Mechanical Room

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Add location
  Address

• Select date

  Date

• Add signature

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• Add media

  Media

Air Permits (EPA)

• All applicable air discharges have required permits

  Yes

  No

  N/A

• List all Permit Names/Numbers and Expire Dates, Equipment Description and Administering Agency

  Yes

  No

  N/A

Chemical Safety (EPA)

• There is an inventory list of all hazardous substances used in the workplace

  Yes

  No

  N/A

• There is a written hazard communication program that includes Material Safety Data Sheets (MSDS), labeling and employee training

  Yes

  No

  N/A

• Each container for a hazardous substance (i.e. vats, bottles, storage tanks, etc.) is labeled with product identity and a hazard warning

  Yes

  No

  N/A

• There is a Material Safety Data Sheet readily available for each hazardous substance used; employees can readily access the MSDS at all times

  Yes

  No

  N/A

• There is an employee training program for hazardous substances

  Yes

  No

  N/A

• A written policy exists that ensures MSDS are obtained for all products

  Yes

  No

  N/A

• Products that are purchased or otherwise bright into the workplace are checked for approved uses, safe handling procedures and MSDSs

  Yes

  No

  N/A

• Procedures are in place for dealing with a substandard MSDS and/or chemicals that are brought into the workplace without an MSDS

  Yes

  No

  N/A

• Procedures are in place for labeling containers into which a substance is decanted and not consumed immediately

  Yes

  No

  N/A

• The hazardous substances inventory is reviewed at a minimum of annually

  Yes

  No

  N/A

• The hazardous substances inventory is used in emergency planning

  Yes

  No

  N/A

Confined Spaces (MIOSHA)

• The facility has confined spaces

  Yes

  No

  N/A

• Confined spaces have been inventoried and there is appropriate labeling on the exterior of the space identifying it as such

  Yes

  No

  N/A

• The confined space entry program is in writing and is current; please indicate date of last review of written program in comments section

  Yes

  No

  N/A

• A hazard assessment has been conducted on those confined spaces where entry is required

  Yes

  No

  N/A

• Confined spaces are thoroughly emptied of any corrosive or hazardous substance, such as acids or caustics before entry

  Yes

  No

  N/A

• All lines to a confined space, containing inert, toxic, flammable or corrosive materials are valued off and blanked or disconnected and separated before entry

  Yes

  No

  N/A

• All impellers, agitators or other moving parts and equipment inside confined spaces are locked-out if they present a hazard

  Yes

  No

  N/A

• Natural or mechanical ventilation is provided prior to confined space entry

  Yes

  No

  N/A

• Appropriate atmospheric tests are performed to check for oxygen deficiency, toxic substances and explosive concentrations in the confined space before entry

  Yes

  No

  N/A

• Adequate illumination is provided for the work to be performed in the confined space

  Yes

  No

  N/A

• The atmosphere inside the confined space is frequently tested or continuously monitored during conduct of work

  Yes

  No

  N/A

• There is an assigned safety standby employee outside of the confined space whose sole responsibility is to watch the work in progress, sound an alarm if necessary, and render assistance

  Yes

  No

  N/A

• All employees involved, including the standby employee are appropriately trained; training is documented and kept on file

  Yes

  No

  N/A

• In the event of an emergency due to an unknown cause, the standby employee or other employees are prohibited from entering the confined space without lifelines and respiratory equipment that is appropriate for the hazard(s)

  Yes

  No

  N/A

• If the atmosphere in the confined space cannot be made acceptable, approved respiratory equipment is required

  Yes

  No

  N/A

• All portable electrical equipment used inside confined spaces is either grounded and insulated, or equipped with ground fault protection

  Yes

  No

  N/A

• Before gas welding or burning is started in a confined space, hoses are checked for leaks, compressed gas bottles are forbidden inside the confined space, torches are lit only outside of the confined area and the confined area is tested for an explosive atmosphere each time before a torch is to be taken into the confined space

  Yes

  No

  N/A

• Sufficient air is provided to assure combustion without reducing the oxygen concentration of the atmosphere below 19.5 percent by volume when employees are using oxygen-consuming equipment such as salamanders, torches and furnaces in a confined space

  Yes

  No

  N/A

• Provisions are made to ensure that the exhaust gases are vented outside of the enclosure whenever combustion-type equipment is used in confined space

  Yes

  No

  N/A

• If the confined space is below the ground and near areas where motor vehicles will operating, checks are made to determine if it is possible for vehicle exhaust or carbon monoxide to enter the space

  Yes

  No

  N/A

Electrical Safety (MIOSHA)

• Contact electrical work specifies compliance with MIOSHA and/or local regulations

  Yes

  No

  N/A

• Employees have been properly trained in Lockout/Tagout

  Yes

  No

  N/A

• Portable electrical tools and equipment are either grounded or of the double insulated type

  Yes

  No

  N/A

• Extension cords have a grounding conductor

  Yes

  No

  N/A

• Multiple plug adaptors are prohibited

  Yes

  No

  N/A

• Temporary circuits ae protected by suitable disconnecting switches or plug connectors at the junction with permanent wiring

  Yes

  No

  N/A

• Exposed wiring and electrical cords with frayed or deteriorated insulation are repaired or replaced promptly (no taping)

  Yes

  No

  N/A

• The use of metal ladders is prohibited in areas where the ladder or the person using the ladder could come in contact with energized parts of equipment, fixtures or circuit conductors

  Yes

  No

  N/A

• All disconnecting switches and circuit breakers are labeled to indicate their use or equipment served

  Yes

  No

  N/A

• Disconnecting means are always opened before fuses are replaced

  Yes

  No

  N/A

• All energized parts of electrical circuits and equipment are guarded against accidental contact by approved cabinets or enclosures

  Yes

  No

  N/A

• Electrical enclosures such as switches, receptacles and junction boxes are provided with tight fitting covers or plates

  Yes

  No

  N/A

• Electrical equipment is correctly grounded with 3-pronged plugs

  Yes

  No

  N/A

• Extension cords are not used for prolonged duration

  Yes

  No

  N/A

• Multi-plug power strips are UL-approved and breakered

  Yes

  No

  N/A

• Multi-plug power strips are not used in tandem

  Yes

  No

  N/A

• Circuit breaker panels and emergency shut-offs unobstructed (36 inch clearance) and unlocked

  Yes

  No

  N/A

• High wattage equipment (i.e. refrigerators, copiers) are plugged directly into wall outlets

  Yes

  No

  N/A

• Outlets within 6 feet of water source are GFCI protected

  Yes

  No

  N/A

• All high voltage oil containing transformers on the property re free of PCBs (Polychlorinated Biphenyls)

  Yes

  No

  N/A

• If working its greater than 50V (energized), an equipment specific SOP (Specified Operating Procedure) is followed

  Yes

  No

  N/A

Fire Safety (MIOSHA)

• Emergency exits are adequately illuminated and unobstructed

  Yes

  No

  N/A

• Exits are clearly marked and visible through use of illuminated/reflective exit signs

  Yes

  No

  N/A

• Fire extinguishers are mounted on walls, charged and inspected/serviced monthly and annually. Documentation is available for these inspections

  Yes

  No

  N/A

• There is a minimum of 18 inch clearance between the sprinkler heads and any stored or stacked materials

  Yes

  No

  N/A

• An Emergency Fire Plan (including evacuation map) is posted

  Yes

  No

  N/A

• Employees are trained on emergency evacuation procedures

  Yes

  No

  N/A

• Flammable liquids are stored in an approved metal cabinet with doors closed

  Yes

  No

  N/A

• Flammable liquids are dispensed using bonding/grounding techniques

  Yes

  No

  N/A

• Flammable liquids are used in safe containers; aerosolizing (spraying) of flammable liquids in spray bottles is not permitted

  Yes

  No

  N/A

• Sprinkler heads are not painted over

  Yes

  No

  N/A

• Ceiling tiles are intact and in place

  Yes

  No

  N/A

• Fire hydrants a kept free of debris, vehicles and accumulation (i.e. snow)

  Yes

  No

  N/A

• Water control valve (on exterior of building) is in the open position at all times; locking of valve in open position is advised

  Yes

  No

  N/A

• Backflow valves are inspected annually by a certified supplier/vendor

  Yes

  No

  N/A

Flammable and Combustible Materials (EPA)

• Combustible scrap, debris and waste materials (oily rags, etc.) are stored in covered metal receptacles and removed from the worksite promptly

  Yes

  No

  N/A

• Approved containers and tanks are used for the storage and handling of flammable and combustible liquids

  Yes

  No

  N/A

• Bulk drums of flammable liquids are grounded and bonded during dispensing

  Yes

  No

  N/A

• Storage rooms for flammable and combustible liquids are equipped with explosion-proof lights

  Yes

  No

  N/A

• Storage rooms for flammable and combustible liquids have mechanical or gravity ventilation

  Yes

  No

  N/A

• Storage rooms for flammable and combustible liquids are sloped, have troughs or retaining walls to contain spills

  Yes

  No

  N/A

• Liquified petroleum gas is stored, handled and used in accordance with safe practices and standards

  Yes

  No

  N/A

• Liquified petroleum storage tanks are guarded to prevent damage for vehicles

  Yes

  No

  N/A

• Solvent wastes and flammable liquids are kept in fire-resistant covered containers until they are removed from the worksite

  Yes

  No

  N/A

• Vacuuming is used whenever possible rather than blowing or sweeping combustible dust (i.e. aluminum, magnesium)

  Yes

  No

  N/A

• "NO SMOKING " signs are posted where appropriate in areas where flammable or combustible materials are used or stored

  Yes

  No

  N/A

• "NO SMOKING" rules are enforced in areas involving storage and use of hazardous, flammable or combustible materials and smoking is not permitted within 50 feet

  Yes

  No

  N/A

• Spills of flammable or combustible liquids are cleaned up promptly and are disposed of properly

  Yes

  No

  N/A

• Fire extinguishers have been selected and provided for the types of materials I areas where they are to be used (Class A Ordinary combustible material fires; Class B Flammable liquid, gas or grease fires; Class C Energized-electrical equipment fires; Class D Combustible metals)

  Yes

  No

  N/A

• Storage tanks are equipped with emergency venting that will relieve excessive internal pressure caused by fire exposure

  Yes

  No

  N/A

General Safety (MIOSHA)

• Book shelves, filing cabinets in excess of 64 inches are secured

  Yes

  No

  N/A

• Hand washing soap and towels are available

  Yes

  No

  N/A

• Corridor doors are kept closed

  Yes

  No

  N/A

• Electrical cords, cables and cords are neatly secured under desks and out of the way of foot traffic

  Yes

  No

  N/A

• Food or beverages are only consumed in areas where there is no exposure to toxic or hazardous material, blood or other potentially infectious materials

  Yes

  No

  N/A

• Only ladders with safety feet (non-sliding soles) are used

  Yes

  No

  N/A

• Step ladders are less than 20 feet in length

  Yes

  No

  N/A

• Aisleways are designated and permanently marked (i.e. in warehouses)

  Yes

  No

  N/A

• Mirrors are used to improve visibility at corners and intersections

  Yes

  No

  N/A

• Air pressure at the end of an air pressure gun does not exceed 30 psig and is equipped with a safety valve at the tip to allow air to escape

  Yes

  No

  N/A

Hazardous Waste (EPA)

• Hazardous waste is shipped by a licensed hauler from the facility

  Yes

  No

  N/A

• List the ID number issued by local agency for the facility's hazardous waste program (in comments section)

  Yes

  No

  N/A

• Total quantity of hazardous waste disposed during the previous calendar year (please specify either kgs or lbs); list average monthly waste shipment

  Yes

  No

  N/A

• EHS completes and documents hazardous waste storage/treatment area inspections on a weekly basis

  Yes

  No

  N/A

• Hazardous labels are dated and initialed prior to use

  Yes

  No

  N/A

• Only one drum/container is permitted in a satellite area

  Yes

  No

  N/A

• Waste containers are closed (bungs tight, lids secure) at all times unless waste is being directly added to container

  Yes

  No

  N/A

• Hazardous waste drums are labeled with accumulation start date, contents and the words "Hazardous Waste"

  Yes

  No

  N/A

• All satellite drums are moved to the central accumulation storage area within 3 days of their accumulation start date

  Yes

  No

  N/A

• Room or area is well-ventilated and hazard warning signs are clearly posted

  Yes

  No

  N/A

• Sumps and secondary containment berms are sealed or lined, free of liquids and inspected at least annually for cracks and leaks

  Yes

  No

  N/A

• Outdoor garbage, waste steel and/or other wastes are covered (protected from the elements) and any runoff is contained and disposed of properly

  Yes

  No

  N/A

• Containers are emptied completely of residual chemcials

  Yes

  No

  N/A

• Chemical containers are not thrown out in trash unless properly rinsed (if applicable)

  Yes

  No

  N/A

• Fire control, spill control, PPR, eyewash facilities are present in hazardous waste storage areas

  Yes

  No

  N/A

• Hazardous waste is stored in drums with secondary containment that is free of liquids, sealed and capable of holding 110% of the largest container

  Yes

  No

  N/A

• A hazardous waste contingency plan and/or business emergency plan for chemical, fuel and waste storage is filed on-site and with local agencies. Indicate "yes" if required; "no" if incomplete; "not applicable" if not required

  Yes

  No

  N/A

• Oil/solvent-soaked rags are not thrown in the regular trash and are disposed of properly

  Yes

  No

  N/A

• Hazardous waste is not transported off site by internal employees

  Yes

  No

  N/A

• Employees who sign hazardous waste manifests have been properly trained and are certified as per local requirements

  Yes

  No

  N/A

• Hazardous wastes have been tested and/or otherwise characterized. A waste profile/list of permissible waste classes is on site at the facility. This also includes any new waste streams

  Yes

  No

  N/A

Spills (EPA)

• All spills are cleaned up immediately

  Yes

  No

  N/A

• Spill equipment is available in fueling, chemical and hazardous material relieving and storage areas

  Yes

  No

  N/A

• Hazardous wastes generated from spill clean up are disposed of properly

  Yes

  No

  N/A

Walking-Working Surfaces (MIOSHA)

• A documented functioning housekeeping program is in place

  Yes

  No

  N/A

• All worksites are clean, sanitary and orderly

  Yes

  No

  N/A

• All spilled hazardous materials or liquids, including blood and other potentially infectious materials are cleaned up immediately and according to proper procedures

  Yes

  No

  N/A

• Combustible scrap, debris and waste are stored safely and removed from the worksite properly

  Yes

  No

  N/A

• Accumulations of combustible dust are routinely removed, including from elevated surfaces such as beams, light fixtures, etc.

  Yes

  No

  N/A

• Metallic or conductive dust is prevented from entering or accumulating on or around electrical enclosures or equipment

  Yes

  No

  N/A

• Covered metal waste cans are used for oily and paint-soaked waste

  Yes

  No

  N/A

• Aisle and passageways are kept clear and are clearly delineated

  Yes

  No

  N/A

• Holes in the floor, sidewalk or other walking surface are repaired properly, covered or otherwise made safe

  Yes

  No

  N/A

• There is safe clearance for walking in aisles where motorized or mechanical handling equipment is operating

  Yes

  No

  N/A

• Materials or equipment are stored in such a way that sharp projectives will not interfere with the walkway

  Yes

  No

  N/A

• Spilled materials are cleaned up immediatley

  Yes

  No

  N/A

• There is adequate headroom provided for the entire length of any aisle or walkway

  Yes

  No

  N/A

• Standard guardrails are provided wherever aisle or walkway surfaces are elevated more than 30 inches above any adjacent floor or the ground

  Yes

  No

  N/A

• Stairways are at least 22 inches wide

  Yes

  No

  N/A

• Floor openings are guarded by a cover, a guardrail, or equivalent on all sides (except at entrance to stairways or ladders)

  Yes

  No

  N/A

• Standard stair rails or handrails are present on all stairways having four or more risers

  Yes

  No

  N/A

• Stairs have landing platforms that are not less than 30 inches in the direction of travel and extend 22 inches in width at every 12 feet or less of vertical rise

  Yes

  No

  N/A

• Step risers on stairs are uniform from top to bottom

  Yes

  No

  N/A

• Steps on stairs and stairways are designed or provided with a surface that renders them slip resistant

  Yes

  No

  N/A

• Stairway handrails are located between 30 and 34 inches above the leading edge of stair treads

  Yes

  No

  N/A

• Stairway handrails are located at least 3 inches of clearance between the handrails and the wall or surface they are mounted on

  Yes

  No

  N/A

• Where doors or gates open directly on a stairway, there is a platform provided so the swing of the door does not reduce the width of the platform to less than 21 inches

  Yes

  No

  N/A

• Where stairs or stairways exit directly into any area where vehicles may be operated, adequate barriers and warnings are provided to prevent employees stepping into the path of traffic

  Yes

  No

  N/A

• All elevated surfaces (beneath which people or machinery could be exposed to falling objects) are provided with standard 4-inch toeboards

  Yes

  No

  N/A

• Permanent means of access and egress is provided to elevated storage and work surfaces

  Yes

  No

  N/A

• Material on elevated surfaces piled, stacked or racked in a manner to prevent tipping, falling, collapsing, rolling or spreading

  Yes

  No

  N/A

• Ladders are inspected at least annually and documentation is kept. Damaged ladders are removed from service and replaced

  Yes

  No

  N/A

• All sharps and broken glass are separately contained and properly disposed of

  Yes

  No

  N/A

• Waste containers are closed, except when in use

  Yes

  No

  N/A

• Waste containers are properly labeled (no abbreviations, shorthand or formulas), including date

  Yes

  No

  N/A

• Oily rags not disposed of in general trash

  Yes

  No

  N/A

• Liquids residue does not remain in discarded waste containers

  Yes

  No

  N/A

• Medical waste registration is current

  Yes

  No

  N/A

• Medical waste is transported off site at least every 90 days

  Yes

  No

  N/A

• Sharps containers containing medical waste prevent puncture exposure

  Yes

  No

  N/A