Information
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Audit Title
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Client / Site
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Conducted on
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Prepared by
Office
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Does this location have a "manned" office?
OSHA Programs
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There is a site specific Emergency Action Plan with proof of training/review.
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Corrected By and Date Corrected:
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There is a site specific Emergency Response Plan with proof of training/review.
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Corrected By and Date Corrected:
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There is a Bloodborne Pathogens Program in place with proof of training/review.
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Corrected By and Date Corrected:
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There is a Confined Space Entry Program (or Non-Entry) in place with proof of training/review.
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Corrected By and Date Corrected:
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There is a site specific Fire Prevention Plan with proof of training/review.
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Corrected By and Date Corrected:
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There is a plan in place for Forklift Operator Evaluation.
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Corrected By and Date Corrected:
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There is a site specific Hazard Communication Program with proof of training/review.
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Corrected By and Date Corrected:
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There is a site specific Hot Work Program with proof of training/review.
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Corrected By and Date Corrected:
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There is a site specific Hazard Assesment Program with proof of training/review.
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Corrected By and Date Corrected:
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There is a site specific LOTO program, appropriate equipment, and proof of training/review.
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Corrected By and Date Corrected:
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There is a copy of the most recent site inspection.
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Have all corrections been made and properly documented?
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Corrected By and Date Corrected:
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There is proper documentation of monthly Safety Awareness Meetings.
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Corrected By and Date Corrected:
NH3 Proof of Training
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There is proof of Classroom Training.
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Corrected By and Date Corrected:
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There is proof of Hands on Training—Appendix C completed for each employee.
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Corrected By and Date Corrected:
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There is proof of Hands on Training—Appendix D completed for each employee.
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Corrected By and Date Corrected:
SPCC
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Supplies for conducting inspections are readily available and appear to be being used appropriately. (Tube and Stick or Interstitial Gauge)
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Observation
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Corrected By and Date Corrected:
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Annual Inspection Checklist is current, complete, and correct.
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Observation
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Corrected By and Date Corrected:
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Monthly Inspection Checklist is current, complete, and correct.
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Observation
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Corrected By and Date Corrected:
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Portable Container Monthly Inspection Checklist is current, complete, and correct.
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Observation
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Corrected By and Date Corrected:
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Is this a PE SPCC facility?
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Spill Prevention Briefings are current, complete, and correct.
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Observation
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Corrected By and Date Corrected:
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Drainage Discharge Report is current, complete, and correct.
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Observation
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Corrected By and Date Corrected:
Fire Extinguishers
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Fire extinguishers are hung properly.
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Observation
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Corrected By and Date Corrected:
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Monthly inspections have been properly documented.
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Electrical breakers are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Exits and non-exits are labeled properly.
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Observation
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Corrected By and Date Corrected:
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OSHA posters are prominently displayed.
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Observation
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Corrected By and Date Corrected:
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OSHA 300 Log has been hung/taken down as appropriate.
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Observation
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Corrected By and Date Corrected:
Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
Shop
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Does this location have a shop?
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Does this facility have used oil?
Used Oil
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Used oil is properly labeled.
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Observation
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Corrected By and Date Corrected:
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Used oil is stored in proper receptacle.
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Observation
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Corrected By and Date Corrected:
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Proper disposal information is posted/available.
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Observation
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Corrected By and Date Corrected:
Fire Extinguishers
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Fire extinguishers are hung properly.
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Observation
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Corrected By and Date Corrected:
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Monthly inspections have been properly documented.
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Observation
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Corrected By and Date Corrected:
Guarding
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Does this area have equipment requiring a 6 sided guard?
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6 sided guards are complete and installed properly.
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Observation
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Corrected By and Date Corrected:
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Does this area have a bench grinder?
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Guards on grinder are set properly. 1/4" Tongue and 1/8" Rest
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Observation
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Corrected By and Date Corrected:
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Does this area have any other machines requiring guards?
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Guards on other machines are set properly.
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Observation
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Corrected By and Date Corrected:
Signage
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Are there areas requiring eye protection?
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Appropriate eye protection warning signs are posted.
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Observation
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Corrected By and Date Corrected:
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Exits and Non-Exits are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Proper and adequate NFPA signs are posted.
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Observation
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Corrected By and Date Corrected:
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Does this area have electrical overhead doors?
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All overhead doors have proper and adequate crush protection. (Sign or Photo Eyes)
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Electrical breakers are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Does this area have shelving and storage?
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Shelving and storage is properly anchored.
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Observation
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Corrected By and Date Corrected:
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Combustible materials/trash are in a steel can with lid in accordance with the recently implemented fire prevention plan. (May SAM)
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Observation
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Corrected By and Date Corrected:
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The general cleanliness of this area promotes prevention of slips, trips, and falls.
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Observation
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Corrected By and Date Corrected:
Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
Liquid Operations
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Does this location have Liquid Operations?
General
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Tanks and their contents are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Does this facility have elevated walkways and/or platforms?
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Access to elevated walkways, platforms, and tanks is controlled to OSHA standards.
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Observation
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Corrected By and Date Corrected:
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Elevated walkways and platforms are constructed to OSHA standards.
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Observation
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Corrected By and Date Corrected:
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Adequate measures have been taken to provide site security.
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Observation
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Corrected By and Date Corrected:
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Secondary containment structures are in good repair and appear to be functioning properly.
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Observation
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Corrected By and Date Corrected:
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There is an eyewash/safety shower station located on site.
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Observation
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Corrected By and Date Corrected:
Signage
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Exits and Non-Exits are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Proper and adequate NFPA signs have been posted.
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Observation
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Corrected By and Date Corrected:
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Does this facility have electrical overhead doors?
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All overhead doors have proper and adequate crush protection. (Sign or Photo Eyes)
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Observation
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Corrected By and Date Corrected:
Fire Extinguishers
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Is this facility required to have a fire extinguisher?
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Fire extinguishers are hung properly.
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Observation
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Corrected By and Date Corrected:
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Monthly inspections have been properly documented.
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Electrical breakers are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Does this facility have shelving and storage?
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Shelving and storage is properly anchored.
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Observation
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Corrected By and Date Corrected:
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All tanks have proper confined space stickers.
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Observation
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Corrected By and Date Corrected:
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The general cleanliness of this area promotes prevention of slips, trips, and falls.
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Observation
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Corrected By and Date Corrected:
Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
Dry Operations
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Does this location have Dry Operations?
General
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The contents of all bins are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Does this facility have elevated walkways and platforms?
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Access to elevated walkways and platforms is controlled to OSHA standards.
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Observation
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Corrected By and Date Corrected:
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Elevated walkways and platforms are constructed to OSHA standards.
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Observation
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Corrected By and Date Corrected:
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Adequate measures have been taken to provide site security.
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Observation
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Corrected By and Date Corrected:
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Secondary containment structures are in good repair and appear to be functioning properly.
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Observation
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Corrected By and Date Corrected:
Signage
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Exits and Non-Exits are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Proper and adequate NFPA labels have been posted.
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Observation
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Corrected By and Date Corrected:
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Does this facility have electrical overhead doors?
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All overhead doors have proper and adequate crush protection. (Sign or Photo Eyes)
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Observation
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Corrected By and Date Corrected:
Guarding
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6 sided guards are complete and have been installed properly.
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Observation
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Corrected By and Date Corrected:
Fire Extinguishers
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Fire extinguishers are hung properly.
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Observation
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Corrected By and Date Corrected:
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Monthly inspections have been properly documented.
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Electrical breakers are properly labeled.
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Observation
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Corrected By and Date Corrected:
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The general cleanliness of this area promotes prevention of slips, trips, and falls.
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Observation
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Corrected By and Date Corrected:
Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
Chemical Warehouse, Seed Storage, Treatment
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Does this location have a Chemical Warehouse, Seed Storage, Treatment area?
Signage
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Exits and Non-Exits are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Proper and adequate NFPA signs have been posted.
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Observation
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Corrected By and Date Corrected:
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Does this facility have electrical overhead doors?
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All overhead doors have proper and adequate crush protection. (Sign or Photo Eyes)
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Observation
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Corrected By and Date Corrected:
Guarding
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Does this facility have equipment requiring 6 sided guards?
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6 sided guards are complete and installed properly.
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Observation
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Corrected By and Date Corrected:
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Does this facility have other equipment requiring guards?
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Other guards are complete and installed properly.
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Observation
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Corrected By and Date Corrected:
Fire Extinguishers
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Fire extinguishers are hung properly.
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Observation
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Corrected By and Date Corrected:
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Monthly inspections have been properly documented.
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Electrical breakers are properly labeled.
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Observation
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Corrected By and Date Corrected:
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Does this facility have shelving and storage?
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Shelving and storage is properly anchored to floor or wall.
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Observation
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Corrected By and Date Corrected:
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The general cleanliness of this area promotes prevention of slips, trips, and falls.
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Observation
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Corrected By and Date Corrected:
Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Add media
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Observation
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Corrected By and Date Corrected:
NH3 Operations
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Does this location have NH3 Operations?
General
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Adequate and proper crash protection is installed.
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Observation
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Corrected By and Date Corrected:
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Adequate measures have been taken to provide site security.
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Observation
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Corrected By and Date Corrected:
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Emergency water tank is full and water is generally clear and free of debris.
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Observation
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Corrected By and Date Corrected:
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Bleed off water tank is properly sized and labeled.
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Observation
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Corrected By and Date Corrected:
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Tank is properly labeled.
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Observation
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Corrected By and Date Corrected:
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Emergency shutdowns are properly labeled and in working order.
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Observation
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Corrected By and Date Corrected:
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Stairs to the riser are built according to OSHA standards.
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Observation
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Corrected By and Date Corrected:
Guarding
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6 sided guards are complete and installed properly.
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Electrical breakers are properly labeled.
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Add media
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Observation
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Corrected By and Date Corrected:
Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
LP Operations
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Does this location have LP Operations?
General
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Adequate and proper crash protection is installed.
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Observation
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Corrected By and Date Corrected:
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Adequate measures have been taken to provide site security.
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Observation
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Corrected By and Date Corrected:
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Tank is properly labeled.
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Observation
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Corrected By and Date Corrected:
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Emergency shutdowns are properly labeled and in working order.
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Observation
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Corrected By and Date Corrected:
Guarding
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6 sided guards are complete and properly installed.
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Add media
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Observation
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Corrected By and Date Corrected:
Fire Extinguishers
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Fire extinguishers are hung properly.
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Add media
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Observation
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Corrected By and Date Corrected:
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Monthly inspections have been properly documented.
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Add media
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Electrical breakers are properly labeled.
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Observation
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Corrected By and Date Corrected:
Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Add media
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Observation
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Corrected By and Date Corrected:
Bulk Fuel Operations
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Does this location have Bulk Fuel Operations?
General
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All tanks are properly and adequately labeled.
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Observation
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Corrected By and Date Corrected:
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Adequate measures have been taken to provide site security.
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Observation
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Corrected By and Date Corrected:
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Gasoline nozzle extension is installed.
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Observation
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Corrected By and Date Corrected:
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Secondary containment structures are in good repair and appear to be working properly.
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Observation
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Corrected By and Date Corrected:
Fire Extinguishers
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Fire extinguishers are hung properly.
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Add media
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Observation
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Corrected By and Date Corrected:
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Monthly inspections have been properly documented.
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Electrical breakers are properly labeled.
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Observation
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Corrected By and Date Corrected:
Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
911 Information
Contact Information
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911 contact information sign is up to date.
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Observation
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Corrected By and Date Corrected:
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Non-essential 911 information is updated or removed.
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
Forklift
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Does this location have a forklift?
General
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Green inspection card is posted and legible.
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Observation
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Corrected By and Date Corrected:
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Seatbelt is in working order.
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Observation
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Corrected By and Date Corrected:
Other Concerns
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Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
Other Areas
Other Concerns
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Additional Safety Issues
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If this box is not checked you have the following additional concerns to address:
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Observation
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Corrected By and Date Corrected:
Review and Sign
Review and Sign
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