Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Components

Valves 112.8 (d)(4) 112.9 (d)(1)

  • Are there any signs of misting

  • Are there any liquid leaks?

Flanges 112.8 (d)(4)

  • Are there any liquid leaks?

  • Are there any signs of misting?

Pumps 112.8 (d)(4)

Dump Lever Arms 112.11(d)

  • Are there any liquid leaks?

  • Are there any signs of misting?

Vessels

Tanks 112.9(c)(3)

  • Do the tank surfaces show signs of leakage?

  • Is there any staining on the ground?

  • Are there holes in the tanks? (Including pinholes)

  • Are the tanks damaged, rusted, or deteriorated?

  • Are any of the bolts, rivets, or seams damaged?

  • Are level gauges or alarms inoperative?

  • Are any signs or labels missing on tanks?

  • Have any tank supports deteriorated or buckled?

  • Have the tank foundation eroded or settled?

Secondary Containment 112.9(c)(2) 112.9(b)(1) 112.9(b)(1) 112.7(c)

  • Is the secondary containment damaged or not adequate?

  • Is the drainage valve open or broken?

  • Is there trash or vegetation inside the containment?

  • Is there any staining inside or outside the containment?

Hatches 112.8(d)(4)

  • Are there stains around the hatches?

  • Are any hatches open or partly open?

  • Gaskets not properly sealing or showing signs of deterioration?

  • Are there visible gas emissions?

Relief Valves & Vents 112.9(d)(2)

  • Are there any leaks?

  • Are there any visible gas emissions?

  • Vents are obstructed?

Separator(s) 112.9(c)(3)

  • Does she'll condition show signs of pitting, rusting, or deterioration?

  • Gaskets not properly sealing or showing signs of deterioration?

  • Does the equipment show signs of leakage?

Piping

Pipelines 112.8(d)(4) 112.9(d)(1)

  • Are any pipeline or supports damaged or deteriorating?

  • Is any buried piping exposed?

  • Are there any out of service pipes without caps

  • Are there any liquid leaks?

Response Equipment 112.7(d)(2) 112.7(a)(3)(iv)

  • Response equipment inventory is complete

Security/Safety

Fencing & Gates 112.7(g)

  • Fencing and gates are damaged or non-functional?

Lighting 112.7(g)

  • Is lighting non-functional?

Signage

  • Is proper signage missing?

Pumps & Valves 112.7(g)

  • Pumps and valves are not locked (if not in use)?

Transfer Equipment

Load lines 112.7(h) 112.9(d)(1)

  • Are load line damaged or deteriorated?

Environmental Pots 112.9(b)(2) 112.7(h)

  • Are environmental pots damaged or leaking?

  • Is there any staining beneath environmental pots?

  • Is there any any liquid in environmental pots?

Additional Comments

Has any equipment been added or remover since last inspection?

  • Add drawing

  • Add signature

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.