Title Page

  • Conducted on

  • Prepared for

  • Location

Office

  • Safety Binder programs appear to be up to date with a clear process for providing proof of training as well as a clear process for program updates.

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Extension cords are free of splices, defects, or exposed wiring as well as not being used as a substitute for fixed electrical wiring.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Employees have access to the most current OSHA labor law posters.

  • A current WPS Safety Poster and emergency medical care information is posted and readily accessible to all workers.

  • A "SDS available upon request" sign is posted and easily visible to patrons and employees.

  • Doorways and passageways are marked with their specific purpose, not an exit, to an exit, or exit.

  • Is this area free of other safety issues not previously addressed?

Dry Fertilizer Warehouse

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Protective guards are properly installed and maintained as necessary.

  • All bins are properly and adequately labeled.

  • Ladders, stairways, walkways, and platforms are constructed to OSHA specifications.

  • Doorways and passageways are marked with their specific purpose, not an exit, to an exit, or exit.

  • Is this area free of other safety issues not previously addressed?

Bulk Liquid Fertilizer

  • Confined spaces are properly labeled.

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Protective guards are properly installed and maintained as necessary.

  • All tanks are properly and adequately labeled.

  • Ladders, stairways, walkways, and platforms are constructed to OSHA specifications.

  • Is this area free of other safety issues not previously addressed?

Anhydrous Ammonia Facility

  • Bulkhead, tank, piping, and valves are color coded, labeled, and marked in a manner consistent with corporate expectations.

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Storage tank is protected by suitable barriers to prevent damage by trucks or other vehicles.

  • Protective guards are properly installed and maintained as necessary.

  • All tanks are properly and adequately labeled.

  • Hoses have no visible defects, are designed and approved for anhydrous ammonia service, and within the manufacturer's stamped date for safe usage.

  • Ladders, stairways, walkways, and platforms are constructed to OSHA specifications.

  • Appropriate PPE is readily available and easily accessible for those employees engaged in operating, repairing, and inspecting all equipment used in anhydrous ammonia activities.

  • Safety water is appropriately available, relatively clean, and easily accessible.

  • Wheel chocks are both adequate and available.

  • A legible emergency notification sign at the entrance to the facility is is readily visible to emergency response personnel.

  • Is this area free of other safety issues not previously addressed?

Anhydrous Ammonia Mobile Equipment

  • Hoses have no visible defects, are designed and approved for anhydrous ammonia service, and within the manufacturer's stamped date for safe usage.

  • Pressure relief valves are protected by a rain cap.

  • Towed equipment is equipped with proper and adequate safety chains.

  • 5 gallon water tanks are properly installed and available on all nurse tanks.

  • SMV signs are properly mounted and displayed as necessary.

  • Nurse tanks are properly placarded, marked, and labeled.

  • Is this area free of other safety issues not previously addressed?

Shop

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Extension cords are free of splices, defects, or exposed wiring as well as not being used as a substitute for fixed electrical wiring.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Compressed gas cylinders are stored properly and segregated appropriately.

  • First aid kit is adequately stocked and readily available.

  • Portable gas containers are metal safety cans with a spring-closing lid.

  • Protective guards are properly installed and maintained as necessary.

  • Grinder clearances are properly set and grinder is properly secured.

  • All bays, bins, tanks, and containers are properly and adequately labeled.

  • Ladders, stairways, walkways, and platforms are constructed to OSHA specifications.

  • Portable ladders are constructed and maintained to OSHA specifications.

  • Pallet racks and other shelving is properly secured.

  • Pedestal mounted tools are adequately secured to prevent movement during operation.

  • There is an adequate safety shower/eyewash with proof of consistent inspection.

  • Doorways and passageways are marked with their specific purpose, not an exit, to an exit, or exit.

  • Used oil and filters are stored and labeled properly with the process for recycling posted.

  • Is this area free of other safety issues not previously addressed?

Forklifts

  • Forklift visual inspection card is prominently displayed and legible.

  • Forklift is equipped with an operable horn.

  • Forklift seatbelt is in working order and expected to be worn.

  • Lift platform is designed, constructed, and certified to meet OSHA/ANSI specifications.

  • Is this area free of other safety issues not previously addressed?

Commercial Motor Vehicles

  • Emergency triangles are in the power unit of all commercial motor vehicles.

  • Fire extinguisher is properly mounted, latched, and has consistent proof of monthly inspection.

  • First aid kit is readily available.

  • Hazardous materials registration is current and readily available.

  • Proof of annual inspection is current and available.

  • Consistent proof of quality DVIR is prevalent.

  • All cargo, machinery, and equipment is properly and adequately secured.

  • High-vis apparel is available to use as situations and conditions warrant.

  • Is this area free of other safety issues not previously addressed?

Application Equipment

  • Fire extinguisher is properly mounted, latched, and has consistent proof of monthly inspection.

  • First aid kit is readily available.

  • SMV signs are properly mounted and displayed as necessary.

  • High-vis apparel is available to use as situations and conditions warrant.

  • WPS decontamination kits are available.

  • Is this area free of other safety issues not previously addressed?

Fuel and LP

  • Secondary containment is maintained in good operating condition.

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Explosion proof receptacles and equipment with permanent metal conduit is used within 25 feet of bulk fuel storage.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Fuel storage tanks are protected by suitable barriers to prevent damage by trucks or other vehicles.

  • All fuel tanks are properly and adequately labeled. Including NFPA.

  • LP storage tank is protected by suitable barriers to prevent damage to tank and piping by trucks or other vehicles.

  • LP bulkhead, tank, piping, and valves are color coded, labeled, and marked in a manner consistent with corporate expectations.

  • All LP tanks are properly and adequately labeled.

  • Spare LP cylinders are stored and labeled properly.

  • Fuel handling, storage, and dispensing areas have NO SMOKING signs posted.

  • Protective guards are properly installed and maintained as necessary.

  • Is this area free of other safety issues not previously addressed?

Seed Treater/Warehouse

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Protective guards are properly installed and maintained as necessary.

  • All bays, bins, tanks, and containers are properly and adequately labeled.

  • Doorways and passageways are marked with their specific purpose, not an exit, to an exit, or exit.

  • Wheel chocks are readily available and easily accessible at loading dock.

  • Pallet racks and other shelving is properly secured.

  • Is this area free of other safety issues not previously addressed?

Chemical Warehouse

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Emergency spill kit is readily available and relatively easily accessible.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Pesticide containers have a product labels.

  • Ladders, stairways, walkways, and platforms are constructed to OSHA specifications.

  • Pallet racks and other shelving is properly secured.

  • Doorways and passageways are marked with their specific purpose, not an exit, to an exit, or exit.

  • NO SMOKING & DANGER! PESTICIDE STORAGE AREA signs are posted where appropriate.

  • Wheel chocks are readily available and easily accessible at loading dock.

  • Is this area free of other safety issues not previously addressed?

Bulk Pesticide

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Protective guards are properly installed and maintained as necessary.

  • All bays, bins, tanks, and containers are properly and adequately labeled.

  • Ladders, stairways, walkways, and platforms are constructed to OSHA specifications.

  • Portable Refillable Containers are properly marked, labeled, inspected, and tested.

  • Rinsate is properly marked, stored, segregated, and disposed of.

  • There is an adequate safety shower/eyewash with proof of consistent inspection.

  • Doorways and passageways are marked with their specific purpose, not an exit, to an exit, or exit.

  • NO SMOKING & DANGER! PESTICIDE STORAGE AREA signs are posted where appropriate.

  • Is this area free of other safety issues not previously addressed?

Grain/Feed

  • Confined spaces are properly labeled.

  • Electrical panels and circuit breakers are marked and labeled.

  • Live electrical parts are guarded against accidental contact and unused openings are effectively closed.

  • Extension cords are free of splices, defects, or exposed wiring as well as not being used as a substitute for fixed electrical wiring.

  • Employees working at elevated heights have been equipped with fall arrest protection and trained on proper use and inspection of the equipment.

  • Fire Extinguishers are readily accessible and properly mounted with consistent proof monthly inspection.

  • Protective guards are properly installed and maintained as necessary.

  • Ladders, stairways, walkways, and platforms are constructed to OSHA specifications.

  • Pallet racks and other shelving is properly secured.

  • Doorways and passageways are marked with their specific purpose, not an exit, to an exit, or exit.

  • High-vis apparel is available to use as situations and conditions warrant.

  • NO SMOKING signs have been posted in appropriate areas.

  • Is this area free of other safety issues not previously addressed?

Signature Page

  • Per GROWMARK policy all flagged items must be addressed within 30 days. The word "addressed" in this scenario means action has been taken to immediately correct the issue or there is a written commitment to correct within the 30 day window.

  • Completed By:

  • Completed By:

  • Completed By:

  • Completed By:

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.