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136th AW Annual Safety Assessment
136th AW Annual Safety Assessment
Donald Seymore

136th AW Annual Safety Assessment Checklist

136th AW Annual Safety Assessment v.2

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Free 136th AW Annual Safety Assessment Checklist

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Safety Management Program

Unit Safety Representative (USR)

  • Has the commander appointed a primary and alternate USR in writing? AFI 91-202 1.8.21.2

  • Does the USR brief their commander quarterly on the units safety program? AFI 91-202 2.2.2.1

  • Has the USR attended or completed USR training? AFI 91-202 2.2

  • If deficient select the appropriate designator below.

  • Remarks :

Management Commitment

  • Is leadership actively involved in safety? AFI 91- 202 1.4.1.4

  • Ask personnel about theit Commander's/Supervisor's take on safety.

  • Do commanders ensure discrepancies are completed within 30 days or tracked and reported to the safety office every 30 days until complete? AFI 91-202 1.8.21.6

  • If deficient select the appropriate designator below.

  • Remarks :

Safety Bulletin Board

  • Is a safety board available and visible?

  • Is the required information posted?

  • Af 457, Af 457 directions, AFVA 91-307, commanders safety endorsement, mishap prevention brief, CA-10, mishap reporting procedures, SEG-15, SEW-15

  • If deficient select the appropriate designator below.

Emergency Procedures AFI 91-203 6.2.15 OSHA 1910.38

  • Ask personnel if they know: Emergency phone numbers, emergency EXIT locations, fire extinguishers and pull stations location and operation, location of the rally point, and location of the severe weather shelter in place locations.

  • Do personnel know emergency procedures for their area?

  • Has an emergency action plan been developed?

  • Has a written emergency action plan been written that meets the requirement of 29 CFR 1910.38

  • Are emergency procedures briefed annually?

  • Are briefings documented?

  • If deficient select the appropriate designator below.

  • Remarks :

Workplace Safety Inspections/Meetings

  • Is the Supervisor or USR conducting monthly workplace inspections? AFI 91-202 2.2.2.2

  • Are inspections documented IAW AFI 91-202 3.7?

  • Are emergency light tests being conducted monthly? OSHA 1910.37 & NFPA 101

  • Are they documented?

  • Are fire extinguishers inspected and signed off monthly? 91-203 41.2.2.2 and NFPA 10

  • Is the Supervisor or USR conducting monthly safety meetings? AFI 91-202 2.2.2.5

  • Are on and off duty safety items briefed?

  • Are safety meetings documented?

  • If deficient select the appropriate designator below.

  • Remarks :

Safety Training

  • Has a Job Safety Train Guide (JSTG) been developed for this section? AFI 91-202 Attachment 4

  • Does the JSTG meet AFI 91-202 Attachment 4 requirements?

  • Has the JSTG been reviewed annually and documented? AFI 91-202 1.8.22.4

  • Is the safety training documeted on an AFTO 55 or electronic equivalent (i.e. ARCNET)? AFI 91-202 1.8.22.5.1

  • Do NCO'S, Air Force civilians, and commissioned officers in a supervisory roll receive Supervisor's Safety Training (SST)? 91-202 1.8.22.13

  • If deficient select the appropriate designator below.

  • Remarks :

Personal Protection Equipment

  • Has the supervisor assessed all PPE needs for the work area? AFI 91-202 1.8.18.11.5

  • Are PPE inspections performed? AFI 91-202 1.8.23.5

  • Was any unserviceable PPE found during the assessment?

  • If deficient select the appropriate designator below.

  • Remarks:

Industrial Work Center

Fall Protection Program AFI 91-203 13.2 & AFI 91-203 24.16

  • Do workers perform duties at 4ft or greater?

  • Has a fall protection program been developed? ANSI Z359.2

  • Does program include an emergency primary and secondary plan if a worker falls? ANSI Z359.4

  • Is the PFAS equipment inspected at least quarterly and records of the inspections kept for at least one year? ANSI Z359.2 Sec 5.5

  • Do employees have documented training? 29 CFR 1926.503 (b)(1)

  • Does the equipment have the manufacturers name, ID code, and date? AFI91-203 13.4.6.2

  • Do all employees who perform work above 4ft, where PFAS systems are available have required training? AFI 91-203 13.5.1

  • If deficient select the appropriate designator below.

  • Remarks:

Lockout/Tagout Progam AFI 91-203 CH. 21,

  • Does this section have a Lockout/Tagout Program?

  • Has the Supervisor developed a Energy Control Program? 29 CFR 1910.147(c)(1)

  • Is each piece of equiment/machinery reviewed annually and documented? 29 CFR 1910.147(c)(6)(I)

  • If deficient select the appropriate designator below.

  • Remarks:

Forklift/Powered Industrial Equipment AFI 24-301, 29 CFR 1910.178 (I)(1)

  • Does the section use a forklift or any powered industrial equipment? 29 CFR 1910.178

  • Does the section have a list of approved trainers on file?

  • Are training programs available and do they meet the requirements in 29 CFR 1910.178(3)(I) for training program content?

  • Are operators reevaluated every 3 years?

  • Are training outline reviewed annually?

  • If deficient select the appropriate designator below.

Industrial Work Centers

  • Is this an Industrial area? (Assess items below and document findings)

  • Compressed Air Lines

  • Compressed Gas Cylinders

  • Hand Tools

  • Ladders

  • Machines firmly secured to floors, bases, or stands

  • Grinding Machines

  • Machine Guards

  • Hydraulic Floor Jacks - lubricated & inspected

  • Remarks :

Hazardous Communication Program (HAZCOM) AFI 90-821, 29 CFR 1910.1200

  • Does the shop maintain chemicals?

  • Has a written hazard communication program been developed? AFI 90-821 CH. 3 and 29 CFR 1910.1200

  • Are Safety Data Sheets (SDS) available?

  • Are chemical inventories available?

  • Are all chemicals label in accordance with the GHS system?

  • If deficient select the appropriate designator below.

  • Remarks :

  • Add media

Confined Space Program AFI 91-203 CH 23, 29 CFR 1910.146

  • Does the area have confined spaces?

  • Is the written confined space program approved and signed by the commander? AFI 91-203 23.2.7

  • Is the program reviewed and documented annually? AFI91-203 23.2.5.7

  • Are the workers that enter the confined spaces adequately trained? AFI91-203 23.2.7.2

  • Are AFTO form 1024's complete, with all of the information that is required? AFI 91-203 23.5.1

  • Are AFTO form 1024's kept on file for one year? AFI 91-203 23.5.1.1

  • If deficient select the appropriate designator below.

  • Remarks :

MICT COMMUNICATOR REVIEW AFI 91-202 3.4.4.

  • Supervisor's Occupational

  • USR

  • Commander

Mishaps over past 12 months

  • Were any mishaps reported over the past 12 months? If yes add total number in notes.

  • Number of mishaps

  • Add signature

136th AW Annual Safety Assessment
Donald Seymore

136th AW Annual Safety Assessment

136th AW Annual Safety Assessment v.2

Use this Template
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