D-1

Appendix D Checklists D

APPENDIX D 

Checklists

This appendix contains the following checklists

 Appendix D.1 DLA Energy Environmental Checklist – A tool for evaluating general compliance with the federal 

U.S. Environmental Protection Agency (EPA) regulations, including some U.S. Department of Transpor

(DOT) hazardous material and cross-country pipeline question

 Appendix D.2 Environmental Management System Checklist – A tool for verifying conformance to the 

International Organization for Standardization 14001 (ISO 14

 Appendix D.3 DLA Energy Safety Checklist – A tool for evaluating general compliance with the federal 

Occupational Safety and Health Administration (OSHA) regulat
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Appendix D.1

DLA Energy Environmental Checklist
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Appendix D Checklists D

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

DLA Energy Environmental Checklist

 General Facility Information

Interviewer: Date:

Facility Name:

Site Location: County

Physical Address: Mailing Address

U.S. EPA Region: USCG Distr

U.S. EPA Identification Number: State Identification

 Facility Contact

Name: Titl

Phone: Emai

Cellular/Pager

 Facility Description

Check all those that apply:

 Aboveground storage tanks (ASTs)  Aircraft fueling  Site remediat

 Underground storage tanks (USTs)  Aboveground piping  Septic tank or drain fi

 Truck/tanker loading and

unloading

 Underground piping  Surface water impoundments o

ponds

 Rail loading and unloading  Off-site or cross-country 

piping

 Potable water wel

 Marine terminal  Oil/water separator(s)  Municipal water supply

 Vehicle fueling or defueling  Laboratory  Underground injection control (UI

well

COMME
D-6 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

DLA Energy Environmental Checklist

 Facility Description

Contractor Name: Full-time Equivale

Actual Property Owner: Total Facility Size (acreage

Facility Operating Hours Mon.-Fri.: Sat.: Sun

Has the facility recently modified or constructed new equipment? What improvements or changes to the facility are planned

What are the facility’s Standard Industrial Classification (SIC) co

What are the facility’s North American Industry Classification System (NAICS) 

Are there potential jurisdictional wetlands on or near the facility?

Yes



No



N/A



Are there known threatened or endangered species and/or habitats on or near the 

facility? Are there known cultural or historic resources on or near the facility?   

General Recordkeeping

Are environmental records kept in a central file?   

If yes, where?

Is access to environmental records adequately controlled? Are environmental records

maintained in an orderly fashion?   

If yes, where

Are employee environmental training records kept in a central file?   

If yes, where

Does the facility staff have access to applicable federal, state, and local regulations?   

COMME
Appendix D Checklists D

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Environmental Plans and Permits

 Management Plans

Does the facility have any of the following plans: Date Last

Revised Yes No N/A

61 FR 31103, 6/19/96 Integrated Contingency Plan?  

40 CFR 112.3 and 112.7 Spill Prevention, Control, and Countermeasure

(SPCC) Plan?  

40 CFR 112.20 Facility Response Plan?   

33 CFR 154, Subpart F Marine Terminal Response Plan?  

49 CFR 194 Onshore Pipeline Response Plan?  

49 CFR 195 Off-site Pipeline Facility Procedural Manual for Operations

Maintenance, and Emergencies?   

30 CFR 254 Offshore Facility Spill Response Plan?  

49 CFR 130 Highway and Railway Oil Transportation Response Plan?  

49 CFR 172 SubpartI Hazardous Materials Security Plans for Shippers?

40 CFR 262, Subpart M Hazardous Waste Contingency Plan f

Large Quantity Generators (LQGs)?  

40 CFR 122.26 and

MSGP Sectos S 

Stormwater Pollution Prevention Plan

(also known as a Soil Erosion and Sediment Control Plan)? 

40 CFR 68 Subpart G Risk Management Plan for Regulated Chemicals?  

E.O. 13834  and 13514 Pollution Prevention Plan?  

E.O. 13834 1 Environmental Management System (EMS) Ma

and Procedures?   

E.O. 13834  and 13514 High Performance and Sustainable Building Plan? 

E.O. 13834 1 Green Procurement Program?  

E.O. 13834 1 Electronics Stewardship Plan? 

E.O. 13834 1 Waste Reduction Plan, Procedure, or Practice(

(Note: May be Combined with Pollution Prevention Plan) 

E.O. 13834  and 13514 Energy Conservation Plan, Procedure, or Practice

(Specify)   

E.O. 13834 1 Sustainability Performance Plan, Procedure, or Practi

(Specify)   

E.O. 13834 1 Greenhouse Gas Management Plan, Procedure, or Practice

(Specify)   

E.O. 13834 1 Electronics Products Efficiency and Services Plan, Procedu

Practice(s)? Note: May be Included with Electronics Stewardship

(Specify

  

E.O. 13834 1 Water Efficiency Plan, Procedure, or Practice(s)? 

1 E.O. 13423 and E.O. 13514 were previously revoked; the replacement Order is E.O. 13834 Efficient Federal Operations, signed May 17, 2
D-8 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Environmental Plans and Permits (cont.)

 Management Plans

Does the facility have any of the following plans: Date Last

Revised Yes No N/A

E.O. 138341 Sustainable Regional and Local Integrated Plan

Procedures, or Practice(s)?  

E.O. 138341 Other Waste Reduction Plan, Procedure, or Practice

 (Note: May be Combined with Pollution Prevention)  

1 E.O. 13423 and E.O. 13514 were previously revoked; the replacement Order is E.O. 13834 Efficient Federal Operations, signed May 17, 2

Environmental Permits

Does the facility have any of the following environmental permits?

Environmental Permit

Air Emission Construction Perm

Permit No. Date Issued Date Expires

Air Emission Operating Perm

Wastewater Discharge (NP

Stormwater Permit (

Stormwater Permit for Construction Activiti

Sewer Discharge Perm

UST Operating Permit/Registrat

AST Operating Permit/Registrat

Hazardous Waste Treatment Storage or Dispos

Facility (Part B

Other

Other

Other

COMME
Appendix D Checklists D

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Aboveground Storage Tanks

Tank Description

Are there any ASTs on-site? If yes, complete the following:

Tank Name, Number, or

Location Tank Material Capacity

(gallons) Date Installed Material Stored

Vapor Pressure 

of Material 

Stored (psia)

40 CFR 63.420(a)(1) How many ASTs have fixed roofs without internal floating roo

Which tanks?

How many ASTs have fixed roofs with internal floating roo

Which tanks?

How many ASTs have external floating roofs with primary sea

Which tanks?

How many ASTs have external floating roofs with primary a

secondary seals?

Which tanks?

40 CFR 112.8(c)(8) For spill prevention, are there level gauging systems and alarms, such as:

Yes No N/A

High−level alarms?   

High-liquid pump cutoff devices?   

Communication system between the tank gauge and pump station?   

Liquid level meters, such as digital computers, telepulse system, or visual gauges?   

Liquid level sensing devices? (These should be regularly tested for prop

operation.)

  

Other devices that provide equivalent protection (such as relief valves and

overflow lines)?

  

40 CFR 112.7(g) Are oil handling, processing, and storage areas secure and are starter controls on oil 

pumps?

  

40 CFR 112.7(g) Are tank flow valves and drain valves (such as water draw-off, sampling, and sparge 

valves) locked or secured when not operational?

  

40 CFR 112.7(g) Is security lighting adequate to prevent vandalism and to discover oil leaks?   

29 CFR 1910.1200(f) Are ASTs that contain hazardous materials labeled with the chemical name an

hazard warning?

  

40 CFR 112.7(a)(3) Are site drawings or facility diagrams showing fixed oil storage containers, mobile or 

portable containers, tank locations, exempt USTs, transfer stations, and connectin

pipes current?

  

Yes No N/A

  
D-10 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Aboveground Storage Tanks (cont.)

Tank Containment

What secondary containment systems are in place:

Yes No N/A

40 CFR 112.7(c) and 112.8(c)(2) Earthen berm

Lined earthen berm? Specify liner materia

  

  

Concrete retaining walls?   

Other (e.g., double-walled or double-bottom tanks)   

40 CFR 112.8(b) Are there valves in the containment system for drainage?   

Valve type? 

Were all drainage valves in the containment system observed to be closed?   

40 CFR 112.8(c)(3) and (10) Was liquid observed in any containment system?   

Tank Maintenance

40 CFR 112.8(c)(6) When was the last tank integrity test or inspection?

Was a standard industry inspection method used (e.g. SP001, API−65

If yes, state metho

  

What integrity test method was used:

Visual inspection?   

Hydrostatic testing?   

Radiographic testing?   

Ultrasonic testing?   

Acoustic emissions testing?   

Nondestructive shell thickness?   

Other

40 CFR 112.8(c)(10) Was rust observed on any of the tank shells?   

Were leaking seams, gaskets, rivets, or bolts observed?   

How often are tank bottom wastes removed

How are tank bottom wastes disposed

When were the tanks last emptied and cleaned?

Have any ASTs been repaired? If yes, describe repairs (changes, dates, 

contractors):

  

Was the tank integrity-tested after the repair?   
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Aboveground Storage Tanks (cont.)

AST Recordkeeping

Are the following AST records availabl

Yes No N/A

440 CFR 112.7(e) Visual tank inspection records (addressing tank supports, foundations, flow 

valves, pumps, flange tanks, expansion joints, etc.)?

  

40 CFR 112.8(c)(6) Tank integrity test results (e.g., hydrostatic test, shell thickness tests)?   

40 CFR 112.8(c)(3) Containment system drainage or pumping records (date, time personnel)?   

AST service, repair, maintenance, and cleaning records?  

COMMEN
D-12 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Underground Storage Tanks

Tank Description

Are there any USTs on-site? If yes, complete the followi

Tank Name, Number, or

Location Tank Material Capacity

(gallons) Date Installed Material Stored

Vapor Pressure 

of Material 

Stored (psia)

 Leak Protection Detection

Yes No N/A

40 CFR 280.42(b) Are USTs double-walled tanks?  

40 CFR 280.43 What leak detection methods are used:

40 CFR 280.43(d) Automatic tank gauging system?   

40 CFR 280.43(e) Vapor monitoring?   

40 CFR 280.43(f) Groundwater monitoring via well sampling?   

40 CFR 280.43(g) Interstitial monitoring?   

40 CFR 280.43(a−c) Inventory control, manual gauging, and tightness testing?   

Other 

40 CFR 280.20(a) Type of cathodic protection for steel tanks

Dielectric coating?   

Impressed current system?   

Sacrificial or galvanic anodes?   

Other 

40 CFR 280.30(a) Do spill catchment basins have liquids in them?   

40 CFR 280.20(c) Is overfill prevention equipment (e.g., automatic shutoffs, alarms) operating

properly?

  

COMMEN

Yes No N/A

  
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Underground Storage Tanks (cont.)

 UST Maintenance

Yes No N/A

When were the tanks last emptied and cleaned? 

40 CFR 280.33 Have any USTs been repaired? If yes: 

Describe repairs:

40 CFR 280.33(d) Was the tank tightness-tested after the repair?   

Do you see any staining of the soil or ground surrounding the tank area?   

40 CFR 280

Subpart

Have any USTs been found to be leaking? If 

Describe actions taken:

  

UST Recordkeeping

Are the following UST records availabl

40 CFR 280.22 UST registration or notification forms submitted to the appropriate state agencies?  

40 CFR 280.31 Cathodic protection system inspection reports?   

40 CFR 280.45 Leak detection system monitoring results?   

40 CFR 280.45(b), 

280.43(c), 280.33(d)

Tank tightness test results?   

40 CFR 280.33(f) UST system repair or upgrade records?  

40 CFR 280.74 UST closure or change of service notification?  

40 CFR 280.53 Spill or overflow reports?   

40 CFR 280.63, 

280.66

UST site assessment and corrective action reports?  

COMMEN
D-14 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Piping

 Buried On-site Pipelines

Yes No N/A

40 CFR 280.20(b) and 

112.8(d) Are there buried pipelines? If yes:   

Do buried steel pipelines have cathodic protection?   

40 CFR 280.41(b) Are buried pipelines pressurized or suction piping?   

40 CFR 280.42(d) Do buried pipelines have secondary containment (double-walled or trench

liners)?

  

40 CFR 280.31(a−c) Has the cathodic protection for buried steel pipelines been tested? If ye

When? 

  

40 CFR 280.45 Are there records of buried pipeline automatic leak detection monitoring or 

integrity testing?

  

40 CFR 280.31(d) Are there records of buried steel pipeline cathodic protection inspections?   

40 CFR 112.8(d)(4) Are there records of integrity and leak testing at the time of buried

pipeline installation, modification, relocation, or replacement?

  

 Aboveground On-site Pipelines

Are there aboveground pipelines? If yes:   

Have any pipelines been repaired? If ye

When? 

  

Are there expansion relief valves that bleed over-pressurized product back to 

the tank?

  

Are there emergency shutoff valves or impact valves in the pipeline

(sometimes at the tank or product dispenser)?

  

29 CFR 1910.106(c)(3) Are flammable and combustible liquid pipe joints vapor- and liquid-tight?   

Are there line leak detectors or alarms that indicate leaks in the lines?   

Are there other leak detection methods employed (tightness testing, soil

vapor monitoring, groundwater monitoring, interstitial monitoring, etc.)

  

40 CFR 112.8(d)(4) Are aboveground pipelines (and pipe supports, connecting joints, valves,

gauges, pumps, appurtenances, and catch basins) inspected regularly?

  

Are there any out-of-service pipelines? If yes,   

40 CFR 112.8(d)(2) Are lines out-of-service for extended periods capped or blind-flanged?   

40 CFR 112.7(e) Are there records of aboveground pipeline inspections (including pipe

supports, connecting joints, valves, gauges, pumps, and catch basins)?

  

COMMEN
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Piping (cont.)

 Off-site or Cross-country Pipelines

Yes No N/A

49 CFR 195.410 Do off-site or cross-country pipelines have line markers or signs?   

49 CFR 195.302 Have off-site pipelines been pressure-tested? If ye

When? 

  

49 CFR 195.452(j) Have pipelines in high consequence areas been integrity-tested in the past 5 years?   

Do off-site pipelines have breakout tanks or pump stations? If yes:   

Are breakout tanks and pump stations provided with:

49 CFR 195.430 Firefighting equipment?   

49 CFR 195.428 Overfill protection system?   

49 CFR 195.434 Signs with the operator and emergency contact phone numbers?   

49 CFR 195.438 No smoking signs?   

49 CFR 195.436 Security to protect from vandalism and unauthorized entry?   

 Off-site or Cross-country Pipeline Recordkeeping

49 CFR 195.404 Are maps of the pipeline system current?   

49 CFR 195.402 Is there a manual of written procedures for conducting normal operations and maintenance activities (e.g., pressure test results) and for handling emergencies

  

49 CFR 195.452 Is there a written integrity management program for pipelines in highly populated

areas, ecologically sensitive areas, and near navigable waterways?

  

49 CFR 195.440 Is there a written continuing public education program consistent with 

Standard 1162

  

49 CFR 195.442 Is there a written damage prevention program addressing dangers of excavation

near the pipeline?

  

49 CFR 195.446(a) Is there a control room that monitors and controls all or part of a pipeline facility

through a SCADA system? If ye

  

49 CFR 195.446 (b)−(j) Are there written control room management procedures?   

49 CFR 195.505 Is there a written operator qualification program?   

49 CFR 195.403 Are employees given emergency response training annually?   

49 CFR 195.412(a) Are off-site or cross-country pipelines inspected at least every 2 weeks?   

49 CFR 195.412(b) Are lines under navigable waters inspected every 5 years?   

49 CFR 195.420(b) Are pipeline valves inspected and maintained every 6 months?   

49 CFR 195.432(a) Are breakout tanks inspected annually?

49 CFR 195.55 Were safety-related condition reports submitted for corrosion damage, material 

defects, pipeline movement (e.g., from earthquakes or floods), or malfunctions?

  

49 CFR 195.310 Are pipeline pressure test results available?   

49 CFR 195.49 Was the annual report submitted to PHMSA by June 15?  
D-16 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Fuel Dispensing

 Fuel Loading and Unloading Areas

Yes No N/A

Do loading areas have roofs?   

40 CFR 112.7(h) Do loading areas have curbing or a containment system?   

Do loading areas have floor drains? If yes

Where do floor drains discharge? 

  

40 CFR 112.8(d)(5) Are vehicles warned (verbally or visually) to avoid endangering piping and 

transfer operations?

  

40 CFR 112.7(g) Are out-of-service and loading/unloading connections of oil pipelines secured?   

40 CFR 112.7(g) Are starter control pumps in an area restricted to authorized personnel?   

40 CFR 112.7(h)(3) Prior to truck or rail car filling and departure, are drains, outlets, and

overfill protection (Scully system) inspected and secure

  

40 CFR 112.7(h)(2) Are there means of preventing a vehicle from leaving before completely

disconnecting from fuel transfer lines (warning lights, signs, physical 

barriers, etc.)?

  

Are emergency shutoffs accessible and well marked?   

40 CFR 112.8(d)(2) Are loading and unloading pipeline connections securely capped or 

blind-flanged when taken out of service?

  

29 CFR 1910.106(f)(7) Are there means of preventing flammable and combustible liquids spilled 

at loading and unloading points from entering sewers and drainage 

systems?

  

29 CFR 1910.106(f)(6) Are “No Smoking” signs posted and ignition sources prohibite

where flammable liquids are handled, drawn, or dispensed?

  

29 CFR 1910.106(f)(5) Are electrical installations explosion proof?   

29 CFR 1910.106(f)(3)(iv) Are grounding and bonding cables for flammable liquids in good condition?   

29 CFR 1910.106(e)(9)(iv) Is the area near flammable and combustible liquid operations kept free

of weeds, trash, and combustible materials?

  

 Marine Terminal or Pier Facilities

33 CFR 154.300(b) Does the marine terminal have a current operations manual?   

29 CFR 1910.106(f)(4) Do pier loading pumps carrying flammable and combustible liquids 

have means to protect against excessive pressure (e.g., bypasses, relief 

valves)?

  

33 CFR 154.740 and29 CFR 

1910.106(f)(4) Are pier pressure hoses and couplings inspected regularly?   

33 CFR 154.735 and29 

CFR 1910.106(f)(4)

Are fire extinguisher locations marked and located within 75 feet of 

hose connections, pumps, and separator tanks at the pier?

  

33 CFR 154.545 Does the terminal have enough containment equipment available to 

capture any petroleum discharges onto the water?

  

33 CFR 154.735 and 29 CFR 

1910.106(f)(6)

Are “No Smoking” signs posted and ignition sources prohibited where flammable and combustible liquids are handled, drawn, or dispense

  
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Air Emissions

Tanks

Yes No N/A

40 CFR 60.7(a)(1) Was their written notification to EPA or the state agency for construction, reconstruction, or modification of petroleum storage tanks or terminal

  

Are there emission control devices associated with the facility’s operations?

If yes, what kind

  

40 CFR 60.113a(a) &

60.113b(b)

For external floating-roof tanks, are primary seals inspected every 5 years and secondary seal seals inspected annually? Are gap measurements recorded and maintained 

on-site for 2 years (5 years for Title V facilities)? (Does not apply to tanks constructed

prior to 1978)

  

40 CFR

60.113b(b)(6)

For external floating-roof tanks, are seals and fittings inspected each time the tank is 

emptied and degassed, and is the agency notified prior to filling (for tanks constructed 

or modified after 1984 only)?

  

40 CFR 60.113b(a) For internal floating-roof tanks, are visual inspections of the primary and secondary rim 

seals conducted annually and recorded (for tanks constructed or modified after 1984 

only)?

  

40 CFR

60.113b(a)(5)

For internal floating-roof tanks, is there written agency notification prior to filling or 

refilling the tanks after visual inspection of the primary and secondary seals (for tanks 

constructed or modified after 1984 only)?

  

 Distribution

40 CFR 60 SubpartXX Is the facility a gasoline distribution terminal with throughput of 20,000 gallons

more? If yes

  

40 CFR 63 Subpart R Does the facility receive gasoline by pipeline, ship, or barge?   

40 CFR 60.505(c) Are there records of monthly leak inspections for the loading rack and vapor collection 

system?

  

40 CFR 60.505(a) Does the facility maintain cargo tank vapor-tightness documentation for tanker trucks 

filled?

  

40 CFR 63 Subpart

Does your facility distribute organic liquids other than petroleum?   

40 CFR 63.2334 Are you located at or part of an installation considered a major source of hazardous air 

pollutant emissions? If yes

  

40 CFR 63.6(e)(3) Do you have a written startup, shutdown, and malfunction plan?   

COMMEN
D-18 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Air Emissions (cont.)

Equipment (Generators and Refrigerants)

Yes No N/A

40 CFR 63 Subpart ZZZZ Are there any stationary engines on-site? If yes, complete the following:  

Engine Name,

Number, or

Location

Compression Ignition or 

Spark Ignition (if spark

ignition-specify 2- stroke or 

4-stroke)

Date

Manufactured Date Installed Rated Capacity(hp)

Used for

Emergency

Purposes Only?

40 CFR 60 Subparts

& JJJJ Do you have documentation showing the engines meet the emissions standards or 

were certified by the manufacturer (Certificate of Conformity)?

Yes



No



N/A



40 CFR 60 Subparts

IIII & JJJJ; 40 CFR 

Subpart ZZZ

Do emergency engines have a non-resettable hour meter installed?   

40 CFR 60 Subparts

IIII & JJJJ; 40 CFR

Subpart ZZZZ 40 CFR

82 Appendix F

For emergency engines, are there records of the operating hours and reason for 

operating?

  

Does the facility use any equipment that contains ozone-depleting substances (ODS)

(i.e., refrigerants)? If yes

  

40 CFR 82, SubpartE Are there appropriate warning labels?  

40 CFR 82, Subpart F Have leaks been fixed within 30 days?  

40 CFR 82.161 Are maintenance and repairs performed by a certified technician?   

40 CFR 82.166 Are service records available for the past 3 years?   

Air Permits, Recordkeeping, Misc.

40 CFR 63 Subpart

ZZZZ

Are there any stationary engines on-site? If yes, complete the following:   

Is the facility a major source? (i.e., does the facility have a Title V Operati

Permit?

  

Have there been any changes in emission levels or operating practices since the air

permit was received?   

Is the facility located in a nonattainment area?   

Has the facility received any nuisance (odor, smoke, noise) complaints from

neighbors?   

40 CFR 60 Subpart A

and 40 CFR 63 Subpart

A

Was an annual Air Emission Inventory Report and/or fees submitted to the stat

agency (Title V facilities only)?   

Were any notifications provided to the EPA for applicability, testing, etc., as require

by applicable SPS and/or NESHAP regulations that the facili

Are all required records being maintained on-site for 2 years (or 5 years if your facility 

has a Title V operating permit)? (This includes copies of any notifications submitted

tanker truck vapor-tightness documentation and documentation of monthly leak 

inspections if subject to Subpart XX, seal inspections for Subparts Ka and Kb

plans, measured values and testing performed for the vapor control system if subject 

to Kb, etc.

  
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Hazardous Waste Management

Hazardous Waste Recordkeeping

Yes No N/A

What type of hazardous waste generator is the facility?1

40 CFR 262.13 Large quantity generator (LQG)  

40 CFR 262.13 Small quantity generator (SQG)  

40 CFR 261.13 Very small quantity generator Small Quantity Generator (VSQG)  

40 CFR 262.18 Does the facility have an EPA identification number?  

40 CFR 262.18 Is there a copy of EPA form 8700−12 “Notification of Regulated Waste Activity” in 

files? If yes

  

Is the information provided current such as the facility contact person named, the

waste codes identified, and the generator status (LQG, SQG, or VSQG

  

40 CFR 262.42 Did you receive a signed copy of each manifest within 35 days of shipment from a 

receiving TSD or recycling facility? If no, was a phone call documented to determi

shipment status, and was an exception report filed as appropriate?

  

40 CFR 262 Subpart

B

Are copies of each manifest signed by the facility, transporter, and receiving TSD o

recycling facility kept for 3 years?

  

40 CFR 268.7(a)(2) Did the facility send a land disposal notification or certification form for each particular waste type with the initial shipment to the receiving TSD or recycling facilit

  

40 CFR 262.41 If the facility is a large quantity generator,1 was the annual or biennial hazardous

waste report submitted to the agency by March 1st (or per state regulations)? If yes

  

Is a copy maintained in the files?   

 Satellite Accumulation Drums

40 CFR 262.15 Is there a satellite accumulation drum for collecting hazardous waste? If yes:  

40 CFR 262.15 Is the drum located where it is observed and monitored by the generator o

operator?

  

40 CFR 262.15 Is the drum marked with the words “Hazardous Waste” and an indication of th

hazards of the contents? 

  

40 CFR 262.15 Is the drum kept closed except when adding or removing waste?   

40 CFR 262 Subpart

M or 262.16(b)(9)

Is emergency information (e.g., name and no. for the fire department and the qualified individual (QI) posted near the phone closest to the hazardous waste dru

  

40 CFR 262 Subpart

M or 262.16(b)(9)

Is emergency equipment available near the hazardous waste drum (e.g., fire extinguishers, spill control supplies, absorbents, safety data sheets [SDSs

  

1Contact your state agency for the specific definition of generator status. In general, an LQG produces 2,200 lbs of hazardous waste per month. A

SQG produces 220 to 2,220 lbs per month, and a VSQG produces less than 220 pounds permont

COMMEN
D-20 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Hazardous Waste Management (cont.)

 Hazardous Waste Central Accumulation Area for SQG and LQGs (Indoor and Outdoor)

Yes No N/A

40 CFR 265 Subpart B Is the hazardous waste storage area clearly identified (e.g., sign)?  

40 CFR 262.16 or 

262.17 Are hazardous waste containers closed?   

40 CFR 265.193 Does the hazardous waste storage area have secondary containment?   

40 CFR 262.16 and 

262.17

Is there sufficient aisle space in the hazardous waste storage area to allow unobstructed movement of personnel and equipment and can you also see the drum

labels?

  

40 CFR 262.16, or 

262.17

Are hazardous waste containers labeled with either 1) the date accumulation 

began or 2) the date when the satellite accumulation area drum became full before 

it was moved to the central accumulation area?

  

40 CFR 2625.16 or 

262.17 Are hazardous waste containers and the accumulation area inspected weekly?   

40 CFR 262.17 Are containers holding ignitable or reactive hazardous waste stored at least 50 feet 

from the property line?

  

40 CFR 262.16 or 262 

Subpart 

Is the hazardous waste storage area equipped with

Internal communications system or alarm system?   

Telephone or two-way radio?   

Portable fire extinguishers or fire control equipment?   

Spill control equipment?   

Decontamination equipment?   

Water of adequate volume for hoses, sprinklers, or water spray systems?   

40 CFR 262.16 or 262 

Subpart 

Is emergency equipment routinely tested to ensure proper operation?   

40 CFR 262.16 or 

Subpart 

Has the facility made arrangements to familiarize local authorities with the characteristics of the facility

  

40 CFR 262.16 or 262 

Subpart 

Are there agreements in place with emergency response contractors and equipment suppliers?

  

40 CFR 262.16 or 262 

Subpart 

Is there one employee on the premises or on call with the responsibility of coordinating hazardous waste emergency response measures? If yes: List name a

contact number of the emergency coordinator:

  

58 FR 31114, 5/28/93 Has the facility implemented a hazardous waste minimization program?   

COMMEN
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Hazardous Waste Management (cont.)

 Hazardous Waste Management Training

Yes No N/A

40 CFR 262.17(a)

(7)

Is the facility a large quantity generator of hazardous waste (>2,200 lbs/mo.)? If yes:  

Is there a written hazardous waste training program addressing

Emergency response procedures?   

Emergency equipment inspection, monitoring, and repair?   

Responses to fires or explosions?   

Shutdown operations and alarm systems?   

Do training records include employee name, job title, and job description related to 

hazardous waste management?

  

40 CFR 262.17(a)

(7)

Is hazardous waste management awareness training conducted annually?   

40 CFR 262.16(b)

(9)(iii)

Is the facility a small quantity generator of hazardous waste (220 to 2200 lbs/mo.)? If yes:  

Is an awareness training conducted so all employees are familiar with proper waste

handling and emergency procedures relevant to hazardous waste?

  

49 CFR 172.704 Have personnel signing hazardous waste manifests been trained (every 3 years) in D

packaging, labeling, marking, placarding, and shipping paper requirements?

  

COMMEN
D-22 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Non-hazardous Waste Management

Specific Waste1

Yes No N/A

Does the facility generate or handle the following waste:

40 CFR 279.22 Oil or grease? If yes:   

Are waste oil containers labeled “Used Oil”?   

Are used oil containers stored inside?   

Are used oil containers stored outside? If yes:   

Is there secondary containment around the container

(required if the facility has an SPCC plan)  

Is used oil recycled?   

40 CFR 266 and/or 273 Batteries – lead-acid, nickel-cadmium, lithium, silver button, etc.? (Does not include 

alkaline batteries.)   

40 CFR 273 Light bulbs or tubes (fluorescent, high-intensity discharge, neon, mercur

vapor, high-pressure sodium, and metal halide)?   

40 CFR 273 Mercury-containing equipment (thermostats, barometers, gauges, and

switches)?   

40 CFR 82 Ozone-depleting substances (chlorofluorocarbons, halons, certain

refrigerants, solvents, and foams)?   

40 CFR 261.39−.41 Cathode ray tubes (CRT) (computer monitors, televisions)?   

40 CFR 273 Does the facility contract pesticide applications?   

40 CFR 273 Subpart

B&C

Has the facility set up a waste management program for universal wastes, suc

as light bulbs, batteries, mercury-containing equipment, and pesticides?   

40 CFR 273.16 Are all employees informed of proper handling and emergency procedures for

universal waste?   

40 CFR 61 Subpart M Are there known asbestos-containing materials at the facility?   

40 CFR 761.50, 761.60

and 761.62

Is there any electrical equipment present at the facility (e.g., transformers

capacitors, light ballasts, etc.) that was manufactured prior to 1978 and may 

contain PCBs?If yes:  

1The following materials are classified as Universal Wastes within certain states, and will have specific regulatory requirements in addition to those

identified above: aerosol cans (CA, CO, WA); antifreeze (LA, NH); ballasts (ME, MD, VT); barometers (NH, RI); electronics (AR, CA, CO, CT;

and NJ); oil−based finishes (NJ); CRTs (ME, NH, and RI); paint and paint-related waste (TX), and pharmaceuticals (MI and FL). This list is not comprehensive. Check each state for specific regulatory requirements and up-to-date 
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Non-hazardous Waste Management (cont.)

 Solid Waste

Yes No N/A

Are the surroundings near the solid waste containers and dumpsters free from debris?   

Does the facility have a scrap yard or a bone yard?   

Does the facility generate:

Laboratory waste?   

Salvage material?   

Demolition material?   

Old drums?   

Yard waste?   

Spill waste (e.g., absorbents, mats/pads, booms, sorbents, soil, sediment, etc.)?   

Other:

E.O. 138341 Does the facility have a recycling program? If yes:  

Describe:

E.O. 138341 Does the facility have a waste diversion program? If yes:  

Describe:

E.O. 138341 Does the facility minimize waste through a source reduction program? If yes:  

Describe:

1 E.O. 13423 and E.O. 13514 were previously revoked; the replacement Order is E.O. 13834 Efficient Federal Operations, signed May 17, 2

COMMEN
D-24 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Stormwater Management

General Information

Yes No N/A

Identify the nearest surface water by name (including distance and direction):

Is the facility in a 100-year floodplain?   

40 CFR 122.26(b)

(14)

Is precipitation runoff directed away from active portions?   

Is runoff originating from active portions collected?   

Are there any stormwater retention ponds on-site?   

Does runoff from neighboring facilities impact this facility?   

40 CFR 122.26(b)

(14)

Does the facility have vehicle and equipment maintenance shops (e.g., vehicle and 

equipment rehabilitation, mechanical repairs, painting, fueling, lubrication, and equipment cleaning)?

  

40 CFR 122.26(b)

(14) and MSG

Is the facility a petroleum bulk station or terminal (SIC 5171)? If yes: 

Did the facility submit a Notice of Intent (NOI) to obtain a Multi-Sector 

General Permit for stormwater discharges

40 CFR 122.26(b)

(14)

Does the facility have an individual NPDES permit for stormwater discharges? 

40 CFR 122.21 Does the facility have an individual NPDES permit for wastewater discharges? If yes: 

Does it also include requirements for stormwater discharges?   

1MSGP means Multi-sector General Permit. The EPA MSGP addresses land transportation facilities in Sector P, such as fuel terminals (SIC

SectorS is for air transportation (SIC 4512−45

Stormwater Pollution Prevention Plan (SWPPP)

Yes No N/A

40 CFR 122.26 

and MSGP Did the facility develop and implement a SWPPP?

Are employees familiar with best management practices (BMPs) for stormwater controls

identified in the SW

  

Are BMPs in good order and functioning properly?   

Are quarterly visual examinations of stormwater outfalls associated with industrial activity 

performed within 30 minutes of rain events?

  

Have any visual observations of contamination (iridescent sheen or rainbow colors) been

observed at stormwater outfalls?

  

MSGP Sectr S Is the facility an air transportation facility (e.g., maintenance shops, equipment-clea

operations, and aircraft or runway deicing and anti-icing operations)? If yes

  

Does the facility use more than 100,000 gallons per year of glycol-based deicing 

agents?

  

40 CFR 122.26(b)

(14)

Is precipitation runoff directed away from active portions?   

Does the facility use more than 100 tons per year of urea? If yes (to either question):   

Have samples of stormwater runoff been collected and analyzed?   
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Stormwater Management (cont.)

Stormwater Training

MSGP Sector S&P Are employees trained or briefed annually on the SWPPP and BMPs? If

the briefing instruct personnel:

Yes No N/A

In good housekeeping and material management practices?   

About the SWPPP requirements? 

About spill prevention, response, and control?   

Stormwater Recordkeeping

40 CFR 122.26(b)(14)(viii) Is the facility identified by any of the following SIC codes: 40, 41, 42, 45, or 5171?

yes to any of the SIC codes abov

  

MSGP Sector S&P Are visual examinations of stormwater outfalls within first 30 minutes of rai

snow event documented (in the SWPPP) on a quarterly ba

  

MSGP Sector S&P Are there annual reports (usually filed in the SWPP

Are analyses of stormwater samples and discharge monitoring reports (DMRs) 

required in the stormwater permit and retained?

  

Construction Site Runoff

40 CFR 126.26(b)(15) Does the facility have any planned or actual construction projects affecting 1 acre 

or greater? If yes

  

Does the facility have authorization to discharge under a General Permit for

Stormwater Discharges from Construction Activities

  

Was an SWPPP prepared? 

40 CFR 450.21(a) Are effective erosion and sediment controls installed, implemented, and 

maintained to minimize the discharge of pollutants?

  

40 CFR 450.21(b) Has any disturbed construction area that has temporarily ceased activity,

exceeding 14 days, been temporarily stabilized?

  

Have disturbed areas that have permanently ceased on any portion of the site

been permanently stabilized?

  

40 CFR 450.21(c) Are discharges from dewatering activities, including dewatering of trenches 

and excavations, being performed with adequate controls?

  

Are pollution prevention measures or BMPs installed, implemented, and maintained to prevent or minimize pollutant discharges (depending on the source)

  

COMMEN
D-26 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Wastewater Management

Wastewater Discharge

Yes No N/A

Does the facility discharge wastewater to surface water (streams, rivers, ponds)?   

40 CFR 122.21 Does the facility have an NPDES Permit for this discharge? 

Does the facility have an oil/water separator?   

Is the oil pumped out of the oil/water separator? If yes:  

How frequently

Describe:

Where does the wastewater in the oil/water separator discharge (storm sewer, sanitary 

sewer, other)?

How is the oil from the oil/water separator managed

E.O. 138341 Is there any other wastewater treatment on-site?  

Does the facility track their water consumption and practice water conservation?   

Sewer Discharge

Does the facility have a septic tank?   

Does the facility have a septic drain field?   

Does the facility discharge to sanitary sewers flowing to a publicly owned   

treatment works (POTW

Are there floor drains in any buildings?   

Are there lab drains?   

Does the POTW know of the facility’s discharge?  

Does the facility have a permit or letter of acknowledgement from the POTW?  

Does the facility have copies of the local sewer use ordinance?   

1 E.O. 13423 and E.O. 13514 were previously revoked; the replacement Order is E.O. 13834 Efficient Federal Operations, signed May 17, 2

COMMEN
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Emergency Response Preparation

 Oil and Hazardous Substance Spill Prevention

Yes No N/A

40 CFR 355.20

49 CFR 194.117

33 CFR 154.1026

Does the facility have a designated person who is accountable for oil and hazardous 

substance spill prevention, such as the QI? If ye

  

Who is the QI?

49 CFR 194.117

33 CFR 154.1050

40 CFR 112.7(f)

Are spill prevention briefings conducted at least annually to ensure adequate understanding of SPCC and spill response plans? If y

  

Does the briefing instruct personnel:

In the operation and maintenance of equipment to prevent the discharge of oil and

hazardous substance?

In applicable pollution control laws, rules, and regulations? Known spill events

failures, or malfunction components? Recently developed precautionary measures?

  

  

 Preparedness for Response Exercise Program

67 FR 2944, USCG

X0241, USCG−X0

Does the facility participate in the National Preparedness for Response Exerc

Program (PREP) for compliance with the Oil Pollution Act of 1990? If yes:

Does the facility conduct quarterly QI notification drills?   

Does the facility conduct annual spill management team tabletop exercises? If yes:   

Has one of these exercises in the past 3 years involved a worst-case discharg

exercise?

  

Does the facility conduct annual unannounced exercises? If yes:   

Was one of the unannounced exercises in the past 3 years an equipment deployment 

exercise?

  

Does the facility conduct semi-annual equipment deployment exercises?   

Does the facility conduct annual Oil Spill Removal Organization (OSRO) equipmen

deployment exercises?

  

40 CFR 112.21 Does the facility response program include evacuation exercises/drills?

33 CFR 154.1055 If the facility is a marine terminal, are announced and unannounced spill management

team exercises conducted annually?

COMMEN
D-28 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Chemical and Material Handling

 Community Right-to-Know

Yes No N/A

40 CFR 370.10 Does the facility have any hazardous chemicals stored on-site (i.e., any with SDSs) at an

one time greater than 10,000 lbs or 4,540 kg (this includes pure form and quantities in 

mixtures)? If yes

  

40 CFR 370.30 

to 370.33

Did the facility submit a list or copies of SDSs to the state emergency respons

commission (SERC), the local emergency planning committee (LEPC), and the 

department?

  

40 CFR 370.40 

to 370.45

Are these chemicals identified on the chemical inventory or Tier I/II report submit

annually to the SERC, LEPC, and the fire department with jurisdiction over your faci

by March 1st?

  

40 CFR 370.10 

and

40 CFR 355.10

Does the facility have any chemicals on the extremely hazardous substances (EHS) li

found in 40 CFR 355, Appendix A? If yes

  

Do any of the quantities of EHSs on-site exceed the corresponding threshold planning quantities given in 40 CFR 355 Appendix

  

Do the quantities of EHSs exceed 500 lbs (227 kg or approx. 55 gallons)?  

40 CFR 355.30 If yes to the above thwo questions, has the facility notified their state commission

and/or local committee of their E

  

40 CFR 370.30 

to 370.33

Were these HS included in the list or copies of SDSs submitted to SE

and the fire department?

  

40 CFR 370.40 

to 370.45

If yes to either question above, is thisEHS chemical identified on the Tier I/II

submitted annually to your SERC, LEPC, and the fire department with jurisdiction

your facility by March 1st?

  

Does the facility have one or more of the 600 toxic chemicals listed in 40 CFR 372.65? If

yes:

  

40 CFR 372.22 Does the facility have more than 10 full-time equivalent employees?   

40 CFR 372.25 Did the facility manufacturer, prepare, process, or import 25,000 lbs or more of the 

toxic chemical per calendar year?

  

40 CFR 372.25 Did the facility use 10,000 lbs or more of the toxic chemical per calendar year?   

40 CFR 372.30 Did the facility submit a Form R or Form A to the EPA and state agency by July 1st fo

each toxic chemical above the reporting threshold?

  

40 CFR 372.10 Does the facility have supporting documentation and calculations determining the 

amounts of toxic chemicals released and reported?

  

49 CFR 172.704 Have personnel involved with preparing hazardous materials for shipment (drums,

packages, tankers) been trained (every 3 years) in DOT packaging, labeling, marking,

placarding, and shipping paper requirements?

  

40 CFR 172.604 Upon review of several facility shipping papers, was a 24-hour emergency response 

telephone number identified on each shipping paper?

  

49 CFR 172.602 Do facility personnel verify that each transporter carries written emergency response 

information for each hazardous material being transported to or from the facility?

  

49 CFR 172.500 Do facility personnel confirm that each transport vehicle, prior to leaving the facility 

loaded with fuel, contains appropriate placards (on each side and each end)?

  

49 CFR 172.506 Does the facility have placards to offer the carrier/transporter?   
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Enforcement Actions, Spills, and Cleanup Projects

Agency Inspections

Yes No N/A

Has the facility received any notices of violation, administrative orders, consent orders, or OSHA citations 

the past 3 years?

  

Have any agency representatives inspected the facility in the past 3 years? If yes, complete the following:  

Agency Date of Visit Inspector’s Name Issues Identified

Spills

Yes No N/A

Are there areas of stained soil or dead vegetation?   

49 CFR 195 Has the facility released hazardous liquids (petroleum, petroleum products,

anhydrous ammonia, or carbon dioxide) from a pipeline?

  

40 CFR 302 Has the facility released (or had the potential to release) a hazardous substance in

an amount over the reportable quantity (RQ) set in CERCL

  

40 CFR 355.33 Has the facility had any release (or threatened release of) of anEHS or C

hazardous substance that meets or exceeds the RQ set forth in EPCR

  

40 CFR 262, 264, 265, 

273, 279

Has the facility released into the environment (air, water or land) any hazardous

waste, universal waste, or used oil?

  

40 CFR 280 Has the facility had a release from a UST?  

40 CFR 761.125 Has the facility has a spill of polychlorinated biphenyl (PCB) liquids at concentrations of 50 ppm or greate

  

Are spill records available?   

Complete the following for spills in the past 2 years:

Spill Date Substance Spilled Quantity

Spilled Location Spilled Cleanup Action AgencyNotified

COMMEN
D-30 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Enforcement Actions, Spills, and Cleanup Projects

Remediation

Yes No N/A

40 CFR 300

40 CFR 264

40 CFR 63, Subpart

GGGGG, or 40 CFR 761

Is remediation activity being performed? If yes, is it according to:  

CERCLA/Superfund?  

The RCRA corrective action process?   

NESHAPs site remediation? 

Voluntary Cleanup?   

The PCB Spill Cleanup Policy? 

Other? 

Are there any groundwater monitoring wells at the facility? If yes

How many?

  

Are they sampled regularly?   

Is there any surface water monitoring/investigations?   

If yes: Have subsurface soil investigations been conducted? If y

When? 

  

Have any treatment systems been installed or operated at the facility? If ye

When? 

  

What type? 

Have any USTs been removed? If 

When? 

  

COMMEN
Appendix D.2 

Environmental Management System Checklist
THIS PAGE LEFT 

INTENTIONALLY BLANK
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Environmental Management System Checklist1

Understanding the Organization and its Context

Yes No N/A

Section 4.1 Has internal & external environmental conditions that are relevant to th

organization been identified?   

Section 4.2 Have those who are interested in your environmental performance bee

identified?   

Section 4.2 Have the needs and expectations of your interested parties been determined?  

Section 4.2 Have those requirements that have become compliance obligations bee

identified?   

Scope of EMS

Section 4.3 Has the scope of your environmental management system (EMS) been defi

and documented?   

Section 4.3 Is there evidence that risks and opportunities related to environmental aspects

compliance obligations and other issues have been identified and addressed?   

Section 4.3 Have emergency situations been determined, within the scope of the E

including those that can have an environmental impact?   

Section 6.1 Does the organization monitor emerging  concerns relevant to the organization’s mission?   

Environmental Policy

Section 5.2 Has top management approved or signed the environmental policy?  

Section 5.3 Has an EMS management representative been identified and given authority

oversee and implement the policy?   

Section 5.2 Are employees, leadership, and contractors made aware and/or trained on the

policy? If yes

How?

  

Section 7.3 Has the facility distributed the environmental policy to all employees? If y

How?

  

Environmental Aspect

Section 6.1.2 What are the environmental aspects of the organization’s activities, products, and

services?

Section 6.1.2 Does the location of the organization require special environmental consideration

(e.g., sensitive environmental areas)?   

Section 6.1.2 How will any intended changes or additions to activities, products, or service

affect the environmental aspects and their associated impacts?

Section 6.1.2 Have the cumulative effects of smaller activities been taken into account?  

Section 6.1.3 Are the environmental aspects of the procurement of new materials and subcontracting identified and considered? If yes:  

How are these environmental aspects and their associated impacts communicated

to suppliers/contractors?

1Source: International Organization for Standardization. ISO 14001:2015, Environmental Management Systems—Requirements with Guidance for Use.
D-34 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Compliance Obligations

Yes No N/A

Section 6.1.3 Does the organization access and identify relevant compliance obligations and

other requirements? If yes:   

How?

Section 6.1.3 Has the facility developed a procedure to identify and have access to complianc

requirements of the facility’s activities, products, and services?   

Sections 7.3 Does the organization communicate relevant information on compliance obligations and other requirements to employees? If yes:  

How?

Section 6.1.3 Have NEPA mitigation activities been addressed? If yes:

How?

Section 6.1.3 Have any agreements (e.g., consent agreements) with public authorities bee

signed that have an effect on the environmental impact of the facility’s processes?   

Objectives, Targets, and Programs

Section 6.2.1 Have mission needs been taken into account in the development of objective

and targets? If yes

How?

  

Section 6.2.1 Does the organization have a structure of communication that will ensure key

contributors/organizations are aware of the facility’s objectives and targets?   

Section 6.2.2 Does the environmental management planning process involve all responsible

parties?   

Section 6.2.2 Are requirements (as related to objectives, targets, and programs) communicated throughout the organization? If ye

How?

  

Resources, Roles, Responsibility, and Authority

Section 7.1 Does the organization identify and allocate the human, technical, and financial

resources necessary to meet its environmental objectives and targets, including 

those for new projects? If yes

How?

  

Section 5.3 Does the organization track the costs and benefits of environmenta

activities? If yes

How?

  

Section 5.3 What is the relationship between environmental responsibility and individual

performance?

Section 5.3 Is the relationship between environmental responsibility and individual performance periodically reviewed?  

Section 5.3 Has an ISO Environmental Management Representative been assigned the

to−day management functions? If yes:   

How was the appointment communicated to all employees
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Competence, Training, and Awareness

Yes No N/A

Section 7.3 Has top management established, reinforced, and communicated organizational commitment to the environmental policy? If y

How?

  

Section 7.2 Does the installation identify competence training needs? If y

How?

  

Section 7.2 Do housing areas contribute to a significant aspect? If yes:  

How are personnel in housing trained (e.g., recycling goals, prohibited disposal)?

Section 7.2 Do you ensure contractors and subcontractors are properly trained in environmental areas? If ye

How?

  

Section 7.2 Does the installation ensure that training continues to reflect changin

data, policies, and objectives and targets or regulations? If yes

How?

  

Communication

Section 7.4.1 Has a process been established for communicating the organization’s environmental policy and performance? If y

Describe 

  

Section 7.4.2 Is it clear how information is communicated across the different functions an

levels within the organization?   

Section 7.4.1 Does the organization meet with its counterparts if under realignment (if

applicable)?   

Section 7.4.1 Does the organization’s communication strategy appear to be effective?   

What evidence exists to support this conclusion?

Section 7.4.2 Are your internal environmental communications used to

Demonstrate management commitment to the environmental policy and 

objectives?   

Answer questions and concerns about the facility’s activities, products, and 

services and their environmental impacts?   

Increase awareness internally about the organization’s policy, objectives, targets,

and programs?   

Identify roles and responsibilities and authorities of key staff members?   

Section 7.4.2 Is internal communication adequate to support continual improvement aroun

environmental issues?   

Section 7.4.2 Does the installation communicate environmental performance data internally,

whenever appropriate?   

Section 9.2.2 Are results of the EMS and compliance audits and reviews communicated 

affected organizations? If yes

How?

  

Section 7.4.3 Have you considered voluntary reporting of environmental management an

performance information to the general public? If yes:   

Have you recorded the decision on this matter?   
D-36 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

 Documentation

Yes No NA

Section 7.5.1 Are environmental management procedures identified, documented, communicated, and revised? If ye

How?

  

Sections 7.5.3 Do employees access EMS documentation needed to conduct their job activitie

If yes

How?

  

Section 7.5.3 Have procedures been established that provide direction on where to obtai

information on the operation of specific parts of the EM

  

Section 7.5.1 Does the facility integrate EMS documentation with documentation of oth

systems the facility has implemented?

  

 Control of Documents

Section 7.5.3 Are procedures established and implemented to approve documents before use?   

Section 7.5.3 Are mechanisms used to communicate changes to controlled documents? If ye

What? 

  

Section 7.5.3 Does the installation keep track of who has a controlled document? If ye

How?

  

Section 7.5.3 Is there a distribution list for controlled documents?  

Section 7.5.3 Is there a person authorized to:  

Create documents? If yes

Who? 

  

Review documents? If yes

Who? 

  

Authorize documents? If yes

Who? 

  

 Operational Control

Section 8.1 Are operational controls reviewed? If ye

How often

  

Section 8.1 Has the facility documented standard operating procedures where their absenc

could lead to deviation from the environmental policy (compliance) and objectives and targets?

  

Section 6.1.2 Have all functions, activities, and processes been identified that have significan

environmental impact?

  

Section 8.1 Have operational controls been identified for all these instances?  

COMMEN
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

 Emergency Preparedness and Response

Yes No NA

Section 8.2 Has the facility compared its documented contingency plan and/or risk management program with the ISO 14001 requirements for these procedures (i.e., is ther

system for reviewing and revising existing plans)?

  

Section 8.2 Have employees been trained on how to respond to accidents or emergenc

situations?

  

Section 8.2 Has the facility coordinated with emergency services such as medical, fire departments, and hazardous material team

  

Monitoring and Measurement

Section 9.1.1 Is environmental performance regularly monitored? If y

How?

  

Section 9.1.1 Does the installation know what type of instrumentation requires calibration and

the calibration frequency? If yes

How?

  

Section 9.1.1 Are control processes in place to regularly calibrate and sample measuring and

monitoring equipment and systems? If yes

What type? 

  

Section 9.1.1 Has the installation established methods to calibrate monitoring equipment

making sure testing and monitoring equipment are working properly and the data 

is reliable?

  

Section 9.1.1 Has the installation established procedures and installed equipment to monitor th

process characteristics that can have a significant environmental impact?

  

Section 9.1.1 Do the monitoring procedures enable the facility to measure its performance

against its objectives and targets?

  

Section 9.1.1 Are monitored indicators linked with the objectives?   

 Evaluation of Compliance

Section 9.1.2 Does the installation have implemented procedures for periodically evaluating

compliance with applicable legal requirements?

  

Section 9.1.2 Is there a person responsible for performing compliance checks? If ye

Who? 

  

 Nonconformity, Corrective Action, and Preventive Actions

Section 10.2 Does the facility have a system in place to review effectiveness of corrective and

preventive actions and make changes when necessary?

  

Section 10.2 Does the facility implement and record any changes in the documented procedures

resulting from corrective and preventive actions? If yes

How?

  

COMMEN
D-38 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Control of Records

Yes No NA

Section 7.5.

Does the organization have the capability to identify and track key indicators of 

performance and other data necessary to achieve its objectives? If yes

What are these capabilities? 

  

Section 7.5.3 Do these records help measure the extent to which the facility has met its objectives and targets

  

Section 7.5.3 Are procedures for control of records implemented and maintained? If ye

How?

  

Section 7.5.

Is there a person responsible for maintaining the procedures for environmental

records? If yes, who?

  

Section 7.5.3 Are the records readily retrievable?   

Section 7.5.3 Have the record retention times been established?  

Internal Audit

Section 9.2.

Does the facility have a system in place to periodically audit the EMS itself, a

opposed to compliance audits? If yes

Who does this? 

  

Section 9.2.2 Does the facility make sure to alter, if necessary, the audit procedure, subject areas

covered, and frequency, based on the results of previous EMS audit

  

Section 9.2.2 Do the people involved with implementing each core element of the EMS participate in these audi

  

Section 9.2.

Is there a person responsible for arranging periodic EMS audits? If y

How?

  

Sections 9.2.

Are audits documented? If yes

How?

  

Section 9.2.

Have previous EMS audit results been provided to management? If 

How?

  

Management Review

Section 9.

Is the EMS periodically reviewed? If 

What is the process? 

  

What is the frequency for complete reviews (Note: It can be done in parts as long a

the entire system is reviewed annually)? 

  

Section 9.3 Did the installation have a management review meeting? If ye

Who was present? 

  

Are there meeting agendas/meeting minutes available for review?   

Do meeting minutes include all of the management review criteria?   
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Management Review (cont.)

Yes No NA

Sections 9.3 Is management made aware of audit results (both EMS and compliance audits)? If

How?

  

Section 9.3 When (e.g., during the management review)

Does the review include:

The sustainability of the environmental policy?   

Is it comprehensive enough?   

Does it still stake the facility to continuous improvement?   

Has it become obsolete?   

Whether the objectives and targets still up-to-date and relevant to the organization’s current activities, processes, and products?

  

Follow-up actions from previous management reviews?   

Whether the EMS audits take place frequently enough and cover the right areas?  

Whether the training system is properly implemented?   

Any recommendations for improvement?   

Whether the facility is making adequate progress concerning environmental 

indicators (e.g., objectives and targets)?

  

COMMEN
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Appendix D.3 

DLA Energy Safety Checklist
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Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

DLA Energy Safety Checklist

 General Facility Information

Interviewer: Date:

Facility Name:

Site Location: County

Physical Address: Mailing Address

U.S. EPA Region: USCG Distr

 Facility Contact

Name: Titl

Phone: Emai

Cellular/Pager

 Facility Description

Check all those that apply:

 Aboveground storage tanks (ASTs)  Aircraft fueling  Site remediat

 Underground storage tanks (USTs)  Aboveground piping  Septic tank or drain fi

 Truck/tanker loading and

unloading

 Underground piping  Surface water impoundments o

ponds

 Rail loading and unloading  Off-site or cross-country 

piping

 Potable water wel

 Marine terminal  Oil/water separator(s)  Municipal water supply

 Vehicle fueling or defueling  Laboratory  Underground injection control (UI

well

COMME
D-44 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

DLA Energy Safety Checklist

 Facility Description

Contractor Name: Full-time Equivale

Actual Property Owner: Total Facility Size (acreage

Facility Operating Hours Mon.-Fri.: Sat.: Sun

Has the facility recently modified or constructed new equipment? What improvements or changes to the facility are planned

What are the facility’s Standard Industrial Classification (SIC) co

What are the facility’s North American Industry Classification System (NAICS) 

 General Recordkeeping

Yes No NA

Are safety records kept in a central file? If yes:   

Where?

Is access to safety records adequately controlled?   

Are safety records maintained in an orderly fashion? If yes:   

Where?

Are employee medical and exposure records kept in a central file? If yes:   

Where?

Is access to medical and exposure records adequately controlled?   

Have employees been notified of their right to access their medical and exposure

records?

  

Are employee health and safety training records kept in a central file? If yes:   

Where?

Does the facility staff have access to applicable federal, state, and local 

regulations?

  

Are the appropriate OSHA posters placed in a conspicuous location?  

29 CFR 1904.32(a) Is a log and summary of all recordable occupational injuries and illnesses (OSHA Fo

300) properly maintained?

  

Are OSHA logs retained for at least 5 years?  

Is the annual summary of injuries and illnesses posted from February 1 through

April 30 in a conspicuous location?

  
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Safety Plans and Permits

 Safety Management Plans

Does the facility have any of the following plans:

Date Last

Revised Yes No N/A

29 CFR 1910.38 Emergency Action Plan or Fire Prevention Plan? 

29 CFR 1910.1200 Written Hazardous Communication Program?  

29 CFR 1910.95 Hearing Conservation Program?  

29 CFR 1910.134 Written Respiratory Protection Program?  

29 CFR 1910.146 Written Permit−required Confined Space Entry Program? 

29 CFR 1910.147 Written Lockout/Tagout Program?  

29 CFR 1910.1450 Chemical Hygiene Plan for Laboratory Operations?  

Other

COMMEN
D-46 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Safety

 Security Systems

Yes No N/A

Is the facility enclosed with a fence?   

Are there means to control entry through entrances? (e.g., attendant, television 

monitors, locked gates)

  

 Housekeeping

29 CFR 1910.22(a) Are work areas clean?   

29 CFR 1910.23 Are permanent and portable ladders and rungs clean and in good condition?   

29 CFR 1910.22 Are portable ladders securely stored when not in use?   

29 CFR 1910. 141(a)(3)(ii) Are spilled materials or liquids cleaned up immediately (e.g., no visible stains or 

other visual indications of long-standing spills)?

  

Are miscellaneous equipment and scrap metal (e.g., pumps, drums, hoses, 

piping, etc.) secured in a storage area?

  

Are the grounds well maintained and free of litter, debris, and scrap equipment?   

 Fire Protection

Are employees familiar with the “No Smoking” policy?  

29 CFR 1910.157(c)(1) 

& (d) and 1910.106(e)

(5)

Are fire extinguishers provided in adequate number and type, and readily 

accessible to employees?

  

29 CFR 1910.157(e) Are portable fire extinguishers visually inspected on a monthly basis?   

29 CFR 19190.157(e) Are portable fire extinguishers inspected annually, recharged, and noted on the 

inspection tag?

  

29 CFR 1910.157(f) Has fire extinguisher hydrostatic testing been performed after repairs, corrosion,

or damage to the shell?

  

29 CFR 1910.158(e) Are water hoses and nozzles inspected annually?   

29 CFR 1910.159(c) Have automatic sprinkler systems been tested annually?   

29 CFR 1910.165(d) Are employee warning alarm devices or systems tested every 2 months?   

29 CFR 1910.160−.163 Does the facility have fixed fire extinguishing systems (e.g., dry chemical, 

gaseous agents, or foam)? If yes

  

29 CFR 1910.160(b)(6) Is the fixed system inspected annually?   

29 CFR 1910.160(b)(9) Are extinguishing material containers inspected semiannually and recorded on 

the containers?

  

29 CFR 1910.160(b)(5) Are there hazard warning signs at the entrance to areas with fixed fire extinguishing systems?

  

29 CFR 1910.38 and 29 

CFR 1910.39

Is there an Emergency Action Plan and/or Fire Prevention Plan? 
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Safety (cont.)

 First Aid

Yes No N/A

29 CFR 1910.151(b) Are first aid kits easily accessible to each work area?   

29 CFR 1910.151(b) Are first aid kit supplies periodically inspected and replenished as needed?   

29 CFR 1910.151(c) Are emergency eye wash and shower facilities within the immediate work area 

where employees are exposed to injurious corrosive materials?

  

29 CFR 1910.1030(d)(3) Is bloodborne pathogen personal protective equipment (PPE) readily availa

where there is a potential for exposure (i.e., first aid providers)?

  

 Electrical Safety

29 CFR 1910.147(c)(4) Does the facility have written procedures for the use of lockout/tagout devices 

to repair or perform service for each machine and piece of equipment?

  

29 CFR1910.147(c)(7) Have employees been trained to recognize hazardous energy sources and the

proper lockout/tagout safeguards?

  

29 CFR 1910.147(c)(6) Are annual inspections of lockout/tagout procedures conducted to verify 

effectiveness?

  

29 CFR 1910.303(f) Are service feeders and circuits (breakers and switches) labeled at their disconnect (panel or switch) indicating what they control if the function or purpose is 

not obvious?

  

29 CFR 1910.305(b)(3)(iii) Are electrical cabinets and doors for systems >600 volts marked “High Voltage”?   

 Confined-space Entry

29 CFR 1910.146(g) Have personnel received confined-space entry training?   

29 CFR 1910.146(c) Are danger signs posted near confined spaces that pose a potential or actual 

safety or health hazard (permit-required)?

  

Do DLA Energy employees enter permit-required confined spaces? If yes:  

29 CFR 1910.146(d)(4) Is forced air ventilation equipment available?   

29 CFR 1910.146(d)(4) Are oxygen meters, combustible gas indicators, and toxic gas meters available and calibrated?

  

29 CFR 1910.146(d)(4) Are communication equipment, harnesses, lighting, and rescue and emergency equipment available and in good condition?

  

29 CFR 1910.146(d)(14) Is the written permit-required confined-space entry program reviewed

annually?

  

29 CFR 1910.146(k) Are practice confined-space rescue operations conducted and evaluated 

annually?

  

COMMEN
D-48 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Safety (cont.)

 Laboratory Safety

Yes No N/A

29 CFR 1910.1450(e) Does the laboratory have a written Chemical Hygiene Pl

containing standard operating procedures and hazard control measures?

  

29 CFR 1910.1450(f) Are lab employees trained on the details of the Chemical Hygiene Plan?  

29 CFR 1910.1450(h)(1)(ii) Are SDSs available for all fuels and chemicals?  

Is the DLA Energy Laboratory Safety Standard available? If yes

Is the government quality assurance representative (QAR) familiar with it?   

NFPA 45 Chapter 6, 29 CF

1910.1450 Appendix A

Is there adequate ventilation in the lab?   

29 CFR 1910.1450(e)(3)(iii) Are there properly functioning fume hoods? If yes

When was the last fume hood inspection?

  

NFPA 45 Chapter

NFPA 45 Chapter 4 Does the laboratory have a fire extinguisher or fire protection system?  

NFPA 45 Chapter 7 Does the lab have sufficient flammable liquid storage? If yes:  

29 CFR 1910.1450 Appendix 

A

Are stored chemicals examined periodically (at least annually) for replacement, deterioration, and container integrity?

  

29 CFR 1910.1450 Appendix 

A

Are acids and incompatible chemicals stored separately?   

NFPA 70 Article 501 Is the laboratory equipped with explosion-proof electrical equipment with

4 feet of the floors and 18 inches of the countertops?

  

NFPA 45 Chapter 9 Is the refrigerator explosion proof?  

NFPA 45 Chapter 9 Is the refrigerator marked whether it meets the requirements for safe stora

of flammable liquids?

  

NFPA 45 Chapter 9 Is the filtration apparatus properly grounded?  

29 CFR 1910.1450 Appendix 

A

Is the lab equipped with an emergency eyewash and shower that are in

working order?

  

Are emergency eyewash and showers maintained in accordance with A

Z358.1?

  

NFPA 45 Chapter 8 Are pressurized cylinders secured to prevent falling?  

29 CFR 1910.1450 Appendix 

A

Is the lab clean and uncluttered with chemicals and equipment properly

labeled and stored?

  

COMMEN
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Emergency Response Preparation

Occupational Safety

Yes No N/A

29 CFR 1910.1200 Have employees been informed of the hazardous chemicals in their work area

under the Hazard Communication Training Progr

  

29 CFR 1910.1200 Have all employees been trained on the new labels and SDS in the hazard communications program based on the United Nations Globally Harmonized S

(GHS

  

29 CFR 1910.151 Is someone adequately trained to render basic first aid?   

29 CFR 1910.1030(f)(1) Have designated first aid providers been trained in universal precautions for

bloodborne pathogens and offered Hepatitis B vaccinations

  

Do DLA Energy staff/contractors respond to clean up spills of hazardous substances? If y

  

29 CFR 1910.120(e) Have emergency responders received 40 hours of initial HAZWOPER train

and 8 hours annually afterward before they are allowed to engage in cleanup 

operations?

  

29 CFR 1910.120(f) Have emergency responders received annual respirator fit testing, medical

exams, and respirator training?

  

29 CFR 1910.120(c)(6) Do responders know how to calibrate and operate organic vapor analyzers, 

oxygen meters, and combustible gas indicators?

  

29 CFR 1910.120

Appendix C and NFP

471 and 472

Have any personnel completed the National Fire Protection Association (N

Competent Person course

  

 Government Quality Assurance Representative

29 CFR 1910, SubpartI Are government Quality Assurance Representatives (QARs) (sometimes calle

quality surveillance representatives) provided with E  as follo

29 CFR 1910.136 Safety shoes?   

29 CFR 1910.133 Eye/face protection or splash goggles?   

29 CFR 1910.135 Head protection (e.g., hard hat)?   

29 CFR 1910.138 Butyl rubber gloves?   

29 CFR 1910.95 Hearing protection?   

29 CFR 1910.134 Air purifying respirator with organic vapor cartridges?   

Has the QAR been trained in the proper use of thePPE listed above? 

Has the QAR been provided an oxygen meter, combustible gas indicator, toxic gas

monitor, and organic vapor analyzer? If yes, then

  

Does the QAR know how to operate and calibrate the oxygen meter, combustible 

gas indicator, toxic gas monitor, and organic vapor analyzer?

  

29 CFR 1910.120 Has the QAR received 40 hours of initial HAZWOPER training and 8 hours annua

thereafter?

  

20 CFR 1910.120 & 134 Has the QAR received annual respirator fit testing, respirator training, and medical

exams?

  

20 CFR 1910.95 Has the QAR received annual audiometric testing

20 CFR 1910.1200 Has the QAR completed Hazard Communication training?  

49 CFR 172.700 Has the QAR completed HAZMAT training?  
D-50 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Chemical and Material Handling

 Hazard Communication Program

Yes No N/A

29 CFR 1910.1200 (e)(1)(i) Does the facility maintain a list or inventory of all chemicals received, processed, or stored at the facility?

  

29 CFR 1910.1200 (g) Are SDSs readily available for all chemicals?  

29 CFR 1910.1200(f)(5) Are all containers properly labeled with the chemical name and hazard 

warning?

  

29 CFR 1910.1200(b)(4) Are chemical containers closed when not in use?   

Flammable Liquids1

29 CFR 1910.106(d)(2) Are fire-resistant, covered containers and portable tanks used for the storage 

and handling of flammable liquids (e.g., is gasoline kept in approved safety 

cans)?

  

29 CFR 1910.106(d)(2)(ii) Are portable storage tanks (<660 gallons) equipped with emergency venting 

that will relieve excessive internal pressure caused by fire?

  

29CFR 1910.106(d)(5)(iii) Are flammable liquids kept in closed metal container stored in storage 

cabinets or in safety cans inside storage rooms?

  

29 CFR 1910.106(d)(3)(ii) Are storage cabinets used to hold flammable liquids labeled “Flammable – 

Keep Fire Away”

  

29 CFR 1910.106(d)(7)(iii) &

1910.106(e)(6)

Are flammable liquid storage areas identified as “No Smoking” areas, and ar

sources of ignition such as welding, sparks, and radiant heat prohibited?

  

29 CFR 1910.106(d)(7)(iv) Are water-reactive materials kept out of flammable liquid storage rooms?   

29 CFR 1910.106(f)(3)(vi) Are containers of Class  flammable liquids grounded or bonded during

dispensing or filling?

  

29 CFR 1910.106(f)(1)(iii) Are firm separators placed between containers of flammable liquids when 

stacked on one another to ensure their support and stability?

  

Are flammable liquids stored in a building having a basement or pit where 

vapors may collect? If yes

  

29 CFR 1910.106(f)(2)(iii) Is there adequate ventilation?   

1State Fire Codes often have additional requirements. Flammable liquid means any liquid having a flashpoint at or below 199.4 ̊F (93 ̊C

COMMEN
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Industrial Equipment

 Powered Industrial Trucks

Yes No N/A

29 CFR 1910.178 Do employees operate powered industrial trucks on-site (e.g., forklifts, tractors, platform lift trucks, motorized hand trucks, or other specialized industrial trucks powered 

by electric or internal combustion motors)? If yes

  

29 CFR 

1910.178(l)(2)

Have employees received both formal instruction and practical training prior to

being permitted to operate a powered industrial truck?

  

29 CFR 

1910.178(l)(4)

Is each powered industrial truck operator’s performance evaluated at least once

every 3 years?

  

29 CFR 

1910.178(q)(7)

Is a daily inspection conducted and documented by the equipment operator?   

29 CFR 

1910.178(a)(4)

Are modifications and additions that could affect the capacity and safe operation of 

the equipment only performed with the manufacturer’s prior written approval?

  

29 CFR 

1910.178(n)(4)

Do drivers slow down and sound horns at cross aisles and other locations where 

vision is obstructed?

  

29 CFR 

1910.178(m)(7)

Are trailer brakes set and chocks in place prior to loading/unloading with industrial 

vehicles?

  

Cranes and Hoists

Does the facility have overhead hoists/cranes? If yes:   

29 CFR 

1910.179(b)(5)

Is the load rating plainly marked on each side of each overhead hoist/crane?   

29 CFR 

1910.179(j)(2)

Are daily hoist/crane inspections/observations conducted before use?   

29 CFR 

1910.179(j)(3)

Are detailed hoist/crane inspections conducted at least annually (including all 

periodic inspection criteria stated in the standard)?

  

COMME
D-52 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

 Aboveground Storage Tanks and Pipelines

Tank Description

Are there any ASTs on-site? If yes, complete the followi

Tank Name,

Number, or

Location

Tank Material Capacity

(gallons)

Date Installed Material Stored Vapor Pressure of

Material Stored

(psia)

29 CFR 1910.22(c) Are guardrails warranted on tanks and are they adequate to protect workers?   

29 CFR 1910.1200(f)(6) Are ASTs that contain hazardous materials labeled with the chemical name an

hazard warning?

  

29 CFR 1910.106(b)(2)

(vii)(c)(6)

Was any flammable material observed within the containment area?   

Above Ground On-Site Pipelines

Yes No N/A

Are there aboveground pipelines? If yes:   

Have any pipelines been repaired? If yes:  

When?

Are there expansion relief valves that bleed over−pressurized product back to the 

tank?

  

Are there emergency shutoff valves or impact valves in the pipeline (sometimes at 

the tank or product dispenser)?

  

29 CFR 1910.106(c)(3) Are flammable liquid pipe joints vapor- and liquid-tight?   

Are there line leak detectors or alarms that indicate leaks in the lines?   

Are there other leak detection methods employed (tightness testing, soil vapor 

monitoring, groundwater monitoring, interstitial monitoring, etc.)

  

Yes No N/A

  
Appendix D Checklists D-

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Fuel Dispensing

 Fuel Loading and Unloading Areas

Yes No N/A

Do loading areas have roofs?   

29 CFR 1910.106(f)(7) Are there means of preventing flammable liquids spilled at loading and unloading points from entering sewers and drainage systems?

  

29 CFR 1910.106(f)(6) Are “No Smoking” signs posted and ignition sources prohibited where flammabl

liquids are handled, drawn, or dispensed?

  

1910.106(h)(7)(iii) Are electrical installations explosion proof?   

29 CFR 1910.106(f)(3)

(iv)

Are grounding and bonding cables for flammable liquids in good condition?   

29 CFR 1910.106(e)(9)

(iv)

Is the area near flammable liquid operations kept free of weeds, trash, and

combustible materials?

  

Marine Terminal or Pier Facilities

29 CFR 1910.106(f)(4) Do pier loading pumps carrying flammable liquids have means to protect against 

excessive pressure (e.g., bypasses, relief valves)?

  

29 CFR 1910.106(f)(4) Are pier pressure hoses and couplings inspected regularly?   

29 CFR 1910.106(f)(4) Are grounding/bonding cables inspected and in good condition?   

29 CFR 1910.106(f)(4) Are fire extinguishers located within 75 feet of hose connections, pumps, and 

separator tanks at the pier?

  

29 CFR 1910.106(f)(6) Are “No Smoking” signs posted and ignition sources prohibited where flammabl

liquids are handled, drawn, or dispensed?

  

COMMEN
D-54 Appendix D Checklis

FACILITY NAME: DATE: INTERVIEWER INITIALS: 

Enforcement Actions

Agency Inspections

Yes No N/A

Has the facility received any OSHA citations in the past 3 years?  

Have any health or safety agency representatives inspected the facility in the past 3 years? If yes

complete the following:

  

Agency Date of Visit Inspector’s Name Issues Identified

COMMEN