Title Page
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Conducted on
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Prepared by
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Shift
Inspection Items
GROUND SURFACE
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Evidence of spills or releases?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Pavement (including parking areas) - no large cracks or potholes? Any evidence of staining?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Snow (when visible) - any evidence of staining?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Garbage & Recycling bins (number and location adequate)
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
COMPRESSED GAS CAGE
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Cage door is locked, key is located inside bay door
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Cylinders are upright and secured with chain
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Propane cylinders stored correctly (empty's in the empty cage)
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Cage is free of snow and ice and is accessible by employees
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
FIRE PROTECTION
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Fire extinguishers and hoses are properly identified and secured on bracket?
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if missing, indicate specific area/location and extinguisher number
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Fire extinguishers are accessible (not blocked by dies) and inspected monthly (check tags)?
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if missing, indicate specific area/location and extinguisher number
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Oily rags container in good working condition (lid opens/closes)
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Flammables cabinet - must be grounded and only contain flammable substances. Free from rags, cardboard and other combustible materials?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Spill kits are accessible - ensure emergency contact numbers , ID sign and inventory list posted, verified?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
ACCESS / EGRESS
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Route and exits are clearly marked/lighted
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Adequate means of emergency egress?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Exits are clear and unobstructed
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Adequate lighting
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
GENERAL EXTERIOR
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Equipment stored outside is free of contaminants (ie. greases, drained of fluids, dirt, etc.)
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Containers stored outside (product or waste) has secondary containment?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Empty containers outside are marked appropriately?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Area around AST is in good condition and free of debris?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Shipping/Receiving area storm sewer cover readily accessible in case of a spill? (one in shipping and one with maintenance)
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Check sewer drains for signs of staining
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Any abnormal material outside? If yes make note of what and where it is
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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General condition of exterior good? Make note of deficiencies.
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
WASTE DISPOSAL
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Recyclables are being disposed of properly?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Waste bins being emptied regularly?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
STACKING AND STORAGE
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Dies stacked properly? (2 high MAXIMUM)
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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All racks are stable and secure (4 High MAXIMUM)
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
WASTE STORAGE CONTAINERS
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Scrap metal bin(s) in good condition?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Scrap metal bin(s) covered or sheltered?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Scrap metal bins under shelter free of standing liquid?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Scrap metal bins not under shelter, any liquid leaking from bin(s)?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
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Staining around scrap metal bin(s)?
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What is the hazard class rating?
- Hazard Class A - permanent disability, loss of life or body part and/or extensive loss of structure, equipment and/or material
- Hazard Class B - serious injury/illness or property damage that is disruptive but less severe than class 'A'
- Hazard Class C - non-disabling injury/illness or non-disruptive property damage
ADDITONAL ITEMS NOTED/CHECKED:
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Indicate any other issue not previously mentioned
JOB OBSERVATION / PERFORMANCE NOTES: (at least one)
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EMPLOYEE INTERVIEW / WORKER CONCERNS:
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Indicate name of employee interviewed
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Does the employee know what to do in an evacuation?
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Inform employee of nearest evacuation and meeting points. Notify Supervisor.
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Does the employee know hazards of their job? Please indicate
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Inform employee of specific job related hazards. Notify Supervisor
JHSEC Inspector Signature
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JHSEC Member
