Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Completed questionaire information

  • Date property acquisition due diligence report completed

  • Completed by (include position and phone number)

Site Lease Arrangements

  • Is the site currently leased?

  • When does the lease expire?

  • What is the lease duration?

  • Is there an option to renew the lease?

  • If yes, what is the option?

Site History

  • Year of first land development (if developed):

  • Status prior to development (swamp, wetland, marsh, greenfield, woodland, farm land, other):

  • Have prior environmental site assessments been conducted or this property?

  • If yes, provide copies of any reports

  • Are there any past, threatened or pending law suits or administrative proceedings related to any release or health, safety, environment and/or security concerns known?

  • If yes, specify events and dates. Provide copies of investigation reports, where available.

  • Does the owner or occupant of the property have any knowledge of environmental liens or governmental notification relating to past or current violations of environmental laws?

  • If yes, specify events and dates. Provide copies of any correspondence.

  • Have there been any contamination investigation or remediation (cleanup) at the site?

  • If yes, specify events and dates. Provide copies of any correspondence

  • Is there any evidence or knowledge of drums or waste buried on site?

  • If yes provide details

  • Is there any evidence of historic on-site activities ( other than present) potentially having involved hazardous substances?

  • If yes, provide details

  • Are there any known incidents of past chemical spills or fires potentially having caused environmental impact?

  • If yes, provide details

  • Is there a transformer, capacitor or any other equipment for which there are any records indicating the presence of poly chlorinated biphenyl (PCB's)

  • If yes, provide details

  • Do any areas contain or are suspected to contain asbestos or asbestos containing materials?

  • If yes is there an Asbestos Management Plan available?

  • Are copies of the asbestos register available?

  • Are asbestos containing materials clearly identified?

  • Are any areas of the facility known to contain or are suspected to contain lead-based paint?

  • If yes, provide details

Current Site Activities and Practices

Chemical Storage

  • Are hazardous chemicals stored or used on site( oil, solvents, paint, heavy metal solutions, pesticides, volatile organic compounds(VOCs), flammable s, corrosives, etc.)?

  • If yes, provide details

  • Are chemicals mixed, blended or transferred on site?

  • If yes, provide details

  • Are chemicals stored in designated chemical storage area(s)?

  • If yes, provide details

  • Has the facility ever been classified as a Major Hazard Facility?<br>(MHF due to quantities of chemical stored exceeding non reporting limits)

  • If yes, provide details

  • Has an Environmental Relevant Activity (ERA) licence been issued for activities undertaken on site ( current or previously)?

  • If yes, provide details

  • Is LPG gas stored on site in quantities that exceed normal forklift / heating use?

  • Is LPG gas decanted on site?

  • If yes, provide details

Underground Storage Tanks

  • Are any chemicals, oils or vehicle fuels stored in underground Storage Tanks (USTs)?

  • Are there any vents or fill pipes protruding from the ground on the property or to any structure located on the property?

  • Have there been any USTs removed or closed in place (based on site evidence including interviews and records)?

  • If yes, provide details including location, volume, contents any registration or removal information

  • Location

  • Volume

  • Contents

  • Registration or removal information

Sumps / Drains / Oil Water Seperators

  • Have there been any floor drains, sumps or oil / water seperators used for industrial activities?

  • Do any sumps, pits or similar structures now contain or have previously contained hazardous materials such as solvents or oils?

  • Are floor drains blocked or clogged( look for collapsed drains)?

  • If yes, provide the following information for these units

  • Location(s)

  • Contents

  • Discharge information

  • Currently active or inactive

Above Ground Storage Tanks

  • Are hazardous chemicals, oils or vehicle fuel stored in above ground storage tanks of 100 litres or more?

  • Have any halogenated hydrocarbons or chlorinated hydrocarbon based solvents been used at the property or within the facility?

  • If yes, provide the following information for all tanks: Location, volume, contents and is containment (bunding) present

Waste

  • Have wastes been stored in locations other than present storage areas (e.g. Pits, ponds, surface impoundments, lagoons, landfills, container storage areas)?

  • Has waste ever been disposed on site through burning, dumping or buying?

  • Are wastes stored in designated waste storage area(s)?

  • Are wastes or wastewater treated on site prior to shipment or disposal?

  • If yes, describe the treatment process and applicable permits

  • Provide a list of wastes generated, existing vendor and disposal location(s)

  • Type of waste

  • Waste vendor

  • Disposal location

Groundwater

  • Are there known restrictions on water use in the area?

  • Is groundwater a source for drinking water in the area ( I.e., local / residential drinking water via wells )

  • Are any ground, extraction or monitoring wells on site?

  • Are any injection wells / percolation beds / septic systems or leach fields on site?

  • Have soil / groundwater samples Ever been analysed?

  • Are there any direct discharges of water collected on site, other than public sewer?

  • In the past, has industrial wastewater, sanitary wastewater and storm water been discharged to an on site system, land or surface waters?

  • List events and include all relevant information

  • Describe discharge systems (sanitary, storm water, industrial wastewater):

Air Quality

  • Are there any current or past air emission sources?<br>

  • Parts washer / degreaser<br>

  • Grain / seed storage and transfer<br>

  • Fertiliser storage and transfer<br>

  • Fuel storage and dispensing<br>

  • Chemical storage and transfer<br>

  • Engines or generators <br>

  • Dust collectors<br>

  • Other<br>

Building condition

  • Is the internal / external paint in good condition?

  • Is mould or other health concern(s) present?

  • Is roofing, guttering and down pipes in good condition?

  • Do office, warehouse and retail areas have adequate ventilation?

  • Are facility flooring and general structures in good condition and free from trip hazards?

Health, Safety and Security

Electrical and lighting

  • Are electrical services in safe and adequate condition (including electrical panels, transformers, junction boxes and wiring)?

  • Is the site covered by an electrical current device (RCD)?

  • Are electrical cables in good condition, secure and safely located?

  • Is the facilities internal and external lighting sufficient to ensure safe completion of all tasks?

  • If yes to any of the above describe concerns

Site security

  • Has the site been broken into in the past?

  • Is the facility fenced to prevent unauthorised entry?

  • Does the facility use a third party security company?

  • Does the facility have an of electronic alarm system?

  • Has the site been broken into in the past?

  • Are all doors and windows equipped with locks?

  • If yes to any of the above describe concerns

Traffic management

  • Is there a traffic management plan in place for the site?

  • Are pedestrians and vehicles segregated?

  • Is there adequate parking for customers and staff on site?

  • Are walkways, loading and safety zones clearly marked?

  • If yes to any of the above describe concerns

Cranes and hoists

  • Are cranes , hoists and other lifting equipment installed and or used on site?

  • Are cranes, hoists and other lifting equipment, in good condition, inspected and marked for load capacity?

  • Are cranes , hoists and other lifting equipment registered and operated by a licenced operator?

  • If yes to any of the above describe concerns

Hot work

  • Is hot work, welding, cutting, brazing conducted at the facility?

  • Are there designated workshop areas where maintenance, welding etc. takes place?

  • If yes to any of the above describe concerns

Working at heights

  • Are there work areas which represent a falls risk ( e.g. Elevated walkways, stairwells, atrium, elevated light fittings)?

  • Are there adequate controls in place for falls risks (e.g. Anchor points, fixed and / or caged ladders, building maintenance units, toe guards and balustrades)?

  • Have mezznaine and other elevated levels been accessed or rated to meet load capacity requirements?

  • Are stairwells and overhead areas ( mezzanines) in good condition with adequate fall protection ( railings, toe boards, etc.)?

  • If yes to any of the above describe concerns

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.