctly?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 179(j) If any deficiencies were noted on inspections have they been corrected?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 179(j)(2)(iii) Are monthly hook inspections being completed?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 179(l)(1) Is there a documented preventative maintenance program?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 179(j)(3) Have the annual inspections been completed for each crane?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 179(j)(2) Are daily inspections being completed?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 179(m)(1) Are monthly running rope inspections completed and documented?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Slings?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 184(c) Are all slings in good working condition without knots, kinks, or other defects?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 184(d) Are daily inspections being completed?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 184 multiple Are all slings identified with a tag or other marker?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 184(e) Are periodic inspections of alloy steel chain slings being conducted?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 184(e)(9)(ii) Are service hooks in good condition?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Electrical Safety?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 303(f) Are all circuit breaker boxes legibly marked to indicate their purpose?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 303(f)(1) Is each disconnecting means for motors and appliances legibly marked to indicate its purpose, unless located and arranged so the purpose is evident?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 303(g)(1)(i)(B) Is the width of working space in front of the electrical equipment the width of the equipment or 30 inches, whichever is greater?

  Yes

  No

  N/A

• Corrective Action

• Completion will be on or before:

  Date

• 4. 304(g)(5-6) Do all tools and equipment have the required grounding plug? (unless it is a double-insulated tool).

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 334 (a) (2) (ii) Is defective equipment removed from service & properly tagged?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 305(b)(1)(ii) Are all unused openings in cabinets, boxes, and fittings effectively closed?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 305 (b) Is all conduit, cable, etc properly attached to all supports & tightly connected to junction/outlet boxes?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 305(g)(1)(iv) Are extension cords only used on short-term temporary basis, not as a replacement for permanent wiring?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 305 (g)(2)(ii) Are extension cords used only in continuous lengths without splice or taped? Is "Daisy Chaining" Prohibited?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 305(g)(1)(iv) "Is the plant preventing extension cords from being: attached to the building surface; concealed; run through holes in the wall, ceiling, or floors; run through doorways, windows, or similar openings?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 11. 305(g)(2)(ii) Are all extension cords free from damage and/or splices?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 12. 305(j) Are receptacles installed outdoors or in wet areas adequately protected/covered?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 13. 305(j)(2)(iv) Are there GFCI receptacles installed in damp locations?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 14. 331 Are only qualified persons allowed to work on electrical equipment?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Emergency Action?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 36(d)(1) "Can employees open an exit route door from the inside at all times without keys, tools, or special knowledge?"

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 2. 36(g)(2) Is exit access at least 28 inches (71.1 cm) wide at all points?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 3. 37(a)(3) Are exit routes free and unobstructed?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 4. 37(b)(2) "Is each exit clearly visible and marked by a sign reading ""Exit.""?"

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 5. 37(b)(4) Is the line-of-sight for each exit sign clearly visible at all times?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 6. 36 ( e ) Are exit doors side-hinged?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 7. 36 ( e ) Is a revolving, sliding or overhead door prohibited from serving as a required exit door?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 8. 38(b) "Is an emergency action plan in writing, kept in the workplace, and available to employees for review?"

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 9. 38(c)(2) "Does the plan include procedures for emergency evacuation, including type of evacuation and exit route assignments?"

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 10. 38(c)(4) Does the plan include procedures to account for all employees after evacuation and how to report an emergency?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

• 11. Are emergency numbers posted in conspicuous location where telephones serve as a means of reporting emergencies?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on of before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Fall Protection?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 132(d)(2) Has an evaluation been conducted to identify areas where fall protection is required?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 132(f)(1) Have employees been trained in the use of the fall protection equipment?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. ANSI Z359 Is the fall protection equipment inspected prior to each use?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 132(e ) Is the fall protection equipment in good working condition?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. ANSI Z359 Is the fall protection adequate for the exposure?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. ANSI Z359 Is there a written fall protection plan? Does the plan include adequate rescue operations?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. ANSI Z359 Is personal fall protection equipment marked with the rating and the date put into service?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. ANSI Z359 Is personal fall protection taken out of service when the service life, per the manufacturer's recommendation, is expired?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. ANSI Z359 Is personal fall protection equipment properly stored when not in use?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. ANSI Z359 Are there adequate tie off points which are rated at 5000 lbs. per person tied to the point?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Fire Protection?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 39(b) Is there a fire prevention plan in writing, in the workplace and reviewed with employees?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 157(c)(1) Are portable fire extinguishers mounted, located and identified, so that they are readily accessible to employees without subjecting the employees to possible injury?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 157(c)(4) Are portable fire extinguishers maintained in a fully charged and operable condition and kept in their designated places at all times except during use?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 157(e)(2) Are Portable extinguishers & hoses visually inspected monthly and documented?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 157(e)(3) Are all portable fire extinguishers subjected to an annual maintenance check?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 165(b)(3) Is the employee alarm distinctive and recognizable as a signal to evacuate the work area or to perform actions designated under the emergency action plan?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 165(d)(1) Are all employee alarm systems maintained in operating condition except when undergoing repairs or maintenance?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Flammable Materials ?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. NFPA 30 Are no more than three (3) cabinets located in one fire area?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 106(d)(2)(i) Are only approved containers used for storing flammable or combustible liquids?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 106(d)(2)(iii) Is gas stored in safety cans in quantities of less than 5 gallons?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 106(d)(3)(ii) Are all cabinets labeled in conspicuous lettering: "FLAMMABLE-KEEP FIRE AWAY"?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 106(d)(3)(ii)(a) Is the door provided with a three point lock and a sill raised at least 2 inches above the bottom of the cabinet?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 106(d)(5)(i) Is the storage of flammable or combustible liquids prohibited near exits, stairways, or areas normally used for the safe exit of people?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 106 (d) (iv) -( e ) Are combustible scrap, debris and waste materials (oil rags, etc.) stored in covered metal receptacles and promptly removed from the work-site?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 106(d)(7) Are portable fire extinguishers available at locations where flammable or combustible liquids are stored?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. NFPA 30 Are storage areas for flammable or combustible liquids kept free from combustible materials?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 106 (b) (c) Are "No Smoking" signs posted in areas where flammable or combustible materials are used or stored?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 11. 106(e)(2)(ii) Are containers of flammable and combustible liquids closed when not in use?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Hazardous Communication ?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 1200(e)(1) Is there a written Hazard Communication Program on location?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 1200(e)(1)(i) Is there a list of chemicals known to be present in the facility?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 1200(e)(4) Do employees have access to the written Hazard Communication Program?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 1200(f)(5) Are all secondary containers labeled?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 1200(g)(8) Are there SDS's for all chemicals on location?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 1200(g)(8) Are the SDS's readily accessible?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 1200(g)(8) Is there a system in place to ensure that incoming chemicals are included on the inventory list?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 1200(h)(1) Have all employees received training in the Hazard Communication Program?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 1200(h)(2)(iii) Do employees know where to go to get chemical information?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Hearing Protection?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 95(c)(1) Is there a written HCP? (Hearing Conversation Program)

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 95(d)(1) Have all areas been tested to determine whether or not a HCP is needed?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 95(g)(1) Is there an Audio-metric testing program?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 95(g)(5)(i) Do HCP employees receive their baseline within 6 months of employment (unless mobile van exception)?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 95(g)(6) Are annual audiograms conducted?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 95(i)(3) Is a variety of hearing protection made available to employees?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 95(k)(3) Does the training meet OSHA standard 1910.95(k)(3) and conducted yearly?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 95(l) Is a copy of the HCP standard available to employees? (1910.95i) and posted?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 95(m)(3) Are copies of audio-metric tests kept for the duration of the employee's employment?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Industrial Hygiene?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 151(c). Are emergency eyewash/shower stations provided where caustic or corrosive materials are handled?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. ANSI Z358.1 Is the path of travel to the eyewash free of obstructions and can it be reached within 10 seconds?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. ANSI Z358.2 Is the eyewash equipped with valves that stay open without the use of hands once activated?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. ANSI Z358.3 Are plumbed eyewashes activated weekly to ensure flushing fluid is available?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. ANSI Z358.4 Is the temperature of the eyewash flushing fluid between 60 and 100 degrees Fahrenheit?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of LOTOTO?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 147(c)(1) Is there a written Lockout Program?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 147(c)(4) Has an Equipment Evaluation (Form 142 or equivalent) been conducted for all pieces of equipment that require Lockout?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 147(c)(5)(ii) Do Authorized Employees have identification tags?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 147(c)(5)(i) Are there a sufficient number of locks and isolation devices available?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 147(c)(6)(i) Are Periodic Inspections being completed?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 147(c)(7) Has Lockout training been conducted and documented for all employees?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 147(c)(7)(i) Do Affected Employees know their responsibilities?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 147(c)(7)(i) Do Authorized Employees know their responsibilities?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 147(d)-(e) Is Lockout being conducted?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 147(f)(3)(d) Is there only one key made available for each lock?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Machine Guarding?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 212(a)(1) Do all machines have proper guarding to protect employees from in-running rollers, nip points, point of operation, rotating parts, flying chips, etc.

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 212(b) Are machines designed for a fixed location adequately bolted to the floor?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 213(b)(3) Are provisions made to prevent restart of machines after power outages?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. Multiple Are all chains, sprockets, flywheels, gears, and other moving machinery located less than 7 feet above the working surface guarded?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 213(c) Do hand-fed ripsaws (table saws) have a hood, spreader, and anti-kickback devices?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 213(g)-(h) Do all swing or radial cut-off saws have a hood, automatic return, and end stops?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 215(a)(4), (b)(9) Is the work rest on grinding wheels adjusted to 1/8" or less and the spark arrest on grinding wheels adjusted to 1/4" or less?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 242(a) Are all hand and portable power tools in good working condition?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 242(b) Have compressed air nozzles that are used for cleaning been reduced to less than 30 psi?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 243(a)(2) Do all hand-held power tools have a constant pressure switch to activate tool?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Powered Industrial Trucks?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 178(a)(3),(6) Do all forklifts have nameplates that rated capacities and testing laboratory approvals?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 178(g) Are specific areas identified as battery charging and maintenance areas that meet the standard 1910.178(g)?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 178(i)(1) Is caution taken to ensure Mobile Equipment, Generators, Portable Welding Machines, etc. are only operated in well ventilated areas?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 178(l) Does the forklift training follow the requirements as provided in 1910.178(l)

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 178(l)(4)(ii) Is refresher training given to employees involved in an accident or near-miss situation?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 178(l)(4)(iii) Have all forklift operators been trained in the past 3 years?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 178(l)(6) Do forklift operators have their certification card (or on file)?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 178(m)-(n) Are forklifts operated in a safe manner?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 178(p)(1) Are Forklifts/Mobile Equipment in good operating condition (brakes, back up alarms, warning lights)<br>

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 178(p)(7) Are daily inspections being completed with each forklift?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Personal Protective Equipment ?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 132(d) Has an evaluation of job functions been conducted to determine PPE needs of employees?<br>

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 132(e) Are all damaged and defective PPE removed from the facility?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 132(f)(1) Does the PPE training include the following: when PPE is necessary, what PPE is necessary, how to wear and adjust PPE, the limitations of the PPE, and care, storage and disposal of PPE?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 132(f)(4) Is there documentation of PPE training for employees?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 133(a)(1) Are employees wearing proper eye protection in areas where there is a potential for an injury to the eye (flying objects, chemicals, radiation, etc.)?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 133(a)(5) For welding operations, is the proper shaded lenses being used for the operation?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 133(b)(1) Is eye protection that is labelled ANSI Z87 provided to the employees?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 135(a)(1), (b)(2) Are employees wearing (ANSI Z89.1) hard hats in areas where there is a potential for an injury to the head or falling objects?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 136(a)(1) Are employees (ANSI Z41) wearing foot protection in areas where there is a potential for an injury to the foot by falling or rolling objects?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 138(a) Are employees wearing hand protection in areas where there is a potential for an injury to the hand by cuts, punctures, abrasions, chemicals, heat, etc.?<br>

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Respirators?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 134(a) Has the facility tried to eliminate exposures leading to respirator use?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 134(c)(1) Is there a written Respirator Protection Program (RPP) that meets the standards outlined in 1910.134(c)(1)

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 134(c)(2)(i) Are voluntary users of respirators provided with the information in Appendix D?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 134(d) Has a Hazard Evaluation been conducted to determine if respirator use is required?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 134(d)(1)(ii) Are respirators NIOSH certified?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 134(e) Have all employees using respirators be given a medical evaluation in accordance with 1910.134(e)?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 134(f) Have all employees using respirators been fit tested in accordance with 1910.134(e)?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 134(h)(1),(2)(i) Are respirators clean and stored to prevent damage?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 134(h)(3)(i)-(ii) Do employees wearing respirators know how to inspect the respirators?<br>

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 134(k) Are all employees who use respirators trained at least annually according to the guidelines listed in 1910.134(k)

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Walking Working Surfaces?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 22(a)(1) Are places of employment, passageways, storerooms, and service rooms kept clean and orderly and in a sanitary condition?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 22(b)(1) Where mechanical handling equipment is used, are sufficient safe clearances allowed for aisles, at loading docks, through doorways and wherever turns or passage must be made?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 22(b)(1) Are aisles and passageways kept clear and in good repairs, with no obstruction across or in aisles that could create a hazard?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 22(b)(2) Are permanent aisles and passageways appropriately marked?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 23(a)(10) Where doors or gates open directly on a stairway, is a platform provided?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 23(a)(8) Is every floor hole into which persons can accidentally walk guarded by either a standard railing with standard toe-board on all exposed sides, or a floor hole cover of standard strength and construction?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 23(c)(1) Where there is exposure below to falling materials, is a removable toe board or the equivalent provided?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 23(c)(1) Is every open-sided floor or platform 4 feet or more above adjacent floor or ground level guarded by a standard railing on all open sides except where there is entrance to a ramp, stairway, or fixed ladder?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 23(d)(1) Are every flight of stairs having four or more risers equipped with standard stair railings or standard handrails?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 26(c) Are ladders in good working condition and used as intended?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Does the plant (PM, Supervisors, & Employees) show general knowledge & compliance of Welding & Cutting ?

• Has the plant completed and scored greater than 85% on a Safety & Health Program review, or can the plant produce sufficient documentation of compliance such as recent training records, certifications, hazard assessments, etc.? <br><br>Based on these high level questions the plant:

  Is Compliant

  Needs Further Inquiry

  N/A

• 1. 252(a) Are all move-able fire hazards and combustibles moved to at least 35 feet away from areas or objects to be welded?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 2. 252(a)(2)(ii) Is suitable fire extinguishing equipment kept where welding or cutting is done?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 3. 252(b)(3) Are welders provided with proper PPE and is it in good, usable condition?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 4. 252(b)(2)(iii) Are employees working nearby protected from arc welding rays by screens, booths, or shields?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 5. 252(c) Has an evaluation of the welding areas been conducted to ensure compliance with air quality levels?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 6. 253(b)(1)(ii) Are all compressed gas cylinders legibly marked on their shoulders (by stenciling, stamping, or permanent labeling) with the chemical or trade name of the gas?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 7. 253(b)(2)(ii) Are cylinders stored in a designated space where they will not be knocked over, damaged by passing or falling objects or subject to tampering by unauthorized people and have valve protection caps?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 8. 253(b)(4)(iii) Are stored oxygen cylinders separated from fuel-gas cylinders or combustible materials by at least 20 feet, or by a noncombustible barrier at least 5 feet high with a fire-resistance rating of at least one-half hour

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 9. 254(d)(8) Are electrode cables free from splices within 10 feet from holders?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

• 10. 254(d)(9)(iii) Are cables with damaged insulation or exposed bare conductors replaced?

  Yes

  No

  N/A

• Corrective Action:

• Completion will be on or before:

  Date

Other Conditions

• Were there any other conditions found during the site visit that have not previously been listed?

Condition

• Describe:

• Add media

  Media

• Corrective Action:

• Completion will be on or before:

  Date

Best Practices

• Did you observe any Best Practices during visit?

Best Practice

• Describe:

• Add media

  Media

Employee Interviews

• Were there any employee interviews conducted during visit?

Interview

• Discussed:

Unsafe Acts

Unsafe Act

• Describe:

• Corrective Action:

• Completion will be on or before:

  Date