PPM Assessment Worksheet

Date

Lab Location:

Completed by:

Assessment Team:

1A.) When was Annual PPM training Last Performed

2A.) Is Annual PPM training Documented for each employee? (APPM-FO-009)

• Yes
• No
• N / A

1.) When was the current year PPM Self-Assessment completed? (APPM-FO-005)

2.) When were the action items for the previous PPM Self-Assessment completed?

3.) Does the plant have a system for tracking and closing action items generated by reviews or management of change, etc.?

• Yes
• No
• N / A

4.) Has the PPM Filing System been reviewed, and are all documents current? (ARP-JA-031)

• Yes
• No
• N / A

5.) Does the filing system contain the current year's agency plans as well as archived plans?

• Yes
• No
• N / A

6.) Does the filing system contain records of facility monthly PPM meetings? (APPM-FO-003)

• Yes
• No
• N / A

7.) Who is responsible for updating the PPM filing system?

8.) Track a BOL back to its sample, lab record, and batch sheet.

• Yes
• No
• N / A

9.) How do employees handle questionable situations? Do they know who and when to report?

10.) Is the plant staffing level sufficient to meet PPM goals?

• Yes
• No
• N / A

1.) Who is responsible for managing each Agency Plan?

2.) Have you reviewed the most current agency plans acknowledged by the agency? Where can employees find these?

• Yes
• No
• N / A

3.) Do the employees understand their responsibilities regarding the Agency Plans?

• Yes
• No
• N / A

4.) When was the testing matrix of the current year plan reviewed with all employees?

5.) What is the response to non- conforming products? (ARP-JA-036 and -037)

6.) What is the process for communicating to the agency if a non-conforming product is used?

7.) Where are the Agency Plan matrices and state specifications posted?

1.) Does the plant contain all the equipment required to test to the agency plan?

• Yes
• No
• N / A

2.) Is an offsite lab used for testing?

• Yes
• No
• N / A

3.) Where is the test data from offsite labs stored?

4.) Is the equipment properly tagged and calibrations current?

• Yes
• No
• N / A

5.) What system is used to schedule and track calibrations?

6.) Has the Laboratory Notebook Policy (APPM-PO-001) been reviewed and is it being followed?

• Yes
• No
• N / A

7.) Which operators perform tests? When was training verified? (ARP-FO-018, -019, -023, -024)

6.) What is the process to review completed BOL’s?

8.) Who is responsible for sample collection? When was training updated?

9.) What is your sample retention policy, and is it documented?

10.) Where are samples stored?

11.) What system is used to schedule and track QC and spec compliance testing?

12.) How is emulsion production and QC test data retained?

13.) How is PG production and QC test data retained?

14.) Is the production data retention policy being followed? (APPM-AP-003 & ARP-JA-031)

• Yes
• No
• N / A

15.) Is SAP compliance data entry up to date?

• Yes
• No
• N / A

16.) Are the latest AASHTO and applicable agency test methods available and have they been reviewed? (AETOP-AP-002)

• Yes
• No
• N / A

17.) Have the latest PSP results been reviewed and any deficiencies addressed? (APPM-FO-008)

• Yes
• No
• N / A

18.) For AASHTO Satellite Program Facilities (inspected by Paragon): When were AASHTO Quality System assessment findings addressed?

19.) Have all action items generated from the most recent Lab Inspection Group assessment been completed?

• Yes
• No
• N / A

20.) How is the Terminal Offload Plan implemented? (ARP-JA-038)

21.) What is the procedure for returned loads?

1.) What is the process to prevent contamination during loading?

2.) Does the plant have an up-to-date Loading Status Board and GO/NO-GO markers on each tank?

• Yes
• No
• N / A

3.) Who has the authority to change the GO/NO-GO status of a shipping tank?

4.) What is the process for changing the GO/NO-GO status of a shipping tank?

5.) Are appropriate personnel trained on generating BOL’s?

• Yes
• No
• N / A

7.) What system is in place to ensure that each BOL has the correct certification statement?

8.) What products don’t require state certification statement on the BOLs?

9.)Who makes the decision to change a BOL certification statement from "certified" to "non-certified"?

10.) When was the BOL Language Overview (APPMAP-002) reviewed with appropriate personnel?

11.) If changes to the state certification statements are needed, who is responsible?

12.) What is the procedure for returned loads?

13.) What is your inline blending system validation requirements, and is it documented?

14.) Do truck scales have current calibration? What is the calibration schedule?

• Yes
• No
• N / A

1.) Does the plant have a clear understanding of the MOC process and requirements?

2.) Can all employees define management of change? Management of Change Overview (APPM-AP-006)

• Yes
• No
• N / A

3.) What are some examples of Change? Example of Change (ARP-JA-034)?

4.) What systems are in place to manage and communicate changes to employees?

5.) When were SAP formulas last reviewed, and are they current?

• Yes
• No
• N / A

Review Item

• Yes
• No
• N / A

Completion Date

Comments:

Next Review Date: