Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

Stormwater

  • Is rain gauge present at facility?

  • Is rainfall being recorded and current?

  • Are preventative maintenance/inspections being conducted and documented on stormwater controls?

  • Are Monthly Periodic Inspections being conducted and documented?

  • Are any deficiencies noted on inspection forms?

  • Are Quarterly Visual Inspections being conducted and documented?

  • Has stormwater sample been collected for the period of January-June?

  • Has stormwater sample been collected for the period of July-December?

  • Are spills, if any, documented in Inspection Book?

  • Has employee training been conducted? Is employee training documentation present?

  • Have spills, leaks, or soil staining been cleaned?

  • Are buckets used to catch oils, or other open containers, covered and/or not exposed to the weather?

  • Are areas where water runoff water leaves the site free of visible silt or contaminant laden runoff?

  • Are good housekeeping practices being utilized?

  • Is windblown trash being removed and placed in trash containers?

Air Permitting

  • Does facility have air permit summary page?

  • Does Plant Manager know maximum operating temperature for mix types?

  • Does Plant Manager know maximum production rate (TPH)?

  • Does Plant manager know maximum production rate (TPY)?

  • Are hourly and annual production rates of all mix types being kept? Are records summarized daily and monthly?

  • Is documentation from a laboratory listing concentrations of ingredients of reclaimed industrial oil (RFO) present?

  • Are daily records of hours of operation present?

  • Are records present for the volatility of asphalt binders?

  • Are temperature charts for the last 2 years present?

  • Can Plant Manager produce requested Temperature Charts in a timely manner?

  • Are Maintenance, Startup, Shutdown (MSS) Emissions being documented?

  • Are records of road cleaning, application of dust control, or road maintenace for dust control present?

  • Are records of Warm Mix technologies used for All Mix Types documented?

  • Are records of Asphalt Additives for All Mix Types documented?

  • Are MSDS sheets for each asphalt additive/asphalt cement present?

  • Are inspections, malfunctions, repairs, and maintenance of abatement equipment (Baghouse/Cyclone), Including bag replacement documented?

  • Is a copy of the manufacturer's suggested cleaning and maintenance schedule for abatement equipment present?

  • Are Quarterly observations for visible emissions and/or opacity determinations documented?

  • Is a copy of the stack test or the test waiver that shows compliance with NSPS Subparts A and I and the outlet grain loading limitation present?

  • Is quantity of fuel used in the Hot Oil Heater documented?

  • Are fuel analysis for the dryer and hot oil heater present?

  • Is dryer fuel type for each mix type documented?

  • Is current documentation from an accredited laboratory listing loss-on-heating values for all mix types for which the drum temperature will exceed 325 deg. F present?

  • Standard Permit-Is PG binder recorded when mix temperature is greater than 325 deg F?

  • Are records of dryer fuel type and its maximum sulfer content present?

Spill Prevention, Control, and Countermeasure (SPCC)

  • Are containment drain valves closed at time of inspection?

  • Is facility storage capacity correct?

  • Does site/tank diagram match what is actually at the site?

  • Is containment drainage log on-site and current?

  • Are Tanks, Piping, and Containments inspected monthly and documented?

Texas Tier II

  • Is Texas Tier II Report on-site?

  • Are MSDS present for hazardous chemicals reported on the Tier II?

Petroleum Storage Tanks / Storage Containers

  • Is PST registration certificate on-site?

  • Are PSTs not being utilized empty and marked "out of service"

  • Do Aboveground Storage Tanks (ASTs) have labels as to their contents?

  • Are all other on-site containers containing fluids labelled as to their contents?

  • Are Safety Data Sheets (SDSs) available for contents of all containers on-site?

General - Additional Items

  • List any additional items.

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.