Annual OFE Inspection Form

UMC-Transformers Year:

Instructions: This form is specific to the operational area noted above. Complete this inspection form annually for each regulated oil-filled equipment for proper operation,
damage, leaks and suitability for continued service. Any oil-filled equipment at this Facility with a reservoir capacity of more than 55 gallons is subject to regulation. Forward
completed checklists monthly to campus EHS staff; EHS staff maintains inspection documentation onsite for 3 years from the date of the inspection.

Date and time of inspection: Name of inspector:

Part A. Container Visual Check

Review all oil-filled equipment, piping

TR014 - West of Kiehle

Centennial Hall Mineral
TR003 - West of Owen

TR004 - East of Selvig

Widseth Field Mineral

TR016 - West of Kiser

Mineral Oil (94 each)
and associated equipment and indicate

TR015 - East of Early

Sahlstrom Conf. Cen

Horticulture Building

TR010-012 - Sports
whether the following criteria are met.

Research Center
TR002 - North of

TR006 - North of

TR009 - North of
Mineral Oil (260)

Mineral Oil (219)

Mineral Oil (135)

Mineral Oil (135)

Mineral Oil (350)

Mineral Oil (180)

Mineral Oil (300)

Mineral Oil (140)

TR001 - West of

TR007 - West of
TR005 SW Ag
Indicate Yes, No or N/A for each

Center, RM 170
TR008 - East of

TR013 - East of
Mineral Oil (74)

Mineral Oil (74)

Centennial Hall

Childhood Bldg
Evergreen Hall
item. For any answer indicated as No,

Heritage Hall

Mineral Oil
indicate specific finding, corrective
Oil (158)

Oil (250)

Building
action(s) required, along with the date,
time and person(s) notified of actions
Hall

Hall

Hall
required.
1. Labels and signage for reservoir is in place,
legible and accurate.
2. Exterior of reservoir, including paint and
coatings, is in good condition, with no
evidence of leaking around the reservoir,
concrete pad or ground.
3. Above-ground piping, valves, pumps,
sensors and associated equipment are in
good condition with no evidence of leaking.

4. Foundations and supports are structurally

sound, free from corrosion and other
damage, and in good condition.

5. Grounding straps, wires and sensors are

secure, free from corrosion and other
damage and in good condition.

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Part B. Containment Areas
Review containment areas associated

Centennial Hall Mineral

TR003 - West of Owen

TR014 - west of Kiehle

TR004 - East of Selvig
Widseth Field Mineral

TR016 - West of Kiser

Mineral Oil (94 each)
with oil-filled equipment and indicate

Sahlstrom Conf. Cen

TR015 - East of Early

Horticulture Building

TR010-012 - Sports
whether the following criteria are met.

Research Center
TR002 - North of

TR006 - North of

TR009 - North of
Mineral Oil (260)

Mineral Oil (219)

Mineral Oil (135)

Mineral Oil (135)

Mineral Oil (350)

Mineral Oil (180)

Mineral Oil (300)

Mineral Oil (140)

TR001 - West of

TR007 - West of
TR005 SW Ag
Indicate Yes, No or N/A for each

Center, RM 170
TR008 - East of

TR013 - East of
Mineral Oil (74)

Mineral Oil (74)

Centennial Hall

Childhood Bldg
Evergreen Hall
item. For any answer indicated as No,

Heritage Hall

Mineral Oil
indicate specific finding, corrective

Oil (158)

Oil (250)

Building
action(s) required, along with the date,
time and person(s) notified of actions

Hall

Hall

Hall
required.
1. Containment area, if present, is dry or has
a minimal level of standing water.
2. There is no evidence of release or
regulated substance in containment area,
if present.
3. Containment structures, if present, are in
good condition and free from cracks,
chipping or other damage, and in good
condition.

Part C. Safety Precautions & General Conditions

Widseth Field Mineral

TR016 - West of Kiser

Mineral Oil (94 each)
Review safety precautions in the area of
Sahlstrom Conf. Cen

TR015 - East of Early

Horticulture Building

TR010-012 - Sports
the oil-filled equipment and indicate

Research Center
TR002 - North of

TR006 - North of

TR009 - North of
Mineral Oil (260)

Mineral Oil (219)

Mineral Oil (135)

Mineral Oil (135)

Mineral Oil (350)

Mineral Oil (180)

Mineral Oil (250)

Mineral Oil (300)

Mineral Oil (140)

TR001 - West of

TR003 - West of

TR007 - West of
TR005 SW Ag
whether the following criteria are met.

Center, RM 170
TR004 - East of

TR008 - East of

TR013 - East of

TR014 - East of
Mineral Oil (74)

Mineral Oil (74)

Centennial Hall

Centennial Hall

Childhood Bldg
Evergreen Hall
Indicate Yes, No or N/A for each item.

Heritage Hall

Kiehle Hall

Mineral Oil
Selvig Hall
Owen Hall

For any answer indicated as No, indicate

Oil (158)

Building
specific finding, corrective action(s)
required, along with the date, time and
person(s) notified of actions required.
1. Safety equipment is in place and
operative. Fire extinguishers in place.
2. There are no other conditions that should
be addressed for continued safe operation
or that may affect the site SPCC plan.
3. Information on site map & list is complete
and accurate.

Findings/Comments:

UNIVERSITY OF MINNESOTA | Environmental Health and Safety Annual OFE Inspection Form
Page 2 of 4 Rev. 5/2016
Part A. Container Visual Check
Review all oil-filled equipment,

TR017 - West of Bergland

piping and associated equipment

TR022 - East of Parking

TR023 - East of Parking

storage building Mineral

TR024 - South of Farm

TR019 - North of Farm
Laboratory Mineral Oil
and indicate whether the following

TR018 - Southwest of

TR021 North of hay

Farm Maint. building

Teaching/Outreach
criteria are met. Indicate Yes,

Mineral Oil (250)

Mineral Oil (680)

Mineral Oil (292)

Mineral Oil (250)

No or N/A for each item. For any

TR020 - East of
Research Ops
answer indicated as No, indicate

Mineral Oil

Mineral Oil
specific finding, corrective action(s)

Buildings
Oil (350)
required, along with the date, time

Lot C

Lot C
(250)
and person(s) notified of actions
required.
6. Labels and signage for reservoir is in
place, legible and accurate.
7. Exterior of reservoir, including paint
and coatings, is in good condition, with
no evidence of leaking around the
reservoir, concrete pad or ground.
8. Above-ground piping, valves, pumps,
sensors and associated equipment are
in good condition with no evidence of
leaking.
9. Foundations and supports are
structurally sound, free from corrosion
and other damage, and in good
condition.
10.Grounding straps, wires and sensors
are secure, free from corrosion and
other damage and in good condition.

Part B. Containment Areas

Review containment areas associated
storage building Mineral

TR024 - South of Farm

TR019 - North of Farm

with oil-filled equipment and indicate

TR018 - Southwest of

TR021 North of hay

Bergland Laboratory

Farm Maint. building

Teaching/Outreach

whether the following criteria are met.

Mineral Oil (250)

Mineral Oil (250)

Mineral Oil (680)

Mineral Oil (292)

Mineral Oil (250)

TR017 - West of

Indicate Yes, No or N/A for each

TR020 - East of

TR022 - East of

TR023 - East of
Research Ops

Parking Lot C

Parking Lot C
item. For any answer indicated as No,
Mineral Oil

Mineral Oil
indicate specific finding, corrective

Buildings
Oil (350)

action(s) required, along with the date,

time and person(s) notified of actions
required.
4. Containment area, if present, is dry or has
a minimal level of standing water.

UNIVERSITY OF MINNESOTA | Environmental Health and Safety Annual OFE Inspection Form
Page 4 of 4 Rev. 5/2016
5. There is no evidence of release or
regulated substance in containment area,
if present.
6. Containment structures, if present, are in
good condition and free from cracks,
chipping or other damage, and in good
condition.

Part C. Safety Precautions & General Conditions

Review safety precautions in the area of

TR018 - Southwest of

TR021 North of hay

Bergland Laboratory

Farm Maint. building

Farm Research Ops

Teaching/Outreach
the oil-filled equipment and indicate

TR024 - South of
TR019 - North of
Mineral Oil (250)

Mineral Oil (250)

Mineral Oil (680)

Mineral Oil (292)

Mineral Oil (350)

Mineral Oil (250)

TR017 - West of
whether the following criteria are met.

storage building
TR020 - East of

TR022 - East of

TR023 - East of

Farm Buildings
Parking Lot C

Parking Lot C
Indicate Yes, No or N/A for each item.

Mineral Oil

Mineral Oil
For any answer indicated as No, indicate
specific finding, corrective action(s)
required, along with the date, time and
person(s) notified of actions required.
4. Safety equipment is in place and
operative. Fire extinguishers in place.
5. There are no other conditions that should
be addressed for continued safe operation
or that may affect the site SPCC plan.
6. Information on site map & list is complete
and accurate.

Findings/Comments:

UNIVERSITY OF MINNESOTA | Environmental Health and Safety Annual OFE Inspection Form
Page 4 of 4 Rev. 5/2016