McCoy's Facility and Fleet Safety Evaluation

• Document No.

• Enter Date

  Date

• Store Number

• Store Name

• Location
  Address

• Store Manager

• Survey Prepared by

Store

• 1. Is the sidewalk or flooring free from large cracks or a significant change of elevation? If no, document measurements and take picture.

  Yes

  No

  N/A

• 2. Are the front doors operating properly, free from obstructions with adequate closure speed?

  Yes

  No

  N/A

• 3. Are all shopping baskets (seat belts), freight carts, panel carts in good operating condition, organized and properly stored?

  Yes

  No

  N/A

• 4. Are there MSDS posters, stickers, AVC, HVC, Ag certificates (must be presented at front of store) and large HR signs posted? If no, make note and post replacements.

  Yes

  No

  N/A

• 5. Are the emergency procedures posted?

  Yes

  No

  N/A

• 6. Are there lock-out tag-out forms and tags present? If no, make note and post replacements.

  Yes

  No

  N/A

• 7. Is there a first aid kit present and stocked with at least minimum supplies?

  Yes

  No

  N/A

• 8. Is all PVC, EMT, moulding, flashing, lumber etc. restrained with cable, rope or chain?

  Yes

  No

  N/A

• 9. Are the floors clean, dry and uniform surface with no protruding items or STF hazards?

  Yes

  No

  N/A

• 10. Are all vanities, lavatories, commodes and water heaters secured from movement?

  Yes

  No

  N/A

• A. List any other item(s) not listed above.

  Yes

  No

  N/A

Electrical

• 11. Are extension cords used for temporary use only (permanent or excessive)? If no, describe location(s) and insert picture.

  Yes

  No

  N/A

• 12. Are all areas free from "daisy chaining" of extension cords or power strips (including kiosk)?

  Yes

  No

  N/A

• 13. Are all extension cords in good condition and free from damage? If no, describe location(s). Destroy, dispose and make note.

  Yes

  No

  N/A

• 14. Is all wiring covered and not exposed? If no, describe location(s) and insert picture.

  Yes

  No

  N/A

• 15. Is all electro metallic tubing (EMT) connected (unbroken and connected)? If no, describe location(s).

  Yes

  No

  N/A

• 16. Are all switch, plug and junction boxes covered? If no, describe location(s) and insert picture.

  Yes

  No

  N/A

• 17. Are all power cords (computer, etc.) free from laying on a sharp edge? If no, describe location(s).

  Yes

  No

  N/A

• 18. If there are electrical outlets near wet areas (i.e. break room and restroom sink) are they GFCI outlets? If no, describe location (s).<br>

  Yes

  No

  N/A

• 19. Is conduit free from items secured to it (i.e. power strip)? If no, describe location(s).

  Yes

  No

  N/A

• 20. Is there clear access (aisle) and a minimum of 36 inches in front of the electrical equipment (breaker panels, transformers, etc.)? Is the breaker room free from being used as a storage area? If no, describe location(s). OSHA 1910.303(g)(1)(i), 30 inches and NEC 110-26, 36 inches.<br>

  Yes

  No

  N/A

• 21. Is the electrical room free of flammable or combustible materials? -- 1910.303(g)(1)(i) If no, describe location(s) and remove.

  Yes

  No

  N/A

• 22. Is breaker panel temperature less than 115 degrees Fahrenheit? If no, describe location and name from plate (if labeled).

  Yes

  No

  N/A

• 23. Do all breaker panel slots have a breaker or blank? If no, describe location(s).

  Yes

  No

  N/A

• 24. Are all breakers labeled as to location? If no, describe location(s).

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A

Fire Extinguisher Systems

• 25. Are all fire extinguishers within date? If no, describe location.

  Yes

  No

  N/A

• 26. Are all fire extinguishers free from obstruction or blockage? If no, describe area.

  Yes

  No

  N/A

• 27. Is the riser valve (if applicable) open with the current annual inspection tag and free of obstructions? Please enter the water and air gauge readings.

  Yes

  No

  N/A

• 28. Is there at least 18 inches vertical clearance below the automatic fire sprinkler heads? If no, describe location and insert picture.

  Yes

  No

  N/A

• 29. Is there less than 75 feet travel distance to a fire extinguisher from any point in the store or warehouse? If no, describe location(s). 1910.157(d)(2)

  Yes

  No

  N/A

• 30. Does every fire extinguisher have a sign? If no, describe the location.

  Yes

  No

  N/A

• 31. Is every fire extinguisher sign visible from a "distance away"? (i.e. column mounted fire extinguisher and sign not visible while in the middle aisle.)

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A

Power Tools and Ladders

• 32. Are all bench top power tools secured to the bench top? If not, describe tool(s) and location(s).

  Yes

  No

  N/A

• 33. If there is a bench grinder, is the tool rest adjusted to be less than 1/8 inch? If no, adjust and make note.

  Yes

  No

  N/A

• 34. Are all blade guards in place? (i.e. panel saw, chop saw, skill saw, etc.) If no, tag out of service and make note.

  Yes

  No

  N/A

• 35. Are all fans protected with a screen? If no, describe location. Destroy and dispose if portable and make note.

  Yes

  No

  N/A

• 36. Are all pigtail cords for all power tools free from damage? If no, describe location. Destroy and dispose or tag out of service if portable and make note.

  Yes

  No

  N/A

• 37. Are all ladders free from damage and in good working order? If no, describe location. Destroy and dispose and make note.

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A

Mezzanine, Warehouse and Yard

• 38. Do all mezzanines have a handrail, mid-rail and toe board? If no, describe location and insert picture.

  Yes

  No

  N/A

• 39. Do all handrails (including gates) seem to withstand approximately 200 pounds of direct force from any direction? If no, describe location and insert picture.

  Yes

  No

  N/A

• 40. Are all "decking" surfaces (example, plywood) above head height secured? (Example locations, on top of merchandising racks, electrical spool racks, etc.) If no, describe location(s) and insert picture.

  Yes

  No

  N/A

• 41. Are all chairs/stools in good condition and not broken? If no, describe location.

  Yes

  No

  N/A

• 42. Are all displays or shelving knee height or taller? If no, describe location and insert picture.

  Yes

  No

  N/A

• 43. Is the yard paved?

  Yes

  No

  N/A

• 44. Is the yard free of "pot holes"? If no, describe location, take pictures and file in separate folder (due to file size).

  Yes

  No

  N/A

• 45. Does the yard gate open easily, secured from movement and in good physical condition?

  Yes

  No

  N/A

• 46. Are the fire plugs and FDC free from being blocked by freight & merchandise? If so, please have items relocated and make note.

  Yes

  No

  N/A

• 47. Are all fire pull stations clear and not blocked? If so, please have items relocated and make note.

  Yes

  No

  N/A

• 48. Is every overhead and sliding warehouse door completely operational and free of damage? If no, describe location and insert picture.

  Yes

  No

  N/A

• 49. Are all warehouse walls free of serious damage or holes? If no, describe location(s) and insert picture.

  Yes

  No

  N/A

• 50. Does the ramp loading dock (if applicable) have wheel stops on the sides of it to prevent forklifts from dropping off the sides?

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A

Racking

• 51. Are all cantilever arms free from damage? If no, mark, describe location, get measurements and count the number of arms.

  Yes

  No

  N/A

• 52. Is every rack column (upright) free of damage? If no, describe location(s), enter measurements and insert picture. <br>“H” Overall Height of the Upright (e.g. 9’, 12’, 14’)<br>“D” Overall Depth of the Upright (e.g. 42”, 48”)<br>“C” Tubular Column Dimensions (e.g. 1.5”x3”, 3”x3”)<br>“PL” Foot Plate Dimensions (e.g. 4”x4”, 5”x7”, 5”x8”)<br>“T” Thickness Dimension of the Step Beam (e.g. 4.5”, 5”, 6”)<br>“W” Inside Clear Dimension between the Uprights (e.g. 5’, 8’, 9’)<br>

  Yes

  No

  N/A

• 53. Is every rack beam free of damage and not "bowed"? If no, enter dimensions, describe location(s) and insert picture.

  Yes

  No

  N/A

• 54. Do all beams have clips to secure to columns? If no, describe location(s).

  Yes

  No

  N/A

• 55. Are all rack feet secured to the floor? If no, describe location(s).

  Yes

  No

  N/A

• 56. Are all display racks commercial made (vs "homemade")? If no, describe location(s) and insert picture.

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A

LPG Bottles and Storage

• 57. Do all cages have mounted flammable or combustible signs on the cage?

  Yes

  No

  N/A

• 58. Are all LPG bottles inside the cage?

  Yes

  No

  N/A

• 59. Is the cage door(s) secured shut?

  Yes

  No

  N/A

• 60. Does the LPG cage have "bumper" protection (bollards, car stops, etc.) at least 4 feet from cage?

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A

Fuel Tank

• 61. Is the fuel tank double walled? If not, what type of wall is around it to contain spills.

  Yes

  No

  N/A

• 62. Is there a fire extinguisher and sign located within 30 feet of a fuel storage tank?

  Yes

  No

  N/A

• 63. Is the storage tank marked with a flammable/combustible sign?

  Yes

  No

  N/A

• 64. Is there an emergency shut off switch and is it properly identified?

  Yes

  No

  N/A

• 65. Are there bollards around the tank?

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A

Other Items

• 66. Is all signage in place and easily seen? (Hash marks for loading at door, ADA parking, fire lanes, no parking, FDC, fire plugs, No vehicles allowed in warehouse, etc.) If no, describe location.

  Yes

  No

  N/A

• 67. Are all combustible liquids (fuel, solvents, etc.) in an approved container and stored in a proper manner?

  Yes

  No

  N/A

• 68. Does the "cutting area" have PPE available and signage posted?

  Yes

  No

  N/A

• 69. Are all exits free of blockage? If no, report to management and describe location.

  Yes

  No

  N/A

• 70. Are all exits marked, operational and close with adequate speed?

  Yes

  No

  N/A

• 71. If the space on top of the bathrooms meet egress guidelines (80" to lowest fixture or 90" to ceiling), is the area free of all items?

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A

Fleet

• 72. Are all trucks in satisfactory condition to operate? If no, list asset number, describe and take picture.

  Yes

  No

  N/A

• 73. Is all necessary vehicle paperwork present and current (insurance, registration, inspection, cab card, etc.)?

  Yes

  No

  N/A

• 74. Are all driver vehicle inspection reports (DVIR's) complete for the past 90 days?

  Yes

  No

  N/A

• 75. Are all forklifts in satisfactory condition to operate? If no, list asset number, describe and take picture.

  Yes

  No

  N/A

• 76. Are all forklift inspection forms complete for the past 90 days?

  Yes

  No

  N/A

• 77. Are all truck mounted forklifts (TMFL) in satisfactory condition to operate? If no, list asset number, describe and take picture.

  Yes

  No

  N/A

• 78. Are all TMFL inspection forms complete for the past 90 days?

  Yes

  No

  N/A

• A. List any other area(s) not listed above.

  Yes

  No

  N/A