HazMat/Business Plan Program On-Site Checklist

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

I. SITE MAP:

• Missing

• Unreadable

• Acceptable

• N/A

A. General Site Map Layout

• 1. 8 1/2 x 11 size

  Yes

  No

  N/A

• 2. Scale

  Yes

  No

  N/A

• 3. Approximately to scale

  Yes

  No

  N/A

• 4. Outline of buildings/ facilities/ areas

  Yes

  No

  N/A

• 5. Site Orientation

  Yes

  No

  N/A

• 6. Parking Lots

  Yes

  No

  N/A

• 7. Internal roads & access

  Yes

  No

  N/A

• 8. Adjacent streets/alleys names & locations

  Yes

  No

  N/A

• 9. Location of nearest fire hydrant

  Yes

  No

  N/A

• 10. Location of adjacent railroad tracks

  Yes

  No

  N/A

• 11. Location of adjacent rivers/creeks

  Yes

  No

  N/A

• 12. Legend

  Yes

  No

  N/A

• 13. Site Map in Pencil: Unnacceptable

  Yes

  No

  N/A

B. Facility/ Building Map

• 1. Specific map for each building/floor area

  Yes

  No

  N/A

• 2. Outline of building (s)

  Yes

  No

  N/A

• 3. Building location (s) in relation to street

  Yes

  No

  N/A

• 4. Location of interior/exterior chemical storage

  Yes

  No

  N/A

• 5. Location of chemical use/handling areas

  Yes

  No

  N/A

• 6. Fire rated corridors (if known)<br>

  Yes

  No

  N/A

• 7. Business name

  Yes

  No

  N/A

• 8. Site address (number, street, zip code)

  Yes

  No

  N/A

• 9. Date

  Yes

  No

  N/A

• 10. Site map page number

  Yes

  No

  N/A

II. EMERGENCY CONTACT INFORMATION

• 1. Name of emergency contact

  Yes

  No

  N/A

• 2. Title of emergency contact<br>

  Yes

  No

  N/A

• 3. Business phone number

  Yes

  No

  N/A

• 4. 24-hour phone number

  Yes

  No

  N/A

III. Business Emergency Plan:

• Missing

• Unreadable

• Acceptable

• 1. Business name

  Yes

  No

  N/A

• 2. Site Address

  Yes

  No

  N/A

• 3. A. Business phone

  Yes

  No

  N/A

• B. 24-hour phone

  Yes

  No

  N/A

• 4. Notification procedures<br>

  Yes

  No

  N/A

• 5. Emergency response procedures/prevention

  Yes

  No

  N/A

• 6. Mitigation & abatement procedures<br>

  Yes

  No

  N/A

• 7. Evacuation procedures<br>

  Yes

  No

  N/A

• 8. Location of Business Plan & Records

  Yes

  No

  N/A

• 9. Certification

  Yes

  No

  N/A

IV: INVENTORY:

• 1. Part I: Owner/ Operator page complete

  Yes

  No

  N/A

• A. Description of business

  Yes

  No

  N/A

• B. Certification signed

  Yes

  No

  N/A

• 2. Part II: Hazardous Material Inventory Complete

  Yes

  No

  N/A

• A. Chemical name & product name

  Yes

  No

  N/A

• B. Chemical CAS number

  Yes

  No

  N/A

• C. Trade secret information accurate

  Yes

  No

  N/A

• D. EHS reported in pounds

  Yes

  No

  N/A

• E. Physical state

  Yes

  No

  N/A

• F. Units

  Yes

  No

  N/A

• G. Maximum & average amount at one time

  Yes

  No

  N/A

• H. Storage container type

  Yes

  No

  N/A

• I. Storage temperature & pressure<br>

  Yes

  No

  N/A

• J. Hazardous components (mixture) complete

  Yes

  No

  N/A

IV. EMPLOYEE TRAINING:

• 1. New employee and annual refresher training

  Yes

  No

  N/A

• 2. Procedures for handling hazardous materials release<br>

  Yes

  No

  N/A

• 3. Procedures for notification of responding agencies

  Yes

  No

  N/A

• 4. Procedures for mitigation of a release

  Yes

  No

  N/A

• 5. Emergency response plan procedures

  Yes

  No

  N/A

• 6. Evacuation plans and procedures<br>

  Yes

  No

  N/A

Hazardous Materials / Business Plan Inspection Report: Violations Cited

• Chapter 6.95 California Health and Safety Code (HSC) Title 19, California Code of Regulations (CCR) Chapter 6.11

• U100- Failure to establish/ implement a Hazardous Materials Business Plan (HSC25503.5, CCR2729)

• U102- Chemical inventory section is incomplete, needs to be updated and/or has not been annually certified. (HSC 25504, 25505 (d), CCR 2729.4)

• U101- Failure to submit a Hazardous Materials Business Plan. (HSC 25505, CCR 2729.21)

• U104- Failure to review and update the emergency response plan section. (HSC 25505 (c), CCR 2731)

• U105- Emergency response plan is inadequate. (HSC 25504, CCR 27311)

• U108- Employee training program is not implemented / maintained. (HSC 25504, CCR 27321)

• U106- Business Owner/Operator Identification page is incomplete or outdated. (HSC 25509,CCR 2729.51)

• U109- Site map is incomplete or insufficient. (HSC 2SS09(a)(5), CCR 2729.21)

• U110- Failure to report a release or threatened release. (HSC 25507, CCR 27031)

• U112- Failure to submit the required Hazardous Materials Disclosure/Business Plan electronically (25404(e)(4))

• Other: No violations found at this time. No corrective actions required.

• Comments