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Yes □ No □
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Is training provided for new hires and people newly assigned to a different job on a regular basis?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are there appointed First Aid (and CPR) trained employees, and are they available for medical emergencies?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are workers familiar with the hazards of chemicals and trade products? Are all employees up to date on the HazCom 2012 standards and the transition to Safety Data Sheets (SDS) from Material Safety Data Sheets (MSDS)?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are all workers trained on the emergency evacuation plan?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Has fire extinguisher training been provided?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
ABC-rated dry chemical extinguishers are appropriate in most areas. They should each have attached inspection tags that indicate they have been inspected within the last 12 months.
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Environment
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Yes □ No □
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Are wall, floor, and ceiling penetrations for cables, wires, pipes and mechanical systems (such as ductwork) sealed to prevent the spread of fire and smoke?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
Sealed wall penetrations prevent the spread of fire and smoke from one room to another. Penetrations can be sealed with drywall, fire-retardant pipe seal or fire stop pillows.
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Yes □ No □ N/A □
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Are flammable and combustible liquids stored in approved flammable storage cabinets?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
Quantities of flammable and combustible liquids in excess of the following quantities should be stored in approved flammables storage cabinets:
- 25 gallons of Class IA liquids (flashpoint below73 degrees F. and boiling point below 100 degrees F.)*
- 120 gallons of Class IB, IC, II or III (flashpoint below73 degrees F. and boiling point above 100 degrees F.)*
*Refer to the product’s material safety data sheet (MSDS) or safety data sheet (SDS) to determine its flammability/combustibility class.
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Yes □ No □ N/A □
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Are “No Smoking” signs posted in appropriate areas, and no smoking rules enforced?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □ N/A □
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Have the facility’s sprinkler and/or fire alarm systems been inspected in the past 12 months? Is the fire suppression system tagged to verify this inspection?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □ N/A □
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Do sprinkler heads have at least 18 inches of vertical clearance from material stored below?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □ N/A □
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Are resources available to deal with very hot or very cold conditions (drinking water, appropriate personal protective equipment such as lined gloves or insulated boots)?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
Additional inspection requirements may apply according to local regulations.
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Hazard Communication and Substances
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Yes □ No □
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Does the facility have a written hazard communication program, including a complete chemical list and file of safety data sheets (SDSs) for chemicals used and stored in the facility? Are these SDSs accessible to all employees, visitors, and contractors for review upon request? Does the written program describe how the employer will meet the requirements of OSHA’s Hazard Communication Standard?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
SDSs should be on file for solvents, fuels, batteries, cleaners, lubricants, and other potentially hazardous materials.
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Personal Protection Equipment (PPE)
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Yes □ No □
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Is required equipment provided, maintained, and used?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Does equipment meet requirements and is it reliable?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Is personal protection utilized only when it is not reasonably practicable to eliminate or control the hazardous substance or process?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are areas that require PPE properly identified with signs?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Is hearing protection available and used properly?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Emergency Exit Procedures
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Yes □ No □
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Is there a clear fire response plan posted in each work area? Are all workers aware of the plan?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are emergency exit drills held regularly?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are there an adequate number of fire extinguishers present, and are they clearly marked and located in conspicuously marked locations?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are all fire extinguishers fully charged and operable?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are all exits clearly marked and unblocked for egress?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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Yes □ No □
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Are exits and exit routes equipped with emergency lighting or marked to illuminate in the dark?
Condition: ________________________________________________
Person responsible: ________________________ Due date: _____________
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