Loss Prevention, Safety, And Food Safety

• Audit Title

• Audit Site

  Select Ypsilanti Montgomery Rockmart Plainfield Baltimore Eau Claire Springfield

  • Ypsilanti
  • Montgomery
  • Rockmart
  • Plainfield
  • Baltimore
  • Eau Claire
  • Springfield

• Conducted on

  Date

• Prepared by

• Personnel

• Is perimeter fencing in good condition?

  Good

  Fair

  Poor

• External Gates: In good operation, closed and secured. Locked during non-operational hours. Not blocked or obstructed. (per video review)

  Good

  Fair

  Poor

• External Perimeter Building Doors: closed and secured, no external door knob, strike plate security cover in place.

  Yes

  No

  N/A

• Dock Doors: Unused doors left closed and locked. No damage to the door or dock leveler that would allow unauthorized access.

  Yes

  No

  N/A

• Perimeter Lighting: All lighting in good working order and sufficiently lighting the exterior (per video review)

  Yes

  No

  N/A

• Plants, Trees, and Debris: the perimeter fence line will have a three foot clearance on either side of the fence, stacks of pallets, boxes, etc., are not permitted.

  5 or more

  3 - 4

  2 or less

• Camera System: Functional as intended (obstructions to camera), all camera views approved by LP, individual user access only.

  Yes

  No

  N/A

• Burglar Alarm Equipment: Secured/limited access to alarm panel, no apparent physical damage to wiring, door contacts, motion detectors, photo-beams.

  Yes

  No

  N/A

• Entrance and Exit: Specific location controlled for employee entrance and exit.

  Yes

  No

  N/A

• Access Control: Individual code numbers when possible, codes changed after turnover, functioning as required.

  Yes

  No

  N/A

• Signage: Directional signage for visitors and vendors. No Smoking and No Weapons Permitted signs displayed as necessary.

  Yes

  No

  N/A

• Live Test: Are all panic bars functioning as intended?

  Yes

  No

  N/A

Document Review

• Alarm Testing: Must be completed twice a year, documented, and all deficiencies repaired in a timely manner.

  Yes

  No

  N/A

• Burglar Alarm Codes: Only managers or those authorized by VPOP/GM/LP are to have codes. No shared codes, codes must be deleted after turnover, codes should be changed annually.

  Yes

  No

  N/A

• Key Control: Key issuance controlled, logged and distributed per policy. Spare keys accounted for and secured. Key acknowledgment letter signed by employees.

  Yes

  No

  N/A

• Visitor Program: Visitor forms signed, badges worn by visitors.

  Good

  Fair

  Poor

• Employee Badges: Are all employees wearing company issued name badge and is it clearly visible?

  Yes

  No

  N/A

• Limited access: Doors/gates closed and secured, panic bars functioning properly, and clickers/buzzers working as intended.

  Yes

  No

  N/A

• Stamp Cabinet: Closed and locked, accessed only by manager or assistant.

  Yes

  No

  N/A

• Tax Stamp Security

• Are unused stamps secured in the cabinet?

  Yes

  No

  N/A

• Is management recording the roll number and number of stamps on the roll time forms?

  Yes

  No

  N/A

• Does the stamper and management agree on the roll number and number of stamps on the roll then both initial roll time?

  Yes

  No

  N/A

• Is management punching the number of stamps into the stamp machine monitor?

  Yes

  No

  N/A

• Is first in/first out being followed for partial rolls?

  Yes

  No

  N/A

• Is management inspecting used roll paper for scrap stamps?

  Yes

  No

  N/A

• Are all taxing areas reconciled prior to trash being thrown away?

  Yes

  No

  N/A

• Is management checking every roll time form daily to follow the stamps from start to finish and ensuring the forms reflect this?

  Yes

  No

  N/A

3.1 Pest Control

• Are traps and bait boxes in place per policy, clean, and damage free?

  Yes

  No

  N/A

• Is the facility free of pests or signs of pest?

  Yes

  No

  N/A

• Is the sanitation line maintained on the interior of the building?

  Good

  Fair

  Poor

• Is there vegetation, equipment, or other objects within 18 inches from the perimeter of the exterior?

  Good

  Fair

  Poor

• Are all door seals in good condition and continuous without gaps?

  4 or more

  3

  2

  1

  0

• Are all cracks and crevices sealed to prevent insect or rodent entry?

  2 or more

  1

  0

• Is the warehouse free of unattended pesticides or consumer pesticides?

  Yes

  No

  N/A

Food Safety Program

3.2 Interior

• Is the sanitation of the facility maintained?

  Good

  Fair

  Poor

• Are all food items stored off the floor on pallets or shelves?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are chemicals stored above food, or not guarded from contacting food?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Is there evidence of pilferage, eating, or drinking in the warehouse?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Is the warehouse free of evidence of smoking or smokeless tobacco use?

  2 or more

  1

  0

• Are all garbage cans clean with can liner being utilized, not overflowing, with exposed food removed daily?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are the restrooms and break room clean and sanitary with the necessary supplies provided?

  Good

  Fair

  Poor

• Do the restrooms have wash hands signage?

  2 or more

  1

  0

• Are the freezer and cooler free of ice buildup or condensation?

  Good

  Fair

  Poor

• Are liquid and food spills cleaned immediately?

  Good

  Fair

  Poor

• Is the plant following the procedures for properly date stamping product (i.e. sandwiches, danishes)?

  Good

  Fair

  Poor

3.3 Exterior

• Is the area around the dumpster free of debris and spills?

  Good

  Fair

  Poor

• Are the grounds and parking areas free of trash and debris?

  Good

  Fair

  Poor

• Are the exterior trash cans and dumpsters covered to prevent rodent infestation?

  Good

  Fair

  Poor

3.4 Document Review

Pest Control

• Is a valid business license, applicators license, and certificate of insurance on file for the pest-control provider?

  2 or more

  1

  0

• Are monthly inspections by the technician properly documented?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are open conditions addressed within 30 days when issues are noted on the service inspections?

  4 or more

  3

  2

  1

  0

Food Safety Program

• Are storage temperatures taken, recorded, and reviewed at least once per week?

  4 or more

  3

  2

  1

  0

• Are storage temperatures taken by third-party monitoring system being reviewed at least weekly?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are receiving trailer temperatures being taken, recorded, and reviewed?

  Yes

  No

  N/A

• Has the HACCP plan been reviewed annually and a signed copy included in the Food Safety folder?

  Yes

  No

  N/A

• Has the Preventative Controls Plan been reviewed within the last three years and a signed copy included in the Food Safety folder?

  Yes

  No

  N/A

• Has the plant completed their Food Defense Plan?

  Yes

  No

  N/A

• Are cleaning procedures documented and reviewed?

  Good

  Fair

  Poor

• Are temperature check logs maintained for storage trailers or offsite storage?

  Yes

  No

  N/A

• Are outbound trailer inspection logs being documented and kept on file?

  Yes

  No

  N/A

• Are egg invoices which includes the shippers information and proper documentation being kept for 30 days?

  Yes

  No

  N/A

• Is the GMP-self inspection being completed once a month?

  4 or more

  3

  2

  1

  0

• Are receiving trailers inspected for cleanliness and pest free?

  4 or more

  3

  2 or less

• Is the thermometer calibration log completed weekly?

  4 or more

  3

  2 or less

4.0 Fuel Island

• Adequate spill kit available at the fuel island?

  Yes

  No

  N/A

• Fire extinguisher accessible and free of damage?

  Yes

  No

  N/A

• No smoking and emergency response numbers posted?

  Yes

  No

  N/A

• Emergency shut off identified and accessible?

  Yes

  No

  N/A

Interior of Cab

• Is the fire extinguisher present and does it meet all requirements: properly mounted, pin intact, fully charged, serviced within the last 12 months?

  Yes

  No

  N/A

• Is the yellow Penske Book available in each cab and contains vehicle registration, insurance card, and HAZMAT letter?

  Yes

  No

  N/A

• Is the cab free of trash and debris?

  Good

  Fair

  Poor

• Are both seat belts in good condition and working properly?

  Yes

  No

  N/A

Equipment

• Is the ramp functioning as intended?

  Yes

  No

  N/A

• Is the side ladder available and working properly?

  Yes

  No

  N/A

• Is there a safety cone present?

  Yes

  No

  N/A

• Are there means of securing the load (i.e. load bars, safety straps)?

  Yes

  No

  N/A

Miscellaneous

• Is there evidence that the slam lock is being bypassed?

  Yes

  No

  N/A

• Are outbound trailers on the lot locked and sealed?

  4 or more

  3

  2

  1

  0

• Are keys being left while vehicle is unoccupied?

  Yes

  No

  N/A

• Are trailer washes being completed on a monthly basis and documented?

  4 or more

  3

  2

  1

  0

• Are loaded trailers on the lot kept within food safety temperature standards?

  Yes

  No

  N/A

• Are drivers in proper uniform?

  Yes

  No

  N/A

• Are safety vests readily available for all drivers?

  Yes

  No

  N/A

• Are the drivers using the 3-points of contact when entering the vehicle?

  Yes

  No

  N/A

• Is petty cash reconciled monthly?

  Yes

  No

  N/A

• Is the on hand petty cash count reconciled with the log?

  Yes

  No

  N/A

• Are all checks accounted for?

  Yes

  No

  N/A

• Is the SWAT/Safety Bonus sign-off sheet Form 111 and Form 142 completed and verified against the disbursement?

  Yes

  No

  N/A

Fire Systems and Extinguishers

• Is the annual fire system test completed?

  Yes

  No

  N/A

• Sprinkler Valves: Maintained clearance, unobstructed, emergency shut off valve visibly marked and accessible?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Sprinkler Heads: Minimum 18" clearance between sprinkler head and stacked materials?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Fire Extinguishers

• Fire extinguishers are unobstructed and stored properly (mounted 3.5' to 5' from ground, OSHA recommendation)?

  4 or more

  3

  2

  1

  0

• Fire extinguishers are inspected each month with seal/pin intact and fully charged?

  4 or more

  3

  2

  1

  0

• Fire extinguishers are identified with proper and adequate signage?

  4 or more

  3

  2

  1

  0

• Fire extinguishers are recharged annually?

  Yes

  No

  N/A

• Are all devices for the fire alarm system (including horns, strobes, and pull stations) free from damage?

  4 or more

  3

  2

  1

  0

Emergency Egress

• Aisles, walkways, and work areas are free of trip and fall hazards (i.e. torn carpets, turned up edges of door mats, boxes etc.)

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are points of emergency egress kept clear?

  2 or more

  1

  0

• Are there objects stored under stairs that are part of an emergency exit route?

  2 or more

  1

  0

• Are the emergency exit signs and lights functioning properly?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

Racking and Storage Safety

• Are materials secure and not leaning off the edges of the racks?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are pallets on edge and/or do they have broken/protruding wood or nails?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are pallets stacked in excess of O.H. Sprinkler combustible load ratings (6ft.)?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are flammable liquids stored under barriers (not stacked on top tier of racking)?

  2 or more

  1

  0

• Are rack uprights bolted to prevent tipping or falling?

  2 or more

  1

  0

• Are rack uprights and crossbeams in good condition? Bent racks and beams must be repaired or replaced.

  4 or more

  3

  2

  1

  0

Machine Guarding

• Are guards firmly secured and free of damage?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are safety switches, interlocks, and/or emergency pull-cords functioning properly?

  Yes

  No

  N/A

• Are pinch points and inward running rollers properly guarded?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

Control of Hazardous Energy

Lockout/Tagout

• Are the proper Lockout/Tagout devices available for all energy sources available?

  Good

  Fair

  Poor

• Are you utilizing equipment specific Lockout/Tagout procedures for each piece of equipment?

  Good

  Fair

  Poor

Electrical Safety

• Do electrical panels and disconnects have 36" radial clearance for emergency access?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are extension cords properly used and not in place of permanent wiring?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Electrical cords and plugs are in good condition (i.e., not frayed, taped, spliced, or ground prong missing)

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are electrical panels, disconnects and breakers labeled as to what they control?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are electrical panels and disconnects labeled with amperage and voltage? NFPA70E

  4 or more

  3

  2

  1

  0

• Observed electrical panels and disconnects or junction boxes with open slots, uncapped conduit holes, discontinued circuits or uncovered wiring

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Is the facility free of any exposed or damaged wiring?

  4 or more

  3

  2

  1

  0

Hazard Communication

• Does the plant have current 3E coordinators? (2 per shift = 6 total)

  Good

  Fair

  Poor

• Are 3E instructions posted at all check stations?

  Good

  Fair

  Poor

• Are all non-stock chemicals entered into the database?

  4 or more

  3

  2

  1

  0

Freezer/Cooler PPE

• Are employees wearing the approved PPE?

  4 or more

  3

  2

  1

  0

• Is the PPE clean and damage free?

  4 or more

  3

  2

  1

  0

• Is the PPE storage adequate and clean?

  Good

  Fair

  Poor

Emergency Response and Emergency Action Plans

• Evacuation maps displayed and up to date?

  4 or more

  3

  2

  1

  0

• Do the evacuation maps possess a 'You are Here" sticker, primary exit route, and secondary exit route?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are emergency numbers posted and up to date in a conspicuous location?

  Yes

  No

  N/A

Forklifts and Powered Industrial Trucks

Forklift Operation

• Are horns used while backing, approaching corners, or other potentially dangerous situations?

  4 or more

  3

  2

  1

  0

• Are forklifts properly supervised and not left unattended?

  2 or more

  1

  0

• The original capacity, operation and maintenance instruction plates, tags or decals on powered industrial trucks are in place and legible.

  Good

  Fair

  Poor

• Is fall arrest system attached to all order pickers and functioning properly?

  Yes

  No

  N/A

Forklift Battery Charging Stations

• Do battery charging/changing stations contain a compliant and functional eye wash/shower?

  Yes

  No

  N/A

• Is the eye wash/shower inspected monthly, and cleaned weekly?

  Good

  Fair

  Poor

• Are spill kits with acid neutralizer available where required and adequate for amount and type of chemicals on site?

  Yes

  No

  N/A

• Is the required PPE available, clean, and in good condition?

  2 or more

  1

  0

• Are signs posted in charging area that state "No Smoking" and "PPE Required"?

  Yes

  No

  N/A

Welding and Hot Work

• Are gas and oxygen bottles stored properly?

  Yes

  No

  N/A

• Is the welding equipment kept in good condition?

  Yes

  No

  N/A

Hearing Conservation

• Is hearing protection available for all affected employees?

  Good

  Fair

  Poor

• Are employees wearing the hearing protection?

  Yes

  No

  N/A

• Are areas posted where hearing protection is required?

  Good

  Fair

  Poor

First Aid, First Response, and Bloodborne Pathogens

• Are first aid cabinets/kits adequately maintained?

  Good

  Fair

  Poor

• Is necessary Bloodborne Pathogen PPE available to First Responders?

  Good

  Fair

  Poor

Fall Protection

• Railing and/or covers are in place to protect personnel from fall hazards?

  Good

  Fair

  Poor

• Are employees using adequate fall protection?

  Yes

  No

  N/A

• Are employees using the chains, ropes, and nylon belts on elevated pick modules?

  Good

  Fair

  Poor

Ladder Safety

• Are ladders inspected quarterly to ensure they are in good condition?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Are there any unapproved ladders located in the facility?

  4 or more

  3

  2

  1

  0

• Are ladders safely secured to prevent tipping or falling?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

Machine Shop and Maintenance Area

• Bench Grinders - Is there clearance between the wheel side and the guard of not more than 1/16 inch? 1910.215(b)(1)(iii)

  Yes

  No

  N/A

• Are tools properly guarded?

  Good

  Fair

  Poor

• Are tools in safe working order?

  Good

  Fair

  Poor

Aerosol Cage

• Is the chain-link fence free from damage?

  Good

  Fair

  Poor

• Are doors/gates operable and adequate for emergency egress?

  Yes

  No

  N/A

• Is there a fire extinguisher located outside of the aerosol cage, but no less than 10 feet from the door opening?

  Yes

  No

  N/A

General conditions

• Are employees using proper lifting technique for the materials being handled?

  Yes

  No

  N/A

• Are wheel chocks and/or trailer restraint systems being utilized?

  Yes

  No

  N/A

• Are dock inspection lights in good condition and being utilized?

  Good

  Fair

  Poor

• Are confined spaces identified, marked, and barricaded to notify and protect employees?

  4 or more

  3

  2

  1

  0

• Is the ReportIt hotline awareness poster posted in a conspicuous location?

  Yes

  No

  N/A

• Only approved box cutters in use, used properly?

  4 or more

  3

  2

  1

  0

Safety Committee

• Is the Safety Committee meeting monthly?

  Yes

  No

  N/A

• Are the meeting minutes posted in a conspicuous location?

  Yes

  No

  N/A

• Are Safety Talks conducted weekly?

  Good

  Fair

  Poor

• Are monthly "Special Topic" inspections completed?

  Yes

  No

  N/A

• Are monthly warehouse inspections completed?

  Yes

  No

  N/A

Document Review

• Is the required monthly emergency lighting test documented and completed?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• Have 2 evacuation drills been conducted for all shifts?

  Yes

  No

  N/A

• Have 2 severe weather drills been conducted for all shifts?

  Yes

  No

  N/A

LOTO

• Has an authorized person completed the annual inspection of the LOTO procedures?

  Yes

  No

  N/A

• Have all authorized employees received their annual training?

  Yes

  No

  N/A

Forklifts

• Do all Powered Industrial Truck operators have current training certifications?

  Yes

  No

  N/A

• Are operators being retrained after accidents?

  Yes

  No

  N/A

• Are daily or pre-shift industrial truck inspections kept?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

• If applicable, is the blue light facing the correct direction?

  Yes

  No

  N/A

Incident/Injury Record Keeping

• Is the OSHA 300 log maintained and filled out correctly?

  Yes

  No

  N/A

• Is there an Associate Incident Report (Form 221) with each entry?

  Good

  Fair

  Poor

• Is there an Incident Investigation Report (Form 221A) with each entry?

  Good

  Fair

  Poor

• Are pictures included with each Incident Report?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

Hearing Conservation Program

• Is the hearing conservation program up to date?

  Yes

  No

  N/A

• Are annual hearing protection requirements met?

  Yes

  No

  N/A

First Aid, First Responders, and BBP

• First Responders Required Training

• Bloodborne Pathogens (BBP) Training?

  4 or more

  3

  2

  1

  0

• First-Aid Training?

  4 or more

  3

  2

  1

  0

• Cardiopulmonary Resuscitation (CPR) Training?

  4 or more

  3

  2

  1

  0

• Fire Extinguisher Training?

  4 or more

  3

  2

  1

  0

• Hepatitis B vaccination or declination signed and on file?

  4 or more

  3

  2

  1

  0

• Are there a minimum of 2 certified first responders on every shift?

  No Responders per Shift

  1 Responder per Shift

  2 Responders per Shift

Fall Protection

• Is the date of service recorded on fall protection with no past due equipment being used?

  4 or more

  3

  2

  1

  0

• Are quarterly fall protection inspections being completed?

  7 or more

  5 - 6

  3 - 4

  1 - 2

  0

Welding Operations

• Are Hot Work Permits completed, filed, and posted for every welding event?

  Good

  Fair

  Poor

• Select date

  Date

• Reviewed With:

• Comments:

• Reviewed

  Sign