TS Branch Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Section 1.0 GENERAL

• 1.1 Are Daily Tool Box talks being conducted and signed by each employee?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 1.2 Are all incidents (near misses) being reported?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 1.3 Are employees properly trained on Hazard Assessments (JHAs) and do they sign off on them?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 1.4 Have employees been trained on the Working Alone Standard?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 1.5 Do employees have properly equipped gear/spill bags?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 1.6 Are respirators properly stored within a sealed, rigid container?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 1.7 Are gear bags equipped with eye wash bottles?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 1.8 Are Safe Work Practices/Standard Operating Procedures available for the work being performed and have employees been properly trained?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 1.9 Are all doors and windows properly secured when not in use?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

Section 2.0 SAFETY BOARD/DOCUMENTATION

• 2.1 Is the company Corporate Health & Safety and Environmental Excellence Commitment Policy posted?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 2.2 Are Safety Meeting Minutes and recent Safety Alerts posted?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 2.3 Are designated first-aid responders listed? Emergency contacts? Directions to nearest medical facility?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 2.4 Are all required federal, state and local labor and safety posters posted?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 2.5 Do workers have adequate access to the Site Specific Safety Policies/Procedures and the Sharepoint Site?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 2.6 Is an Emergency Response Plan/Procedure posted in a conspicuous location?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

Section 3.0 SHOP/WAREHOUSE

• 3.1 Are all fire extinguisher stations properly marked, free of obstructions and mounted off the floor?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.2 Have all fire extinguishers been checked on a monthly basis to ensure they are fully charged and in good working order?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.3 Have all fire extinguishers been inspected by an outside agency on an annual basis?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.4 Are Emergency Back-up Lights functioning as required?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.5 Have NO SMOKING signs been posted in the chemical/flammable material storage areas?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.6 Are workers protected from rotating/moving equipment by the use of approved safety guards?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.7 Have chemical & oil spills been properly contained and/or cleaned up as required?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.8 Are fumes, vapors and/or exhaust controlled or vented from the building?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.9 Is the shop area generally clean and free of housekeeping hazards (i.e., tripping hazards)?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.10 Is the area well lit?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.11 Are all electrical outlets and cords in safe condition (free of cuts, splices or exposed wires)?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.12 Are all ignition sources (excluding electrical wiring) turned off or protected when not in use?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.13 Are all propane-fueled vehicles parked with the gas valve closed and are surplus propane cylinders stored properly with necessary signage?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.14 Are gas cylinders secured upright? Are oxygen and flammable gas cylinders stored separately?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.15 Are cylinder caps securely in place on the cylinder when the cylinder is not in use?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.16 Are all electrical tools equipped with a grounding wire or cable and in good repair?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.17 Are all tools in good repair with no modifications?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.18 Is all PPE clean and stored in its respective locations (i.e., fall arrest gear, respirators)?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.19 Annual inspection of overhead door(s) completed?  

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• Date Last Checked (mm/dd/yy):

  Date

• 3.20 Are Emergency exits well identified and unobstructed?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.21 Is there a First Aid Kit available? Is it clearly marked and fully stocked?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.22 Has a chemical inventory been developed? Is it current/accurate?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.23 Are current MSDS (Material Safety Data Sheets) available for all chemical stored on site (hard copy or electronic version)?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.24 Are chemical bags and drums properly identified by WHMIS/HazCom labels?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.25 Are chemicals being stored in their appropriate locations? (i.e. Flammable Storage Cabinet)

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.26 Are all chemical containers closed properly and free of leaks?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.27 Is material for chemical spill clean-up or containment available and inspected (i.e. spill kit, spill tray, etc)?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.28 Are Emergency Eye Wash & Safety Showers being routinely inspected per the manufacturer’s specifications

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.29 Are portable ladders inspected and maintained in good working order? Documentation of inspections?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.30 Are mechanical aids available for lifting and moving heavy items?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 3.31 Are all utility or box cutter knives self-retracting?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• Comments/Recommendations (include item number noted above with your comments):

Section 4.0 VEHICLES

• 4.1 Are Fire Extinguishers mounted on all vehicles?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 4.2 Have all equipment-mounted Fire Extinguishers been checked on a monthly basis to ensure they are fully charged and in good working order?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 4.3 Have all equipment-mounted Fire Extinguishers been inspected by an outside agency on an annual basis?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 4.4 Are all vehicles equipped with the appropriate safety equipment (i.e., reflective triangles, flares, wheel chocks, tire chains, etc.)?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 4.5 Are all vehicles equipped with First Aid Kits? Are they fully stocked?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 4.6 Have all document pouches been checked within the last three (3) months (i.e., insurance documents, registration, accident report forms)?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• Date last checked:

  Date

• 4.7 Are wheel chocks down on all units parked inside the shop (or outside if mobile repair/inspection)?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 4.8 Are units locked-out when repairs or inspections are being conducted?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• Comments/Recommendations (include item number noted above with your comments):

Section 5.0 YARD

• 5.1 Are all empty drums stored in such a way to prevent hazards?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 5.2 Are all hoses placed in their appropriate storage areas? Are they kept neat and tidy?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 5.3 Are empty aerosol cans stored in appropriate containers for approved disposal?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 5.4 Is contaminated floor dry stored in appropriate containers for approved disposal?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 5.5 Are used batteries stored outside and within secondary containment?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 5.6 Is there a posted speed limit for the yard?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• Comments/Recommendations (include item number noted above with your comments):

Section 6.0 OFFICE/GENERAL

• 6.1 Are hallways/aisles free of tripping hazards?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.2 Are all doorways clear of obstructions?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.3 Are Fire Extinguisher Stations clearly marked and in appropriate locations within office?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.4 Have all fire extinguishers been checked on a monthly basis to ensure they are fully charged and in good working order?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.5 Have all fire extinguishers been inspected by an outside agency on an annual basis?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.6 Are Emergency Back-up Lights functioning as required?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.7 Are smoke, fire and burglar alarms in place and functional?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.8 Is the area well lit?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.9 Are all electrical outlets and cords in safe condition?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.10 Are signs and fixtures securely fastened to walls?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.11 Are racks/shelving/drawer systems in adequate condition? Are weight ratings affixed and legible?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.12 Is there clear access to electrical panels?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.13 Are GFI's (ground fault interrupters) in place where required?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.14 Are MSDS's available for office supplies/chemicals?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.15 Are containers clearly labeled?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.16 Are workstations adequately designed/spaced?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.17 Are parking spots and walkways appropriately lighted?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.18 Is snow, ice and other debris controlled on all walking/driving paths?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.19 Do all electrical panels/disconnects have 36" of clearance? Circuits labeled and accurate?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• 6.20 Extension cords not being used across pathways or doorways? Extension cords for temporary use only?

  Select YES NO Not Applicable

  • YES
  • NO
  • Not Applicable

• Issue Statement

• Corrective Action

• Comments/Recommendations (include item number noted above with your comments):

Section 7.0 INSPECTION SIGN-OFF

• INSPECTOR NAME (please print):

• INSPECTOR SIGNATURE:

  Sign

• NUMBER OF NEAR MISSES REPORTED THIS MONTH:

• NUMBER OF HAZARD ASSESSMENTS COMPLETED THIS MONTH:

• BASE INSPECTED:

• INSPECTION DATE:

  Date

Section 8.0 ACTION ITEMS

• Action Item 1?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 2?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 3?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 4?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 5?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 6?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 7?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 8?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 9?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

• Action Item 10?

  Yes

  No

  N/A

• Description:

• Assigned To:

• Date Due:

  Date

• Date Complete:

  Date

Section 9.0 MANAGEMENT SIGN-OFF

• Hub Manager Sign-off

• Manager Name (Please Print):

• Manager Signature:

  Sign

• Review Date:

  Date

• Vice President Sign-off (if applicable)

• VP Name (Please Print):

• VP Signature:

  Sign

• Review Date:

  Date