SHOP SAFETY O N/A
___SS-1Machine guarding not present / inadequate
___SS-2Missing or incomplete chemical product list
___CS-8MSDSs not readily accessible
___SS-4Local ventilation in need of evaluation
Lock Out Tag Out
___GS-12LOTO procedures not followed
___GS-13No LOTO kit
___SS-5No current hot work permit
___SS-6Stationary power equipment not secured in place
___SS-7Inaccessible / non-functioning emergency power cutoff switch
___SS-71Shop doors not kept closed
___SS-72Electrical service panels not enclosed
___SS-73Evidence of current oil leaks on machinery / equipment
___SS-74Machinery, equipment and / or power tools not clean / not dust-free / not oil-free / not grease-free / electrical cords not in good condition
___SS-99Other Shop Safety Finding:
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NOTES:
UNIVERSAL WASTEO N/A
___UW-71Universal waste not in appropriate containers / boxes
___UW-72Universal waste not properly labeled as "Universal Waste" / waste type / date
___UW-73Broken lamps mixed with universal waste
___UW-74Universal waste stored >1 year
___UW-799Other or Multiple Universal Waste Finding:
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NOTES:
KITCHEN SAFETYO N/A
Fire Suppression System
___KS-71Not tested / inspected / tagged
Cooking Oil / Grease
___KS-72Storage not in generally clean condition
___KS-73Evidence of leeks or spills
___KS-74Not stored to prevent leak from entering drain / waterway / ground
___KS-75Not stored in covered containers
___KS-799Other Kitchen SafetyFinding:
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OTHER FINDINGSO N/A
___OTH-99 Other
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NOTES:
LEVEL II INSPECTION –DSL- Date ______
DLC: ______Room(s):______
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Supv: ______
Rm: ______Tel: ______
EHS Rep: ______
Rm: ______Tel: ______
Space Registration
__Chemicals / __PermitConfSpace / __Noise__ Biologicals / __Cranes/LIfts / __PressureVessels
__Genl/Lab Safety / __Elev Platforms / __PwIndV
__FlamLiq +10 / __Elev.Platf. / __PwTools
__>55g Oil / __LOTOEquip / __#EyeWash
__GasCyl / __Ergo / __FireExtinguisher
__Toxic Gases / __ExposHighVolt / __DrenchShower
__SAA / __HeatStrss
__BloodbrnPath / __HotWrk
GENERAL SAFETY O N/A
___GS-1Space Registration and/or Green Card not accurate and/or missing
___GS-2Rooms not posted with warnings for room hazards
___GS-3EHS training out of date
___GS-71Appearance of area not neat / orderly / clean
___GS-5Evidence of spills not properly cleaned up
___GS-6Evidence of eating / drinking in area
___GS-7Compressed gas cylinders not secured / not labeled
Sharps
___GS-72Sharps not properly managed
___GS-73No container in primary janitorial supply closet / other strategic location
___GS-10Personnel not aware of / not following drain disposal guidelines
___GS-11Mechanical lifting equipment not restricted to trained employees / not under control of trained user / not securefrom unauthorized use
Lock Out Tag Out
___GS-12LOTO procedures not followed
___GS-13No LOTO kit available
___GS-14No sign posted in a known confined space
___GS-15No railings for platforms / scaffolds / work surfaces higher than 4 ft.
___GS-74Haz Comm summary sheet not posted
___GS-75Refuse disposal area not maintained / not sufficient / not clean / w/o covered containers
___GS-99Other General Safety Finding:
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EMERGENCY PREPAREDNESS
Postings
___EP-1Emergency response information not current / posted in all areas
___EP-71Evacuation maps not posted
___EP-72No(t) functional / illuminated exit signs
___EP-73Unclear or inaccessible evacuation route
___EP-74Fire door propped open
EyeWash Stations and Drench Showers
___EP-2Obstructed
___EP-3Not tested / inspected / tagged
___EP-4Insufficient for work area
Fire Extinguishers
___EP-5Tags missing / outdated
___EP-6Missing / discharged / inaccessible
___EP-75Not located within 25' of flammable storage
___EP-7Emergency strobe lights obstructed
___EP-8<18" clearance around sprinklers
___EP-9Appropriate biological/chemical spill kit not readily available
___EP-99______Other Emergency Preparedness Finding:
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BIOLOGICAL SAFETYO N/A
___BS-13Missing or out of date Exposure Control Plan
___BS-71No current Exposure Control Plan in the team room (s)
___BS-99Other Biological Safety Finding:
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CHEMICAL STORAGE & USEO N/A
___CS-2Improperly labeled chemical containers
___CS-71Chemicals not stored appropriately when not in use
___CS-72Flammable liquids not stored in flammable storage cabinet / room marked "FLAMMABLE"
___CS-7Chemical containers in poor condition
___CS-8MSDSs not readily accessible
___CS-99Other Chemical Storage & Use Finding:
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SATELLITE ACCUMULATION AREA O N/A
Waste Containers
___SAA-1Not firmly closed
___SAA-2Multiple of a single waste stream within 1 SAA
___SAA-3Inappropriate / in poor condition
Labeling
___SAA-4Tags or labels missing / incomplete / inaccurate / illegible
___SAA-5Dates on labels over 3 days old
___SAA-6SAA missing its label
___SAA-7Incompatible wastes not properly segregated___SAA-8Lack of appropriate secondary containment
___SAA-9SAA locations not appropriate
___SAA-10Hazardous waste kept outside a marked SAA
___SAA-11Non-waste kept in SAA
___SAA-12SAA(s) not inspected weekly
___SAA-98Multiple findings in single SAA (note details):
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___SAA-99Other SAA Finding:
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NOTES:
Personal Protective EquipmentO N/A
___PPE-1PPE for hazards not available / not stored
appropriately / not maintained in good condition
___PPE-71Personnel not wearing eye protection / gloves / other appropriate PPE
___PPE-3Respiratory protection not appropriate / maintained / stored properly
___PPE-4Respirators used without EHS evaluation / approval
___PPE-99Other PPE Finding:
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NOTES:
ELECTRICAL SAFETYO N/A
___ES-1Extension cords improperly used - daisy chained / substituted for permanent wiring
___ES-4Obstructed electrical panel
___ES-5Wet area without GFCI* circuit protection
___ES-6Exposed electrical wiring
___ES-7Portable electrical tools / equipment not grounded / double insulated
___ES-99Other Electrical Safety Finding:
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NOTES:
*GFCI - ground fault circuit interrupter