Safety Inspection - Scrap Facilities (English)

• Conducted on

  Date

• Prepared by

• Notes:

• Is a Site Map with all the required information available?

  Yes

  No

  N/A

• Is there an effective method to notify employees in the event an evacuation is required?

  Yes

  No

  N/A

• Are exit routes clearly visible?

  Yes

  No

  N/A

• Is there an effective fire suppression system available on-site?

  Yes

  No

  N/A

• Type of fire suppression system:

• Picture:

  Media

• Are there enough fire extinguishers available in all areas required?

  Yes

  No

  N/A

• Do fire extinguishers meet all required criteria?

  Yes

  No

  N/A

• Are flammable or combustible materials in any areas in which they create a hazard?

  Yes

  No

  N/A

• Flammable or combustible materials in hazardous areas:

Material

• Type of material:

• Picture:

  Media

• Select all that apply:

  Select Used in restricted areas Used in excessive amounts Stored near ignition sources Other

  • Used in restricted areas
  • Used in excessive amounts
  • Stored near ignition sources
  • Other

• Other:

• Are approved containers and tanks used for the storage and handling of combustible and flammable liquids?

  Yes

  No

  N/A

• Are compressed gas cylinders (Propane or Acetylene) adequately separated (20 ft) from compressed oxygen cylinders?

  Yes

  No

  N/A

• Are work areas clean, organized and free from materials that might present a hazard?<br>

  Yes

  No

  N/A

• Is there adequate lighting in all areas?

  Yes

  No

  N/A

• Are working areas free from floor openings or uneven surfaces that could present a hazard?

  Yes

  No

  N/A

• is there any tank, cylinder, container or any type of material on-site that might represent a hazard if processed?

  Yes

  No

  N/A

• Materials that might represent a hazard if processed:

Material

• Picture:

  Media

• Type:

  Unexploded Ordnance

  Cylinder

  Container

  Tank

  Other

• Other:

• Can the material be identified?

  Yes

  No

  N/A

• Is the material segregated in a secure area?

  Yes

  No

  N/A

• Do all employees on-site wear the PPE needed to safely perform their tasks?

  Yes

  No

  N/A

• Employees not using PPE:

Employee

• Name:

• Emp. Id.:

• Reason given by employee to explain why PPE is not being used as required?

  Select Not close enough Insufficient content Other

  • Not close enough
  • Insufficient content
  • Other

• Other:

• Do first aid kits and biohazard kits meet all requirements?

  Yes

  No

  N/A

• Select all that apply:

  Select Not close enough Insufficient content Other

  • Not close enough
  • Insufficient content
  • Other

• Other:

• Do eye wash stations meet all of the required safety requirements?

  Yes

  No

  N/A

• Eye Wash Stations - Criteria not met:

  Select Not working properly Not close enough Not inspected Obstructed Other

  • Not working properly
  • Not close enough
  • Not inspected
  • Obstructed
  • Other

• Other:

• Are there any employees whose job task(s) requires the use of fall protection equipment?

  Yes

  N/A

• Do authorized employees have access to fall protection equipment?

  Yes

  No

  N/A

• Is fall protection equipment used as required?

  Yes

  No

  N/A

• Employees not using fall protection equipment as required:

Employee

• Name:

• Emp. Id:

• Reason given by employee to explain why Fall Protection equipment is not being used as required?

  Deteriorated

  Forgot to wear it

  Lost it

  Not available

  Other

• Are there any employees whose job task(s) requires the use of hearing protection?<br>

  Yes

  N/A

• Hearing Conservation - Number of affected employees:

• Do affected employees have access to hearing protectors?

  Yes

  No

  N/A

• Do all affected employees use hearing protection in the areas required?

  Yes

  No

  N/A

• Employees not using hearing protection where required:

Employee

• Name:

• Emp Id:

• Reason given by employee to explain why hearing protection s not used where required?

  Forgot

  Lost it

  Not available

  Other

• Other:

• Are there any employees whose job task(s) requires the use of respiratory protection?<br>

  Yes

  N/A

• Number of employees whose job responsibilities require the use of a respirator:

• Do employees (who are required to use respiratory protection) have access to adequate equipment?

  Yes

  No

  N/A

• Are respirators used by employees when required?

  Yes

  No

  N/A

• Employees not using respiratory protection when required:

Employee

• Name:

• Emp. Id:

• Reason given by employee to explain why respiratory protection is not used when required?

  Deteriorated

  Forgot to wear it

  Lost it

  Not available

  Other

• Other:

• Are respirators used and stored in accordance with the manufacturer's instructions?

  Yes

  No

  N/A

• Select all that apply:

  Select Improperly stored Deteriorated Not clean Other

  • Improperly stored
  • Deteriorated
  • Not clean
  • Other

• Other:

Powered Industrial Vehicles

• Are the required Cal/OSHA or OSHA Industrial Truck Operating Rules posted?

  Yes

  No

  N/A

• Do operators follow what's established in the Cal/OSHA or OSHA Industrial Truck Operating Rules? <br>

  Yes

  No

  N/A

• Equipment Operators not following Industrial Truck Operating Rules:

Equipment Operators:

• Name:

• Emp. Id:

• Equipment:

  Select Aerial Lift Crane Excavator Forklift Front End Loader Scissor Lift Skid-Steer N/A

  • Aerial Lift
  • Crane
  • Excavator
  • Forklift
  • Front End Loader
  • Scissor Lift
  • Skid-Steer
  • N/A

• Rule violation:

• Do equipment operators perform a pre-trip inspection on the equipment they operate?

  Yes

  No

  N/A

• Select three equipment operators and ask for the current week's equipment inspection checklist:

Equipment Inspections:

• Name:

• Emp. Id:

• Equipment:

  Select Aerial Lift Excavator Forklift Front End Loader Scissor Lift Skid-Steer Baler Container Loader Conveyor Belt CRV Baler Trommel Screen Crane Other

  • Aerial Lift
  • Excavator
  • Forklift
  • Front End Loader
  • Scissor Lift
  • Skid-Steer
  • Baler
  • Container Loader
  • Conveyor Belt
  • CRV Baler
  • Trommel Screen
  • Crane
  • Other

• Other:

• Make:

  Select Volvo Samsung CAT Caterpillar Al-Jon JLG Toyota Sierra Tailift Vermeer Clark Hyster International JCB John Deere Sellick Other

  • Volvo
  • Samsung
  • CAT
  • Caterpillar
  • Al-Jon
  • JLG
  • Toyota
  • Sierra
  • Tailift
  • Vermeer
  • Clark
  • Hyster
  • International
  • JCB
  • John Deere
  • Sellick
  • Other

• ECO ID:

• Did the operator provide the equipment inspection checklist for the current week?

  Yes

  No

  N/A

• Reason given by employee to explain why a pre-trip inspection was not performed:

  Forgot

  Lost it

  Other

• Other:

Conveyor Belts

• Are all conveyor belts effectively guarded to prevent contact with the operator?

  Yes

  No

  N/A
Conveyor Belts - Inadequate Machine Guarding

• Conveyor Belt:

• Add media

  Media

• Is there an emergency stop within reach of employees working near conveyor belts?

  Yes

  No

  N/A

• Number of authorized employees (under the Lockout Tagout Program):

• Do all authorized employees have their own lock?

  Yes

  No

  N/A

• Authorized employee without a lock

Employee

• Name:

• Emp. Id:

• Reason given by employee to explain why a lock is not in his/her possession?

  Forgot

  Lost it

  Other

• Other:

• Are there additional devices/equipment for the control of hazardous energy that are required, available on-site?

  Yes

  No

  N/A

• Do authorized employees follow the correct steps for the control of hazardous energy?

  Yes

  No

  N/A

• Authorized Employees - Control of Hazardous Energy (Select no less than two employees)

LOTO Authorized Employees:

• Name:

• Emp. Id:

• Equipment Type:

  Select Aerial Lift Excavator Forklift Front End Loader Scissor Lift Skid-Steer Baler Container Loader Conveyor Belt CRV Baler Trommel Screen Crane Other

  • Aerial Lift
  • Excavator
  • Forklift
  • Front End Loader
  • Scissor Lift
  • Skid-Steer
  • Baler
  • Container Loader
  • Conveyor Belt
  • CRV Baler
  • Trommel Screen
  • Crane
  • Other

• Other:

• Eco Id:

• Able to identify energy sources and energy isolating devices?

  Yes

  No

  N/A

• Able to properly de-energize equipment?

  Yes

  No

  N/A

• Secures energy isolating devices adequately?

  Yes

  No

  N/A

• Is there an adequate provision of water for all employees?

  Yes

  No

  N/A

• Reason why the water provision was considered inadequate:

  Select Insufficient Not close enough Not potable Inadequate temperature Other

  • Insufficient
  • Not close enough
  • Not potable
  • Inadequate temperature
  • Other

• Other:

• Do all employees have access to an adequate shade area?

  Yes

  No

  N/A

• Reason why the shade area was considered inadequate:

  Select Not close enough No ventilation Insufficient for all employees Other

  • Not close enough
  • No ventilation
  • Insufficient for all employees
  • Other

• Other:

• Is the temperature equal or higher than 95 degrees Fahrenheit?

  Yes

  N/A

• Were high heat procedures reviewed with all employees?

  Yes

  No

  N/A

• Are Safety Data Sheets available on-site?

  Yes

  No

  N/A

• Are all tanks, drums, and containers labeled with the specific chemical?

  Yes

  No

  N/A

• Do spill kits meet the required criteria?

  Yes

  No

  N/A

• Reason why spill kits did not meet the required criteria:

  Select Not close enough Insufficient content Other

  • Not close enough
  • Insufficient content
  • Other

• Other:

• Are National Fire Protection Association placards displayed where they are needed?

  Yes

  No

  N/A

• Are all permanent hot work areas clearly marked and visible?

  Yes

  No

  N/A

• Are all cylinders and tanks in good working condition?

  Yes

  No

  N/A

• Are all hoses, fittings and gauges in good working condition?

  Yes

  No

  N/A

• Are flash back arrestors installed on hoses, cylinders or tanks?

  Yes

  No

  N/A

• Are any materials that might represent a hazard, present in areas where hot work is being performed?<br>

  Yes

  No

  N/A

• Hazardous materials in areas where hot work is being performed:

Material

• Type:

• Picture:

  Media

• Has the material been segregated to a safe area on-site?

  Yes

  No

  N/A

• Do hot work areas have adequate fire extinguishers readily available?

  Yes

  No

  N/A

• Are electrical panels, controls, receptacles & wiring covered?

  Yes

  No

  N/A

• Are electrical panels marked and given 3ft clearance?

  Yes

  No

  N/A

• Are disconnecting switches labeled to indicate their use or equipment served?

  Yes

  No

  N/A

• Are electrical power cords in good condition?

  Yes

  No

  N/A

• Are extension cords used accordingly to safety rules and regulations?

  Yes

  No

  N/A

• Reason

  Select Daisy Chaining Excessive war Used through walls, doors, ceilings Used in dangerous areas Used as permanent wiring Other

  • Daisy Chaining
  • Excessive war
  • Used through walls, doors, ceilings
  • Used in dangerous areas
  • Used as permanent wiring
  • Other

• Other:

• Are copies of the company's safety programs available on-site?<br>

  Yes

  No

  N/A

• Is a copy of the Appendix G of the Lockout Tagout Program (Machine Specific Procedures) available on site?

  Yes

  No

  N/A

• Have all employees completed the required monthly safety training within the past three months?

  Yes

  No

  N/A

• Select the three months prior to the audit being conducted:

  Select January February March April May June July August September October November December

  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December

• December - Unexploded Ordnances & Confined Space Entry

  Completed

  Incomplete

  No record

• Employees in need of training:

• November - Fall Protection & Ladder Safety

  Completed

  Incomplete

  No record

• Employees in need of training:

• October - Compressed Gas Cylinder Safety & Welding & Cutting

  Completed

  Incomplete

  No record

• Employees in need of training:

• September - Respiratory Protection & Hearing Conservation

  Completed

  Incomplete

  No record

• Employees in need of training:

• August - Radiation Contingency Plan & Machine Guarding

  Completed

  Incomplete

  No record

• Employees in need of training:

• July - Slips, Trips, Falls (Walking Surfaces) & Heat Illness Prevention<br>

  Completed

  Incomplete

  No record

• Employees in need of training:

• June - Electrical Safety & Fire Prevention, Fire Extinguishers

  Completed

  Incomplete

  No record

• Employees in need of training:

• May - Hazard Communication & Bloodborne Pathogens & Medical Records

  Completed

  Incomplete

  No record

• Employees in need of training:

• April - Heat Illness Prevention

  Completed

  Incomplete

  No record

• Employees in need of training:

• March - Control of Hazardous Energy & PPE

  Completed

  Incomplete

  No record

• Employees in need of training:

• February - Powered Industrial Vehicles

  Completed

  Incomplete

  No record

• Employees in need of training:

• January - Injury and Illness Prevention & Emergency Action Plan

  Completed

  Incomplete

  No record

• Employees in need of training:

• Are copies of the Take 5 for Safety Talks sign-in sheets for the current week, available on-site?

  Yes

  No

  N/A

• Control of Hazardous Energy - Are copies of the Authorized Employee Training list available on-site?

  Yes

  No

  N/A

• Have all authorized employees under the Control of Hazardous Energy Program received adequate training?

  Yes

  No

  N/A

• Authorized employees (under the Control of Hazardous Energy Program) in need of training:

• Powered Industrial Vehicles - Are copies of the Powered Industrial Vehicle Operator List available on-site?

  Yes

  No

  N/A

• Do all PIV Operators have a current license for each piece of equipment they operate?

  Yes

  No

  N/A

• PIV Operators - Expired Licenses

Employee

• Name:

• Emp. Id:

• Expired License

  Select Aerial Lift Crane Excavator Forklift Front End Loader Scissor Lift Skid-Steer N/A

  • Aerial Lift
  • Crane
  • Excavator
  • Forklift
  • Front End Loader
  • Scissor Lift
  • Skid-Steer
  • N/A

• Respiratory Protection - Are copies of the Users of Respiratory Protection List available on-site?

  Yes

  No

  N/A

• Have all employees required to wear a respirator, been medically qualified within the last year?

  Yes

  No

  N/A

• Respirator users in need of a medical evaluation (PFT):

• Have all voluntary respirator users been given a copy of Appendix D of the Cal/OSHA or OSHA Respiratory Standard?

  Yes

  No

  N/A

• Voluntary respirator users in need of Appendix D of the Cal/OSHA or OSHA Respiratory Standard training:

• Hearing Conservation - Are copies of the Users of Hearing Protection List available on-site?

  Yes

  No

  N/A

• Have all affected employees received an annual audiogram test?

  Yes

  No

  N/A

• Affected Employees in need of an audiogram test:

• Fall Protection - Are copies of the Authorized Employee Training list available on-site?<br>

  Yes

  No

  N/A

• Have authorized employees under the Fall Protection Program received the appropriate training?

  Yes

  No

  N/A

• Employees in need of Fall Protection Training:

New Hires

• Have any employees been hired since the last audit?

  Yes

  N/A
Employee

• Name:

• Emp. Id:

• Training

• Will the new employee operate any of the following Powered Industrial Vehicles? (select all that apply)

  Select Aerial Lift Crane Excavator Forklift Front End Loader Scissor Lift Skid-Steer N/A

  • Aerial Lift
  • Crane
  • Excavator
  • Forklift
  • Front End Loader
  • Scissor Lift
  • Skid-Steer
  • N/A

• Does the new employee have a current license for the equipment he or she will be operating?

  Yes

  No

  N/A

• Will the new employee operate any of the following? (Select all that apply)

  Select Baler CRV Baler Container Loader Trommel Screen Conveyor Belt Other N/A

  • Baler
  • CRV Baler
  • Container Loader
  • Trommel Screen
  • Conveyor Belt
  • Other
  • N/A

• Has the new employee received training on the equipment to be operated?

  Yes

  No

  N/A

• Will the new employee perform any maintenance and/or service on machinery or equipment?

  Yes

  N/A

• Has the new employee received the appropriate lockout tagout training?

  Yes

  No

  N/A

• Will the new employee perform any task that requires the use of fall protection equipment?

  Yes

  N/A

• Has the new employee received the appropriate fall protection training?

  Yes

  No

  N/A

• Medical /Acclimatization

• Will the new employee perform any task that requires the use of a respirator?

  Yes

  N/A

• Has the new employee received a Pulmonary Function Test and Fit Test?

  Yes

  No

  N/A

• Will the new employee perform any task that requires the use of hearing protection?

  Yes

  N/A

• Has the new employee received a baseline audiogram?

  Yes

  No

  N/A

• Has the new employee being assigned tasks that allow for an adequate acclimatization period?

  Yes

  No

  N/A

Equipment

• Do all safety related features work properly on all company equipment?

  Yes

  No

  N/A

• Equipment in need of repair:

Equipment

• Type:

  Select Aerial Lift Excavator Forklift Front End Loader Scissor Lift Skid-Steer Baler Container Loader Conveyor Belt CRV Baler Trommel Screen Crane Other

  • Aerial Lift
  • Excavator
  • Forklift
  • Front End Loader
  • Scissor Lift
  • Skid-Steer
  • Baler
  • Container Loader
  • Conveyor Belt
  • CRV Baler
  • Trommel Screen
  • Crane
  • Other

• Make:

  Select Volvo Samsung CAT Caterpillar Al-Jon JLG Toyota Sierra Tailift Vermeer Clark Hyster International JCB John Deere Sellick Other

  • Volvo
  • Samsung
  • CAT
  • Caterpillar
  • Al-Jon
  • JLG
  • Toyota
  • Sierra
  • Tailift
  • Vermeer
  • Clark
  • Hyster
  • International
  • JCB
  • John Deere
  • Sellick
  • Other

• Other:

• Eco Id:

• Description of the issue:

Unsafe Acts

• Were any unsafe acts detected during the inspection?

  Yes

  No

  N/A

• Unsafe Acts:

Unsafe Act

• Unsafe act description:

• Picture:

  Media

• Employee(s) involved:

• Action to take in order to prevent the unsafe act from happening again?

  Select Disciplinary action Training New procedure To be determined Other

  • Disciplinary action
  • Training
  • New procedure
  • To be determined
  • Other

• Other:

• Did the employee(s) involved and the site supervisor received instructions in order to prevent the unsafe act from happening again?

  Yes

  No

  N/A

• Site Supervisor Name:

• Site Supervisor Signature:

  Sign

• Auditor Name:

• Auditor Signature:

  Sign

• Notes: