Safety and Environmental Audit

• Conducted on

  Date

• Prepared by

• Location
  Address

CNH Office

• Are any fire exits blocked

  Yes - Safe

  NO - UNSAFE

• Any notable fire hazards present?

  Yes - Safe

  NO - UNSAFE

• Are Fire Extinguishers in place and charged

  Yes

  No

  N/A

• Are the fire extinguishers properly marked with signs?

  Yes

  No

  N/A

• Are there smoke detectors in place

  Yes

  No

  N/A

• Are the smoke detectors working?

  Yes

  No

  N/A

• Are all emergency lights operational

  Yes - Safe

  NO - UNSAFE

• Any Obvious trip/fall hazards noted?

  Yes - Safe

  NO - UNSAFE

• Any signs of water ingress?

  No

  Yes

• Spill / emergency phone number posted?

  Yes

  No

  N/A

• Any signs of mold or excess dust buildup?

  No

  Yes

• Are hazardous materials stored properly?

  Yes

  No

  N/A

• Any cleanliness issues?

  No

  Yes

• Any signs of pest and or bug infestation?

  No

  Yes

• Any unsafe acts observed?

• Any hazardous conditions present?

Provider Office Area

• Any Fire Exits Blocked?

  Yes - Safe

  NO - UNSAFE

• Any Notable Hazards present?

  Yes - Safe

  NO - UNSAFE

• Are fire extinguishers in place and charged?

  Yes

  No

  N/A

• Are fire extinguishers properly marked with signs?

  Yes

  No

  N/A

• Are there smoke detectors in place?

  Yes

  No

  N/A

• Are smoke detectors working properly?

  Yes

  No

  N/A

• Are all Emergency lights operational

  Yes - Safe

  NO - UNSAFE

• Any obvious trip/fall hazards noted?

  No

  Yes

• Any signs of water ingress noted?

  No

  Yes

• Are the spill and emergency phone numbers posted?

  Yes

  No

  N/A

• Any signs of mold or excess dust buildup?

  No

  Yes

• Are hazardous materials stored properly?

  Yes

  No

  N/A

• Any cleanliness issues?

  No

  Yes

• Any signs of pest and or bug infestation?

  No

  Yes

• Any hazardous acts observed?

• Any hazardous conditions present?

Ship Away Area

• Are wheel chocks in place at each ramp?

  Yes

  No

  N/A

• Are height sticks readily available<br>

  Yes

  No

  N/A

• Spill kit readily available and stocked

  Yes

  No

  N/A

• Spill / emergency phone number posted?

  Yes

  No

  N/A

• All employees wearing high visibility vests and (or) shirts

  Yes

  No

  N/A

• All employees wearing proper PPE?

  Yes

  No

  N/A

• Any trip/fall hazards noted?

  No

  Yes

• Any unsafe acts observed?

• Any hazardous conditions present?

Lot 100

• Are all storm drains clear of debris?

  Yes

  No

  N/A

• Spill kits in front / center / rear of lot and properly stocked?

  Yes

  No

  N/A

• Aisles open and clearly defined?

  Yes

  No

  N/A

• Lot Free of debris and (or) trash

  Yes

  No

  N/A

• All employees wearing proper PPE?

  Yes

  No

  N/A

• All employees wearing high visibility vests and (or) shirts

  Yes

  No

  N/A

• All employees wearing proper PPE?

  Yes

  No

  N/A

• Are all fluids (oils, chemicals, etc.) properly stored?

  Yes

  No

  N/A

• Any spills observed?

  No

  Yes

• Any fire hazards noted?

  No

  Yes

• Are all fire hydrants accessible?

  Yes

  No

  N/A

• Any unsafe acts observed?

• Any hazardous conditions present?

Rubb Building

• Spill kit available in the building?

  Yes

  No

  N/A

• Fire extinguishers available and charged?

  Yes

  No

  N/A

• Any spills present?

  Yes

  No

  N/A

• Are hazardous materials stored properly?

  Yes

  No

  N/A

• Is the area clean and orderly?

  Yes

  No

  N/A

• Any fire hazards detected?

  Yes

  No

  N/A

Lot 90

• Are spill kits present in the front / center / rear of lot and properly stocked?

  Yes

  No

  N/A

• Are all aisles open and clearly defined

  Yes

  No

  N/A

• Lot free of debris and trash?

  Yes

  No

  N/A

• Are all observed employees wearing proper PPE?

  Yes

  No

  N/A

• Are all employees wearing High Visibility vests and (or) shirts?

  Yes

  No

  N/A

• Are all fluids (oils, chemicals, etc.) properly stored?

  Yes

  No

  N/A

• Any spills observed?

  No

  Yes

• Any fire hazards noted?

  No

  Yes

• Are all fire hydrants accessible?

  Yes

  No

  N/A

• Any unsafe acts observed?

• Any hazardous conditions present?