Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

PART I. GENERAL HOUSE KEEPING

  • C1.) Floors, walls, windows, clean and in good repair.

  • C2.) Break rooms cleaned/disinfected daily.

  • C3.) Trash containers sufficient to prevent overflow and emptied and cleaned daily.

  • C4.) All required posters and company policies in place and completed with current information.

  • C5.) Aisles and hallways clearly marked and kept clear of obstacles. (1910.22)

  • C6.) Cleaning supplies readily available. MSDS's and CIL on file electronically and in binder.

  • C7.) a.) Equipment properly stored in designated areas.<br> b.) Unused & broken equipment properly stored and tagged "out of service" as appropriate.

  • C8.) Products/supplies stored in designated areas. Inventory performed and maintained.

  • C9.) Outside area around building(s) clean and neat. Landscaping maintained, Building in good repair.

  • C10.) Proper signs posted at entrances, doorways, storage areas, maximum floor loading, etc..

  • C11.) Lighting in good repair and sufficient. Bulbs replaced as needed. Light bulbs and tubes shielded as required to prevent shattering.

  • C12.) Doors and locks functional and in good repair. Fencing & gates working.

  • C13.) Locker rooms and showers clean and in good repair. Uniforms, towels, & PPE properly stored. Lockers provided and utilized.

  • C14.) Smoking prohibited within building and smoking area designated.

  • C15.) Cargo areas cleaned and disinfected as needed; spills cleaned immediately. Truck cabs clean and orderly.

  • C16.) Secondary containment/spill control pallets utilized to control releases of bulk chemicals.

  • C17.) Floors drains are clean and free of debris. Floor grates/screen netting in place.

  • C18.) Equipment wash water properly disposed. No mixing of industrial process water and rainwater.

  • C19.) Operational and customer records purged/shredded such that only 3 years of records are retained onsite. Review records retention policy as needed.

PART II. EMERGENCY RESPONSE/FIRE CONTROL & PREVENTION

  • C1.) Fire Extinguishers - Inspect all extinguishers and initial tags monthly. Check that all unit are properly hung, clean, and accessible. Place "out of service" tags o n units needing repair.

  • C2.) Review Emergency Contacts List and update as needed. Insure that modified list is provided to appropriate agencies. Provide emergency numbers by each phone.

  • C3.) Check sprinklers system valves and sprinkler heads/pipes for damage. Inspected annually? 18" clearance for heads. Has the sprinkler system had annual inspections?

  • C4.) Check all exits/non-exits for proper signage and access.

  • C5.) Spill kits available and stocked with proper equipment.

  • C6.) Emergency Evacuation Plan posted at required locations throughout facility.

  • C7.) Fire hose connections not obstructed.

  • C8.) All flammables stored in approved containers and cabinets. MSDS's & CIL available electronically and in binder.

  • C9.) Compressed gas cylinders stored & secured. Oxygen/acetylene separated by 20 ft or solid wall.

  • C10.) Emergency eyewash and shower units provided, accessible, and checked/activated weekly.

PART III. BASIC HEALTH & SAFETY

  • C1.) New employees properly trained for specific duties.

  • C2.) PPE designated, provided and utilized for all job duties?

  • C3.) Employee work places clean and orderly - free of spills, oil, grease, and other hazards.

  • C4.) Hand sinks available, accessible, maintained, and used.

  • C5.) First Aid Kit available, stocked, no outdated items and no oral medications in the cabinet.

  • C6.) Chemical containers properly marked/labeled & stored. MSDS & CIL updated as needed.

  • C7.) Engulfment hazards identified and protective measures in place.

  • C8.) All piping properly labeled for contents.

  • C9.) Trained First-Aid/CPR Employee on duty each shift if required.

PART IV. ELECTRICAL SAFETY

  • C1.) Permanent wiring, boxes, switches, outlets, and lights secure, properly mounted, and free of defects. No exposed wiring.

  • C2.) Wiring for extension cords, portable lighting, power tools free of kinks, cuts, other damage.

  • C3.) Extension cords not utilized for permanently mounted equipment.

  • C4.) Portable tools and machinery properly grounded and/or double insulated. Is the ground prong or plugs not removed or converted?

  • C5.) LOTO Program in place and updated as needed. All locks and marking equipment provided.

  • C6.) GFI receptacles present in wet/damp locations.

  • C7.) Breaker and fuse boxes clean, accessible, and all breakers identified

  • C8.) Has a documented Arc Flash analysis been conducted? Is the analysis on site for review?

  • C9.) Are all switchboards, panel boards, industrial control panels, meter socket enclosures, and motor control centers labeled with appropriate Arc Flash Warning?

PART V. MACHINES, EQUIPMENT, & TOOLS (OPERATIONS/SHOP)

  • C1.) Employees properly trained to utilize equipment.

  • C2.) Tool rests on grinders within 1/8 of wheel & 1/4 of tongue guard.

  • C3.) Appropriate warning signs posted on or near equipment as needed (i.e. automatic start, etc.).

  • C4.) Confined space program in place and current. All required signage posted.

  • C5.) Are Powered Industrial Trucks (forklifts) operated by trained/authorized team members only? Are warning signs posted as necessary?

  • C6.) Ladders & Stairways in good repair.

  • C7.) All needed hand tools provided and in good repair.

  • C8.) Freezer and refrigerated trailer(s) maintaining required temperatures.

  • C9.) Are jack and hoist capabilities clearly marked? Are all jack(s) & hoist(s) in good repair?

  • C10.) Secondary storage level - load rating posted.

  • C11.) All moving parts, fans, pulleys, etc., within 7 feet of floor enclosed?.

  • C12.) Boiler inspection certificate up-to-date? Boilore operator certifications up-to-date?

  • C13.) Is boiler maintenance log up-to-date and boiler being blown down daily?

  • C14.) Is Boiler room neat and orderly – no leaks present?

PART VI. MONITORING, REPORTING & TRACKING DOCUMENTS

  • C1.) OSHA 300 & 301 Log: - Has the OSHA 300 log been reviewed for accuracy? Have the 301(s) been reviewed for accuracy?

  • C2.) Have all DOT incident reports been reviewed? (i.e. 5800.1 form completed accurately, affected facilities/agencies notified, copies provided to corporate and on file for two (2) years)

  • C3.) Has the TrueNorth Training/Medical Monitoring Log/report(s) been reviewed? (Review TNCompliance Reports, employees been notified of required training/medical exams, vaccinations)

  • C4.) Have facilities Shipping Documents been reviewed for completeness and accuracy?

  • C5.) Have the Powered Industrial Truck (forklift) daily/shift change inspections been reviewed?

  • C6.) Have Weekly Inspections been performed and reviewed? Are Weekly inspections are being retained on site for 1 year?

  • C7.) Have the BioSystems Cart Logs been reviewed for completeness and accuracy?

  • C8.) Do the Bio System cart shelves have a full complement of containers and security bar in place?

  • C9.) Does each Bio System cart have a completed inspection log that is accurate?

  • C10.) Do all Bio Systems containers containing waste have caps in place?

  • C11.) Are all Bio Systems containers labeled properly?

  • C12.) Are the autoclave records maintained as required by the State and/or policy; time, temperature recording charts; accurate daily operating reports indicating weight/volume processed; maintenance records/logs; completed inspection logs; etc. and available for review?

  • C13.) Are the incinerator records maintained as required by the State and/or policy; time, temperature records charts; accurate daily operating reports indicating weight/volume processed; maintenance records/logs; completed inspection logs; etc. and available for review?

PART VII. RADIATION

  • C1.) Is the radiation storage area clearly marked as required?

  • C2.) Are radiation monitors in place, calibrated, and functional?

  • C3.) Is the detection meter checked and a log available for review?

PART VIII. VEHICLES

  • C1.) Required Safety decals on vehicles - wide right turn, 3 point dismount, height markings, GOAL.

  • C2.) Is the Conspicuity tape on all vehicles correctly applied and functional?

  • C3.) For vehicles that carry bulk material, are proper Bulk Markings on the vehicle? (i.e. 6" Biohazard sign and 3291 Identification Markings)

  • C4.) Has a review of spill kits been conducted?

  • C5.) Has a review of proper load securement been conducted?

PART IX. DRIVER SPECIFIC ISSUES

  • C1.) Have MVR's been reviewed? Review current listing of drivers and modify to obtain MVR's for drivers operating company vehicles.

  • C2.) Have Hours of Service been reviewed? Determine compliance with 10 hour off duty, 11-hr driving/14-hr on-duty, and 60/70 hr 7/8 day limitations. Compare DMO with log books/time records.

  • C3.) Have DVCR's been reviewed? Review to insure accuracy and to insure corrections have been made as needed.

  • C4.) Has the Driver Spill Kit Checklist been reviewed? - Review & replenish equipment/material as needed. Perform monthly inspections.

  • C5.) Hs the Vehicle Emergency Response Manuals been reviewed. Check for completeness & update as needed.

  • C6.) Hs the Driver Management (DMO-JJ Keller) violation reports been reviewed? Has Disciplinary action documented for non-compliant individuals.

  • C7.) Are all vehicles properly signed and marked for each State the vehicle the operates in?

  • C8.) Have the vehicle maintenance files been reviewed? Review minimum 10% of files and record truck numbers.

  • Location CSA current point total:

PART X. DOT PACKAGING

  • C1.) Are Bulk Containers (>119 gallons) labeled with Large 3291, 6" Biohazard symbol, stack weight rating?

  • C2.) Are Tubs/boxes properly labeled with Regulated Medical Waste, n.o.s.; the work "Biohazard", Biohazard symbol, UN 3291 and up arrows?

  • C3.) Are all non-gasketed sharps containers packaged in secondary containers, (excluding Bio Systems containers).

  • C4.) Are all tubs/boxes are in good repair? Are no damaged containers shipped to customer or another SRCL location?

  • Date Inspection Completed:

  • Supervisor/ Facility Manager Signature:

  • Area Safety Manager 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.