Audit

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

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.