Form CEM-4202 "Material Plant Safety Checklist" - California

What Is Form CEM-4202?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2000;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-4202 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-4202 "Material Plant Safety Checklist" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
NOTE: The contractor is responsible for all plant safety issues,
MATERIAL PLANT SAFETY CHECKLIST
regardless of any Caltrans' listing of acceptable or deficient items.
CEM-4202 (REV 11/2000)
Report No.
Plant Owner
Inspection By
Plant Location
Inspection Date
District
Plant Make
Plant Type
EA
Plant Safety Certification Supplied By
Certification Date
INSPECTION AREA
PLANT FEATURE
DEFICIENT
REMARKS
spec
A. Asphalt
1. Sampling height
Sample Area
2. Plumbing size
3. Insulation
4. Shielding
5. Housekeeping
6. Fire protection
7. Underground tank access
1. Access stairs
B. Aggregate/Cement
Sample Area
2. Access stairs, agg
3. Access stairs, binder
4. Guardrails
5. Floor holes
6. Housekeeping, agg
7. Sample size, agg
8. Sample size RAP
9. Conveyor lockout, agg
10. Conveyor lockout RAP
11. Site, dust control
12. Sample support rails
13. Conveyor startup warning
C. Aggregate
1. Drive belt guards
Belts and Drivers
2. Conveyor guards
3. Under conveyor clearance
4. Other conveyors
1. Stairs
D. Control Room
2. Landings
3. Guardrails
4. Fire protection
5. Emergency exit
6. First aid
7. Drinking water
8. Toilet facilities
E. Yard Equipment
1. Loaders
2. Trucks
1. Lighting
F. General Items
2. Wash pits
3. Yard pits
4. Electrical
5. Auto control equipment
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880
ADA Notice
or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
NOTE: The contractor is responsible for all plant safety issues,
MATERIAL PLANT SAFETY CHECKLIST
regardless of any Caltrans' listing of acceptable or deficient items.
CEM-4202 (REV 11/2000)
Report No.
Plant Owner
Inspection By
Plant Location
Inspection Date
District
Plant Make
Plant Type
EA
Plant Safety Certification Supplied By
Certification Date
INSPECTION AREA
PLANT FEATURE
DEFICIENT
REMARKS
spec
A. Asphalt
1. Sampling height
Sample Area
2. Plumbing size
3. Insulation
4. Shielding
5. Housekeeping
6. Fire protection
7. Underground tank access
1. Access stairs
B. Aggregate/Cement
Sample Area
2. Access stairs, agg
3. Access stairs, binder
4. Guardrails
5. Floor holes
6. Housekeeping, agg
7. Sample size, agg
8. Sample size RAP
9. Conveyor lockout, agg
10. Conveyor lockout RAP
11. Site, dust control
12. Sample support rails
13. Conveyor startup warning
C. Aggregate
1. Drive belt guards
Belts and Drivers
2. Conveyor guards
3. Under conveyor clearance
4. Other conveyors
1. Stairs
D. Control Room
2. Landings
3. Guardrails
4. Fire protection
5. Emergency exit
6. First aid
7. Drinking water
8. Toilet facilities
E. Yard Equipment
1. Loaders
2. Trucks
1. Lighting
F. General Items
2. Wash pits
3. Yard pits
4. Electrical
5. Auto control equipment
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880
ADA Notice
or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.