2016 JBS/PP SMS Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Lead Auditor

• Location
  Address

• Personnel

Emergency Response and Action Plan

• Annual Program Review Completed?

  Completed

  Not Complete

• Comment/ Corrective Action

• Equipment List (Hazmat and Confined Space)/Monthly PMs

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• Comment/Corrective Action

• Facility Training (monthly safety training topics one internal one external)

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• Comment/Corrective Action

• Team Emergency Response Training (8 Hr Hazmat CS Rescue, Incident Command)

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• Comment/Corrective Action

• Responder Tasks Assigned (incident command, Logistics, etc) - App A (NM)

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• Comment/Corrective Action

• Quarterly Hazwoper Drill Evaluation Form (can include Hazmat and CS Rescue Training) - App P (MF)

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• Comment/Corrective Action

• Evacuation Maps Current (updated with most recent projects) - App E

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• Comment/Corrective Action

• Annual Evacuation Drill (internal/external) Documented and Critiqued with findings on - App K

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• Comment/Corrective Action

• Emergency Light Monthly Inspection (PMs)/Mapped locations

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• Comment/Corrective Action

• Critical Equipment Process Emergency Shutdown - (review what facility using)

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• Comment/Corrective Action

• Incident Command log for Chemical Releases (last 12 months) - App L

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• Comment/Corrective Action

• Severe Weather Shelter/Power Outage Areas - App H

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• Comment/Corrective Action

• Bomb Threat Receipt form (documentation) App I (make sure use of updated program from 2015)

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• Comment/Corrective Action

• SCBA inspection form - App S

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• Comment/Corrective Action

• LEPC or Fire Dept Coordination

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• Comment/Corrective Action

• Tank Hydrostat testing current

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• Comment/Corrective Action

Confined Space Program

• CS Annual Program Review completed on Program specific form App I

  Completed

  Not Complete

• Comment/Corrective Action

• Using correct CS permit (including completing all fields) on file 1 year - App E (MF)

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• Comment/Corrective Action

• Contractor Authorization to Enter Facility CS (debriefing form); on file 1 year - App H (MF)

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• Comment/Corrective Action

• Confined Space Inventory and Evaluation Table (Key) - App A (MF)

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• Comment/Corrective Action

• CS hazard Assessments (including spec rescue procedures)/Written Procedures - App F (MF)

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• Comment/Corrective Action

• CS Entry and rescue rope history, usage, inspection log - App D (NMF)

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• Comment/Corrective Action

• Related Permits Verified (hot work, Line break permits)

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• Comment/Corrective Action

• Reclassification forms - App G (MF)

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• Comment/Corrective Action

Contractor Safety Program

• Annual Program Review completed

  Completed

  Not Complete

• Comment/Corrective Action

• Pre-Project Review and safety briefing form - App B (MF)

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• Comment/Corrective Action

• Contractor Sign in log - App F (MF)

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• Comment/Corrective Action

• Contractor Safety Orientation acknowledgment documentation - App E (MF)

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• Comment/Corrective Action

• Audits (weekly) - App D (MF)

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• Comment/Corrective Action

• Audits (Self) - App C (MF)

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• Comment/Corrective Action

• Plant ISNetworld usage/evaluation process (comparing Contractor Sign in log)

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• Comment/Corrective Action

• Review all ISN Exempt Contractor files (current) - Contractor safety data and general information - App A (M); insurance accord (coverages outlined in program); OSHA Logs; Safety Programs; Training; Orientation

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• Comment/Corrective Action

Electrical Safety Related Work Practices

• Annual Program Review completed (MF)

  Completed

  Not Complete

• Comment/Corrective Action

• Arc Flash Analysis (most current)

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• Comment/Corrective Action

• Quarterly Infra-red scans performed

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• Comment/Corrective Action

• Infra-red scan current and corrective action of identified hot spots (No critical or serious)

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• Comment/Corrective Action

• Electrical MCC inspections (PMs completed/Documented) - App H (MF)

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• Comment/Corrective Action

• Hot glove - 6 month verification process

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• Comment/Corrective Action

• Electrical Test Meter Monthly Inspection - App D (NMF)

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• Comment/Corrective Action

• Electrical Small Hand Tool Monthly Inspection - App E (NMF)

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• Comment/Corrective Action

• S/O cord requisition permit form - App B

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• Comment/Corrective Action

• Task Specific Procedures - App A

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• Comment/Corrective Action

• Energized Electrical Written Permit - App C

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• Comment/Corrective Action

Ergonomics Program

• Annual Program Review completed (MF)

  Completed

  Not Complete

• Comment/Corrective Action

• Annual Facility Ergonomic Assessment considering Injury/Illness records

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• Comment/Corrective Action

• Annual Facility Ergonomic Assessment considering Review of EJMS scores

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• Comment/Corrective Action

• Annual Facility Ergonomic Assessment considering Facility walk-through

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• Comment/Corrective Action

• Annual Facility Ergonomic Assessment considering Other means (Supervisor/Employee/Union Requests)

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• Comment/Corrective Action

• Trending completed identifying problems, departments, and/or jobs for CTD illness (Top Ten List)

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• Comment/Corrective Action

• Review Work Orders/MOC to verify progress

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• Comment/Corrective Action

• Mechanism to capture quick fixes completed by plant team.

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• Comment/Corrective Action

• Verification of employee involvement on ergo initiatives (EJMS, MOC's, Line meeting, Brain Storming, etc)

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• Comment/Corrective Action

• Plant has identified and implemented job rotations to prevent CTDs

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• Comment/Corrective Action

• Industrial Athlete Program used and documented (New Hire/LOA Stretching process)

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• Comment/Corrective Action

• Follow up process for ramp in (break in) pain- New Hire / LOA

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• Comment/Corrective Action

• PDA (physical demand assessments) completed for all positions (MF)

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• Comment/Corrective Action

• PDA (physical demand assessments) used when assigning Restricted duty.

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• Comment/Corrective Action

• Annual refresher training to include PIT CREW members will be trained on ergonomics and EJMS completion.

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• Comment/Corrective Action

• Knife sharpening program (New hires/dull knife complaints)

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• Comment/Corrective Action

• Annual refresher training to include Annual practical application training for Health Care

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• Comment/Corrective Action

• Annual refresher training to include Upper management and supervisors annual basic ergonomic principles.

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• Comment/Corrective Action

• Annual refresher training to include Annual practical application training for Maintenance and Engineering

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• Comment/Corrective Action

• Annual awareness training for all employees (line meeting) to include stretching.

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• Comment/Corrective Action

• Annual refresher training on work hardening and the JBS Ramp In process.

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• Comment/Corrective Action

• Annual line meeting dedicated to Ergonomics knife sharpening and maintenance.

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• Comment/Corrective Action

Fall Prevention and Protection Program

• Annual Program Review completed on program-specific form (MF)

  Completed

  Not Complete

• Comment/Corrective Action

• Master list identifying all equipment (Harness, Lanyard, Ladders)

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• Comment/Corrective Action

• Manufacturer info for ladders, harnesses, and lanyards

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• Comment/Corrective Action

• Documented monthly inspections completed on each full body harness and lanyard inspection form - App A (NMF)

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• Comment/Corrective Action

• Monthly Ladder Inspection form - App B (NMF)

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• Comment/Corrective Action

• Ladder Out of Service process - App C

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• Comment/Corrective Action

• Hazard analysis completed for each task identified (including rescue procedures) App G and H

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• Comment/Corrective Action

• Anchor points identified on map.

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• Comment/Corrective Action

Fire Prevention Program

• Annual Program Review completed

  Completed

  Not Complete

• Comment/Corrective Action

• Oily Rag Program - Documented SOP (NMF)

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• Comment/Corrective Action

• SOP for Aerosol exchange process

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• Comment/Corrective Action

• Fire Extinguisher location maps

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• Comment/Corrective Action

• Fire Extinguisher Monthly/Annual Inspection - App B (NMF)

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• Comment/Corrective Action

• Fuel Sources - Fire Prevention and Protection Program - App F

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• Documented process (SOP) of fire extinguisher recharges/exchanges

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• Comment/Corrective Action

• Fire Prevention Valve Inspection form (Weekly/Monthly) documentation - App C (NMF)

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• Comment/Corrective Action

• Fire Prevention Equipment Inspection Form (monthly) - App D (NMF) / Third Party Sprinkler Inspection Reports (at least annually) including reviewing any noted recommendations.

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• Comment/Corrective Action

Fire Protection Impairment Program

• Annual Program Review Completed

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• Comment/Corrective Action

• Process for Impairments outage incidents (Site specific - including Steam, CO2, and/or Water)

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• Comment/Corrective Action

• Fire Protection Impairment Tag completed last 12 months

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• Comment/Corrective Action

• Alternate Protective Measures Notification

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• Comment/Corrective Action

• Incident reports for fire incidents (summary documenting events)

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• Comment/Corrective Action

Hot Work Permit Program

• Annual Program Review Completed - App D (MF)

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• Hot work classification map - identifying Type 1, Type 2 & designated areas

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• Hot Work permits completed appropriately (including Contractors)

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• Comment/Corrective Action

• Monthly Welder inspection PM's - App C (NM)

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• Comment/Corrective Action

Hazard Communication Program

• Annual Program Review Completed - Completed on program specific form - App C (MF)

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• Comment/Corrective Action

• Hazardous chemical inventory list - App B (NMF)

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• Comment/Corrective Action

• Chemical Specific Procedures developed (chemical usage (mixing, handling), exposure).

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• Comment/Corrective Action

• SDS on file - Site Hawk system is functional

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• Comment/Corrective Action

• Required personnel trained on use of Site Hawk

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• Comment/Corrective Action

• Process to ensure proper chemical receiving SOP (tanks, totes, drums) & verify acknowledgments

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  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Chemical approval process in place (new or trial chemicals) - Using Site Hawk

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• PM's for eyewash and shower (documented monthly)

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  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Industrial Hygiene

• Annual Program Review

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Master log of IH Sampling Areas Identified (CO2, H2S, Acetic Acid, Chlorine, Heat, CO, etc)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Quarterly sampling of environmental stressors being completed and Documentation (unless otherwise specified per the environmental stressor)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
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  • No Activity

• Comment/Corrective Action

• Results of sampling posted on employee communication boards (min 15 days) App E and F

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  • 100% Complete
  • 90% Complete
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  • No Activity

• Comment/Corrective Action

• Sampling records retained permanently

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  • 100% Complete
  • 90% Complete
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  • 60% Complete
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  • No Activity

• Comment/Corrective Action

• Air sampling equipment being calibrated (per manufacturers recommendations) - maintained for 1 rolling year.

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
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  • No Activity

• Comment/Corrective Action

Heat Stress Program / Hot Weather Process

• Heat stress monitoring being conducted in outlined areas (and any others as requested)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
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  • No Activity

• Comment/Corrective Action

• Analysis to drive engineering controls

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Engineering controls documented (if any high reads are found)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
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  • No Activity

• Comment/Corrective Action

• Hot environment protocol

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  • 100% Complete
  • 90% Complete
  • 70% Complete
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  • No Activity

• Comment/Corrective Action

Hydrogen Sulfide Safety Program

• Notices posted that require monitoring (as identified on the log)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
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  • No Activity

• Comment/Corrective Action

• Monitoring being conducted (minimum weekly) - in areas identified on log

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  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Incident Investigation form - App B (MF)

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  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Carbon Dioxide Monitoring Program

• Notices posted (as identified on the log)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
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  • No Activity

• Comment/Corrective Action

• Monitoring being conducted at least quarterly - in areas identified on log

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
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  • No Activity

• Comment/Corrective Action

• Analysis to drive engineering controls

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Engineering controls documented (if any high reads are found)

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  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Radiation Program

• Notices posted (as identified on the log)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Monitoring being conducted at least quarterly - in areas identified on log

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Process in place to register equipment with specific state requirements (Department of Health)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
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  • No Activity

• Comment/Corrective Action

• Designated RSO

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Hearing Conservation Program

• Annual program review (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Current area sound survey within two years (and any new equipment tested at when implemented)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Dosimetry study completed (high noise areas - every 2 years) (third party)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
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  • No Activity

• Comment/Corrective Action

• Documented engineering controls

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  • 100% Complete
  • 90% Complete
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  • No Activity

• Comment/Corrective Action

Respiratory Protection Program

• Annual program review (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Master list of all employees issued respirators (Including an identification system on each respirator)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Tracking sheet of monthly Respirator cleaning and inspections (by unique identifier)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Master list of all respirator users and fit tests dates and fit factor (annually)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Manufacturer info for equipment

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Cartridge change out or Single Use Policy documentation - App A

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Voluntary Use Form (if any) - App B and C

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  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Lock Out/Tag Out Program

• Annual program review - Completed on program specific form - App F (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Equipment specific procedures written and in place - App B (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Equipment specific procedures reviewed and recertified within last 12 months

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Lock removal authorization form - App D (any within the last year and completed properly) (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Alternate Procedure Form - App C (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• List of all authorized employees - by department and lock number

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Are lock out devises singularly identified by shape, size and color?

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Yellow out of service lock/tag process

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Using correct Line Break permit (including completing all fields) completed properly (all closed loop systems) on file 1 year - App I (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Contractors utilizing line break permits (issued by JBS) - App I

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Personal Protective Equipment Program

• Annual Program Review (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Annual PPE Hazard Assessment been completed/verified (last 12 months) - App B

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Hazard assessment certification forms completed (last 12 months) - App B

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• PPE check sheet developed per unique job (based off PPE haz assessment)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• PPE check completed and documented as required

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Manufacturer information for all PPE

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• JSA (Job Safety Assessments) been completed for all unique jobs

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Prescription eyewear program for high impact jobs

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Knife Handling Program

• Process for transporting knives (straight, whizard, air knives, etc)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Annual program review (MF) Evaluate need for an annual review

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• SOP identifying process for storage of blades (new/used)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Powered Industrial Truck Program

• Annual program review - completed on program specific form - App J (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Pre-shift inspections and a tracking process to ensure all trucks receive the needed inspections / repairs - App C - H (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• SOP's for fueling / battery changing / charging - App A

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Site specific safety repairs (safety measures taken when repairing PID) - App B (if inhouse)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• SOP outlining process for new vehicle brought on-site / training

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Documentation of Dock plates rated and certifications

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• List of Authorized Operators - App P

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Suspension - Revocation Form - App L (NMF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Incident Policy in use - App K (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Manufacturer info for all PIT used onsite

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Rail car, Tanker & Hopper Safety Program

• Annual program review (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Site specific SOP's developed for rail cars, tankers/hoppers

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Coordination with railroad

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Controls are implemented (e.g, blue light / flag, derailer, radios, etc)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Fall protection systems in place

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Pedestrian warning system in place

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Vertical Reciprocating Conveyor Program/Freight Lift/Pedestrian Elevator

• All VRC identified

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Review monthly PMs

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Visitor Safety Program

• Process in place to capture visitors to the facility (maintain for 1 year)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Review visitor sign-offs

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Cold Weather Process

• Any cold weather gear

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• SOP for snow / ice removal

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• Chemical specific for chemicals used (such as ice melt)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Counter balances, chain and cable hoist

• Pre-use inspection completed

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• All annual external inspection completed

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

• All annual inspection findings repaired

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/Corrective Action

Annual Safety Action Plan

• Goals and Objectives Identified?

  Completed

  Not Complete

• Comment/ Corrective Action

• Facility Specific Health and Safety Policy

  Completed

  Not Complete

• Comment/ Corrective Action

• Lines Of responsibility, Authority, and Accountability identified

  Completed

  Not Complete

• Comment/ Corrective Action

• Safety Action Items Identified?

  Completed

  Not Complete

• Comment/ Corrective Action

• Monthly Steering committee meetings held and minutes distributed?

  Completed

  Not Complete

• Comment/ Corrective Action

Employee Involvement

• Suggestion Program/ Process for Safety Concerns?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Involved in Area Inspection/ Audit process

  Yes

  No

  N/A

• Comment/ Corrective Action

• Employee Involvement Process (other than teams and touch-n-go's)

  Yes

  No

  N/A

• Comment/ Corrective Action

• Knowledge of Line Meetings

  Good knowledge

  Some knowledge

  Very Little knowledge

  No Knowledge

• Comment/ Corrective Action

• Knowledge of Cardinal Rules

  Good knowledge

  Some knowledge

  Very Little knowledge

  No Knowledge

• Comment/ Corrective Action

• Knowledge Of Machine Specific training (operators)

  Good knowledge

  Some knowledge

  Very Little knowledge

  No Knowledge

• Comment/ Corrective Action

• Knowledge Of Lockout Procedures/ process (authorized)

  Good knowledge

  Some knowledge

  Very Little knowledge

  No Knowledge

• Comment/ Corrective Action

• Knowledge of Chemicals/ Training

  Good knowledge

  Some knowledge

  Very Little knowledge

  No Knowledge

• Comment/ Corrective Action

Incident Investigation Program

• JBS Incident investigation forms- app E,C,B,D (completing all section properly- including lost time where appicable

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Root Causes Identified

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/ Corrective Action

• Follow up on corrective actions

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/ Corrective Action

• Management review Process

  Yes

  No

  N/A

• Comment/ Corrective Action

• All required Signatures on Forms

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/ Corrective Action

• Completed in a timely manner?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Annual Supervisor/ Superintendent Training

  Yes

  No

  N/A

• Comment/ Corrective Action

• Incident report retention (min of 5 years)

  Yes

  No

  N/A

• Comment/ Corrective Action

Management Of Change Program

• Amount of MOC's completed in the last year (12 months)- small and large projects (20 min)

  Select 20 or more 15 to 19 10 to 14 5 to 9 1 to 5 None

  • 20 or more
  • 15 to 19
  • 10 to 14
  • 5 to 9
  • 1 to 5
  • None

• Comment/ Corrective Action

• MOC Initiation and Hazard Analysis form- app A (MF)

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

  • 100% Complete
  • 90% Complete
  • 70% Complete
  • 60% Complete
  • 50% Complete
  • No Activity

• Comment/ Corrective Action

• Description of change , why is the change being initiated, how will effect safety related issues

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• Comment/ Corrective Action

• Impact on Safety and Health

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• Comment/ Corrective Action

• Training requirements

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• Comment/ Corrective Action

• Review of impacted regulatory requirements

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• Comment/ Corrective Action

• Modifications to operating procedures

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• Comment/ Corrective Action

• Hazard Analysis (all items not required have n/a)

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• Comment/ Corrective Action

• human Factors design (PDA, JSA, EJMS and/ or Sound level reading)

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• Comment/ Corrective Action

• Environmental Analysis (all items not required have n/a)

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• Comment/ Corrective Action

• Levels of Authorization required

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• Comment/ Corrective Action

• Pre- start review completed per projects- app D (MF)

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• Comment/ Corrective Action

• project Line meeting (employee involvement) app B (MF)

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• Comment/ Corrective Action

• Comment/ Corrective Action

• Use of Addendums (if applicable)- app C (MF)

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• Comment/ Corrective Action

• projects documented on project master List- app F (MF)

  Yes

  No

  N/A

• Comment/ Corrective Action

Management Expectation Program

• Participation in all elements of the process (review MEP scorecard and MEP score)

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• Comment/ Corrective Action

• Verify that operations management team using as a tool to achieve goals

  Yes

  No

  N/A

• Comment/ Corrective Action

• Management scorecards issues monthly

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• Comment/ Corrective Action

• Verification that identified deficiencies are corrected (performance plan)

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• Comment/ Corrective Action

Safety improvement Team Policy

• Does the plant safety committee meet on at least a monthly basis?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Are meeting minutes maintained and posted for review and process to follow up on open items (review all minutes)

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• Comment/ Corrective Action

• Has the site established appropriate sub committees to execute the sites safety process?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Comment/ Corrective Action

• Does each safety committee (including safety steering committee) include both hourly and salaried employees?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Are safety committee members released fro the line to participate in each committee meeting?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Are hourly employees who serve on various safety committees provided a means by which employee can identify them on the floor?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Are employees encouraged to bring safety and health concerns to members of the various safety committees?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Does the site safety steering committee review the sites corrective action log at each meeting and assign responsibility for completing open items in a timely fashion?

  Yes

  No

  N/A

• Comment/ Corrective Action

Hazard Identification and Control Program

• Annual Program evaluation (review) being completed and documented

  Completed

  Not Complete

• Comment/ Corrective Action

• FELT - process to capture new management employees (supervisors and managers) and anyone identified for refresher

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• Comment/ Corrective Action

• Supervisor Daily and Leadership Periodic inspections being completed 9review sampling)

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• Comment/ Corrective Action

• Is the facility using unsafe condition action log and following up on deficiencies?

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• Comment/ Corrective Action

• Are safety work orders being prioritized according to 7.3 of the program

  Yes

  No

  N/A

• Comment/ Corrective Action

• Are hazards that present an immediate hazard to the employees being corrected immediately as stated in 7.2 of the program

  Yes

  No

  N/A

• Comment/ Corrective Action

• Are resources being properly allocated for corrective actions?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Completion of TNG/ Observation/ Verification by management team (review sampling) // Safety observations for Pork

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• Comment/ Corrective Action

• Is the facility using unsafe act corrective action log and following up on deficiencies?

  Yes

  No

  N/A

• Comment/ Corrective Action

• Is tracking/ trending performed to identify areas needing attention and reviewed with upper management

  Yes

  No

  N/A

• Comment/ Corrective Action

• Phase 2 findings entered into gaps log

  Yes

  No

  N/A

• Comment/ Corrective Action

• Phase 3 findings entered into gaps log

  Yes

  No

  N/A

• Comment/ Corrective Action

Safety Training and education (master list/ file review)

• New Hire Orientation ( using alchemy playlist)

  Yes

  No

  N/A

• Comment/ Corrective Action

• Annual Job Safety Analysis training (identifying the hazards of the job)

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• Comment/ Corrective Action

• Chemical Specific Training ( employees handling, mixing, exposure or receiving)

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• Comment/ Corrective Action

• Radiation Training (all employees exposed around equipment)

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• Comment/ Corrective Action

• H2S Training completed (for all employees required to use a monitor)

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• Comment/ Corrective Action

• CO2 training completed (all employees required to use a monitor)

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• Comment/ Corrective Action

• Machine Specific training (operators) e.g. saws, air knife, whizard knife, skinners)

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• Comment/ Corrective Action

• Process for capturing job transfers/ bids (reviewing any related training)

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• Comment/ Corrective Action

• Annual Safety Training (alchemy playlist)

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• Comment/ Corrective Action

• Ergonomics Training for Management (within last 2 years)

  Yes

  No

  N/A

• Comment/ Corrective Action

• Review Line Meetings (past six months)/ tracking system for missed employees

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• Comment/ Corrective Action

• Confined space training- authorized entrants/ attendant

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• Comment/ Corrective Action

• Electrical Qualified Training- basic, qualified and arc flash

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• Comment/ Corrective Action

• Fall Protection training (competent person & authorized) including anchor points locations

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• Comment/ Corrective Action

• Fall Prevention training (restraint/ positioning)

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• Comment/ Corrective Action

• Hot work training completed for authorized employees/ Fire Watch/ hot Work permit (classification)

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• Comment/ Corrective Action

• Welding/ grinding/ cutting training completed for authorized employees

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• Comment/ Corrective Action

• Respiratory protection training for all users

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• Comment/ Corrective Action

• Fire extinguisher training

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• Comment/ Corrective Action

• LOTO- Annual Authorized Employees review and audit- App E

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• Comment/ Corrective Action

• LOTO training records (authorized) - including equipment Specific signoffs with process for capturing any chnages

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• Comment/ Corrective Action

• PIT- Current authorized training (3 years) each PIT Authorized to operate , retrain after incidents

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• Comment/ Corrective Action

• PIT- Pre Qualifying form- App I

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• Comment/ Corrective Action

• PIT- Loading Dock policy/ Incident Policy- app K. Sop's for fueling, battery changing, charging

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• Comment/ Corrective Action

• PIT- Annual skills test (each PIT authorized to operate)

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• Comment/ Corrective Action

• SOP for Suppression system- (sprinklers and steam)

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• Comment/ Corrective Action

• SOP's for Railcars- training for all users

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  • 100% Complete
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• Comment/ Corrective Action

• Hand and Power Tools- authorized (mtc and production)

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• Comment/ Corrective Action

• Machine Guarding (mtc)

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• Comment/ Corrective Action

• Chemical Specific Training - aerosols (mtc)

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• Comment/ Corrective Action

• air Blow Gun- Authorized (mtc and production)

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• Comment/ Corrective Action

• Slings, hoist, come along- Authorized (mtc and production)

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• Comment/ Corrective Action

• PIT- loading Dock policy/ incident policy App K SOP's for fueling, charging, battery changing

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• Comment/ Corrective Action

• Fire Arm Training

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• Comment/ Corrective Action

• Bomb Threat Training

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  • 100% Complete
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• Comment/ Corrective Action

Safety Disciplinary Action policy

• Commitment to Safety Posting in Common Areas

  Yes

  No

  N/A

• Comment/ Corrective Action

• cardinal Rules policy posted in common areas

  Yes

  No

  N/A

• Comment/ Corrective Action

• Log to Track Safety Disciplinary violations (HR)

  Yes

  No

  N/A

• Comment/ Corrective Action

• Utilizing the correct discipline

  Yes

  No

  N/A

• Comment/ Corrective Action

Property and Fire Audit and Follow Up

• Loss Prevention Survey- No plant controllable recommendations (e.g. human elements, combustible storage)

  No

  Yes

• Comment/ Corrective Action

• Recommendations evaluated and responded (all recommendations responded)

  Yes

  No

  N/A

• Comment/ Corrective Action

• Combustibles stored properly

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• Comment/ Corrective Action

• property Loss Prevention Survey (all recommendations responded)

  Yes

  No

  N/A

• Comment/ Corrective Action

• Property/ Fire projects reviewed by GAPS prior to AFE submittal

  Yes

  No

  N/A

• Comment/ Corrective Action

Boiler Inspection and Follow Up

• inspections- no plant controllable recommendations (e.g. human elements, combustible storage)

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  • 100% Complete
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• Comment/ Corrective Action

• Jurisdictional Recommendations have been addressed

  Yes

  No

  N/A

• Comment/ Corrective Action

• Boiler Certs copy maintained in centralized location

  Yes

  No

  N/A

• Comment/ Corrective Action

Bloodborne Pathogens

• Is site-specific information completed in the Bloodborne Pathogens Exposure Control Plan?

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• Has the site implemented the corporate Bloodborne Pathogens Exposure Control Plan?

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• Documentation of Bloodborne Pathogens (extensive) training for Occupational Health Staff, Emergency Response Team, those trained in CPR/AED/First Aid, QA, HazMat, janitorial staff (JBS employees only) - every two years (US), 3 years (Canada)

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  • 100% Complete
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• Appropriate training materials used (i.e. AHA, ARC, NSC, JBS Powerpoint, etc.)

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• Bloodborne Pathogens Alchemy Training completed for all employees (at orientation and annually) - verify records

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• Are HBV immunizations offered to each employee with a potential for occupational exposure to blood or bodily fluids and are copies of the bloodborne pathogen vaccination/declination forms (APP A/B) maintained in the Occupational Health Department for each affected employee?

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• Is appropriate PPE readily available in the Occupational Health Department and to the members of the Emergency Response Team?

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• Are Occupational Health and Safety Staff employees familiar with the appropriate procedures for addressing potential exposure to bloodborne pathogens as well as the process for post exposure HIV/HBV testing of both the source and the person potentially exposed? (App C, D, E, & F)

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• Sharps Awareness - Glucometer/Blood Testing/Injections signs posted & reviewed with employees

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

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• Sharps containers in secure locations, less than 3/4 full and checked monthly (30 day checklist)

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  • 100% Complete
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• Sharps Awareness - Glucometer/Blood Testing/Injections signs posted

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  • 100% Complete
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• Is post exposure medical information properly documented (correct forms, marked "privacy case" on OSHA Log, recorded on separate Needle Stick/Exposure Log, vaccination declination/acceptance form) as well as filed and maintained confidentially?

  Select 100% Complete 90% Complete 70% Complete 60% Complete 50% Complete No Activity

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  • No Activity

Workman's Compensation (Case Management)

• In the case of panel providers , is the contact information fir those providers available and correct?

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• Comment/ Corrective Actions

• Does the site have an accurate and current contact list of medical providers (by specialty), resources and treatment options for use I work related case management?

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• Comment/ Corrective Actions

• Does the Occupational Health Manager/ Administrator provide case management for work related injuries/ illness (file review)

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• Comment/ Corrective Actions

• Does the Occ health staff maintain an accurate medical appointment schedule for all work related cases?

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• Comment/ Corrective Actions

• Does the Occ Health manager / Administrator maintain contact with each physician treating employees for work related injuries/ illness to review current status, the treatment plan and to facilitate the employees return to work?

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• Comment/ Corrective Actions

• Select a minimum of 10 claims off the OSHA 300 log within the last 12 months and review per case management questionnaire (review a variety of RD,L, Med Only, Indemnity and first aid case as well)

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• Comment/ Corrective Action

• Is documentation available with a minimum of off work status or restrictions completed by the treating physician/ care provider at each appointment and returned to Occ Health with the injured/ill employee

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• Comment/ Corrective Action

• Are all required state forms/ government forms in claim file? (if applicable)

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• Comment/ Corrective Action

• Are all current PDA' s available to the Occ Health staff for all operations employees

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• Comment/ Corrective Action

• Does the OHM participate in open claims review with adjusters at least quarterly and is the documentation provided

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• Comment/ Corrective Actions

• Are we utilizing MDA guidelines with our case management? (in the absence of MDA guidelines contacting care provider with concerns)

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• Comment/ Corrective Actions

Restricted Duty/Return to Work Program

• Employee restricted Duty/ Medical Duty Form being used- App A/B

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• Is the most current version of the restricted Duty/ return to work program in the Occ Health manual?

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• Red Card- App C

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• Restricted Duty Weekly Tracking Calendar- App D

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• Medical leave of Absence Letter (MLOA) temp restrictions- App E

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• Medical leave of Absence Letter (MLOA) perm restrictions- App F

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• Restricted Duty Tracking Spreadsheet- App G

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Drug Free Work Place

• Is the Occ Health staff trained and familiar with drug and saliva alcohol screening process

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• Is there minimum of one Occ Health staff members per shift certified as breath Alcohol Technician

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• Is there a designated drug and alcohol testing restroom where the faucet can be turned/ taped off and bluing agent added for urine screen collection

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• Are all drug screen results appropriately filed

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• Are all random drug and alcohol tests completed within the assigned month

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• Is documented employee consent obtained for all drug and/ or alcohol test withdrawals

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• Are all drug and alcohol chain of custody forms completed properly

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• Does the OHM have a current copy of the Drug and Alcohol policy printed and easy access to the staff and HR

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Emergency Response Team

• Does the site post a list of all Emergency Response team members and their contact information or department in areas where employees are likely to congregate

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• Does each member of the Emergency Response team possess current certification in CPR, First Aid and AED and are copies of certificates available for review

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Medical Surveillance (HazMat/Confined Space Response Team)

• Has each member of the sites hazmat/ Confined Space team undergone a medical assessment to include pulmonary function test and physical examination conducted by a physician both prior to assignment and annually thereafter

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• Does the Occ health staff maintain a current list of Hazmat/ Confined space rescue team members and physical dates

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• Is a copy of the physician or license health care professional's written respirator user recommendation on file for each covered employee

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• Has each employee who is authorized to wear a respirator (Hazmat, etc) thoroughly completed the respirator medical Evaluation Questionnaire within the past 12 months, was it completed within 2 weeks of the physical and are copies maintained in the employees active medical file

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• Does the Occ Health manager review and the sign the Respirator medical evaluation Questionnaire prior to the employee being sent for a physical as well as initial date the recommendations upon return and has the OHM reviewed any yes questions prior to exam (and have obtained additional information regarding the yes answers)

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• Does the Occ health staff conduct medical surveillance on each hazmat member during any release or drill

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• Hazmat Team Exit examination offer form (certified letter)

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Medical Surveillance (Hearing)

• Has the site implemented a medical audiometric surveillance program and is documentation supporting the program available for review?

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• Does the Occupational Health Manager/Administrator perform otoscopic examinations on each employee with an abnormal initial audiogram and refer employees where necessary to a Physician prior to the audiometric retest?

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• Are retests conducted within 30 days for employees who have a potential standard threshold shift on the initial or annual audiometric test?

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• Verify daily and annual calibration records

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• Are employees with Standard Threshold Shifts put on the OSHA 300 Log only after the physician's confirmation of work relatedness?

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• Verify CAOHC certification for Occupational Health Staff performing hearing tests.

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• OSHA posting - Medical

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Medication Processes

• Are medications carried by the Occupational Health Department covered under a signed physician standing order and/or medical directive?

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• Is access to medications controlled and limited to the Occupational Health Staff?

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• Are all medications which are maintained by the Occupational Health Department within their expiration dates?

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• Is the Occupational Health Staff documenting medication administration appropriately?

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• Does the Occupational Health Staff obtain signed acceptance and/or declination forms prior to giving any immunization with attention to contraindications specific to the agent used for the immunization?

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• Does the Occupational Health Department have a refrigerator for the storage of medication and is this refrigerator labeled "Medication Only?"

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• Is unit does packaging utilized for over the counter medications?

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Occupational Health Equipment, Supplies, & Facilities

• Does the Occupational Health Staff flush each eye wash station located in the Occupational Health Department for three minutes each month and, is this properly documented? Visual inspection weekly.

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• Is oxygen equipment available in the Occupational Health Department and in working condition and is secured?

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• Oxygen equipment checked monthly & documented.

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• Are AED's properly placed and accessible based on corporate recommendations and, has the site implemented the AED Compliance Management Program?

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• AEDs checked monthly & documented.

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• Is the emergency trauma bag/HazMat Medical Kit fully stocked, are all perishable items within their expiration date, and is the kit stored in a location where it is fully accessible to each member of the Occupational Health Staff?

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• Emergency response bag & Medical Kits checked monthly.

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• Does the Occupational Health Department have a working glucometer(s) and are the members of the Occupational Health Staff competent in its use?

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• Glucometer(s) checked monthly.

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• Does the Occupational Health Department have an otoscope and/or ophthalmoscope and are the members of the Occupational Health Staff competent in their use

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• Otoscope and/or ophthalmoscope & batteries checked monthly & documented.

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• Does the Occupational Health Department have a "Snellen"/"illiterate" chart to test for visual acuity and is it hung at the recommended distance (20 ft)?

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• Are flashlights and batteries available and accessible in the Occupational Health Department for the use of the Occupational Health Staff in the event of an emergency?

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• Flashlights and batteries checked monthly and documented.

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• Is EBT screening equipment calibrated and are calibration records maintained and available for review?

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• Are operations and reference manuals for screening equipment (i.e. EBT manual, glucometer manual, etc.) maintained in the Occupational Health Department and accessible to staff?

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• Does the physical environment of the Occupational Health Department allow for patient privacy and, is a private examination room available?

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• Does the Occupational Health Department & Staff have a professional appearance?

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• Is a stocked first aid cabinet, to include bloodborne pathogens PPE, maintained at each remote location and is documentation available indicating that these cabinets are inspected monthly by the Occupational Health Department?

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• Is there a contact at each remote location to ensure first aid equipment/supplies are monitored for compliance.

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Occupational Health Professionals

• Does the Occupational Health Staff hold regular (monthly) staff meetings and are the minutes of these meetings available for review? Does the Occupational Health Manager/Administrator conduct periodic in-service programs for the Occupational Health Staff and are these sessions properly documented?

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• Does each Occupational Health Staff member attend continuing education classes annually (or required by their licensure/certification)?

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• Does the Occupational Health Department have access to current health related resources for the use of the Occupational Health Staff?

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• Is each member of the Occupational Health Staff familiar with the location, layout, and management team of each facility?

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• Does the facility complete a new hire checklist for each new Occupational Health Staff member?

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• Are the Occupational Health Staff members familiar with the treatment, symptoms, and potential effects of ammonia and chlorine exposure?

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• Does the OH staff know how to access the SDS (on SiteHawk) and have it readily available for response efforts?

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• Is there continual communication between Safety and Occupational Health to discuss all injuries and illnesses? (interview staff)

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• Has each member of the Occupational Health Staff participated in a documented training session covering the requirements of HIPAA at time of new hire orientation and annually thereafter?

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• Does Occupational Health provide an orientation to all new employees regarding Occupational Health Department services?

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