Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 4 54 of 53 8 FACIL IT IES S AFETY IN S P ECTION RE P ORT Doc u m e n t Identif icat ion F R M 010 P age Nu m b e r 1 of 1 Doc u m e n t C r e ation Dat e F e bru a r y 24 2016 Im p le m e n tat ion Dat e Ma rc h 1 2016 T h is fo rm s h a ll b e u s e d in co n jun cti o n w ith F RM 0 0 9 Fa cil ity S a f e ty I n sp e ctio n Ch e ckli st DA T E OF INS P E CT IO N T IM E OF INS P E CT IO N B RA NC H L OC A T ION INS P E CT IO N T E A M No A r ea e g off ice sh op exte r ior shipp ing et c S um m ar y of Hazar d Ide ntified Hazar d Rating Recom m en de d Cor r ective A ction Cor r ective A ction T ake n o r P lann ed E stim ate d Com plet ion Date A ctua l Com plet ion Date V er ified by Nam e Initial