AFRC 944th Fighter Wing Annual Ground Safety Assessment/Inspection

• Document No.

• Audit Title

• unit

  Yes

  No

  N/A

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

COMPLIANCE WITH SAFETY PROGRAM DIRECTIVES

• 1. Management & Supervisor Support for Safety

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 1.1 Has the commander ensured all personnel are briefed on BE industrial hygiene surveys and reports? Posted for 10 days? Maintained on file for 2 years? 1.5.20.10

  Yes

  No

  N/A

• 1.2 Has the supervisor conducted and documented a hazard assessment to identify hazards and PPE required for a particular task? 14.3.1, 14.3.2

  Yes

  No

  N/A

• 1.3 Do supervisors ensure that PPE is provided, used, and maintained in a sanitary serviceable condition? 14.3.2

  Yes

  No

  N/A

• 1.4 Is protective footwear provided and worn when there is a reasonable possibility of sustaining foot injuries? 14.4.10

  Yes

  No

  N/A

• 2. Confined Space Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 2.1 Does the unit have a confined space program or policy?

  Yes

  No

  N/A

• 3. Lock-out / Tag-out Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 3.1 Does the unit have a Lockout Tagout Program?

  Yes

  No

  N/A

• 4. Fall Protection Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 4.1 Where, active or passive means of fall protection are not feasible and adequate lead time is available or for repetitive operations, is a JSA conducted and documented IAW AFI 91-202? AFI 91-203, Para 13.3.1.3.1 & 24.16.4

  Yes

  No

  N/A

• 4.2 For local procedural controls, driven by conditions unique to a local facility or equipment design, or local operational requirements, has a JSA been developed and documented IAW AFI 91-202 approved by the maintenance group commander and coordinated with the organizational and appropriate Ground Safety office before the procedural controls are used? AFI 91-203, Para 24.16.5.2.3

  Yes

  No

  N/A

• 4.3 Does each fall protection plan include a rescue plan which includes the availability of rescue personnel, ladders or other rescue equipment shall be determined prior to using a fall arrest system? AFI 91-203, Para 13.7, 13.4.6.1.9 & 24.16.5.2.1<br> <br> <br>

  Yes

  No

  N/A

• 4.4 Is the JSA, developed specifically for the worksite, kept up to date and maintained at the work center for the work site, i.e. Maintenance Supervisor or Superintendent, Flight Chief, Supervisor office, TODO offices, etc.? AFI 91-203, Para 13.3.1.3.1<br> <br>

  Yes

  No

  N/A

• 4.5 Does the JSA include specific items? AFI 91-203, Para 13.3.1.3.1. - 13.3.1.3.1.4

  Yes

  No

  N/A

• 4.6 Is a supervisor designated in writing, responsible for procurement of fall protection/fall arrest systems required by the organization or shop? AFI 91-203, Para 13.5

  Yes

  No

  N/A

• 4.7 Does supervisor ensure each worker; qualified person and competent person using a fall protection/fall arrest system are trained and evaluated on proper use, application and inspection of fall protection and arrest systems? AFI 91-203, Para 13.5

  Yes

  No

  N/A

• 4.8 Does training include: 1. methods of use, 2. application, 3. inspection and storage, as well as any manufacturer‘s recommendations, 4. application limits, 5. proper anchoring and tie-off techniques, 6. estimation of free fall, 7. deceleration and total fall distance to prevent striking a lower level, 8. applicable fall protection, fall prevention, rescue and evacuation plans. AFI 91-203, Para 13.6

  Yes

  No

  N/A

• 4.9 Do anchorages for lifelines and lanyards support at least a 5000 pound load for each person connected to the anchorage and is only one PFAS connected to an anchorage point unless specifically certified for more? AFI 91-203, Para 13.4.6.7

  Yes

  No

  N/A

• 4.10 Do supervisors maintain manufacturer‘s instructions and performance testing information for PFASs used by their workers? AFI 91-203, Para 13.4.6.10.4 & 13.4.6.11.1

  Yes

  No

  N/A

• 4.11 PFAS equipment shall have the manufacturer‘s name, identification code and date of manufacture stamped on the equipment or permanently attached tag and shall be marked to indicate compliance with ANSI Z359.1. AFI 91-203, Para 13.4.6.2

  Yes

  No

  N/A

• 4.12 Is a user inspection made by the person handling or using this equipment each time it is used? TO 00-25-245, Para 2.4.2

  Yes

  No

  N/A

• 4.13 Is a periodic inspection conducted by personnel qualified in the use of this equipment, usually 7 or 9 level, and ensure all PFAS components receive a thorough inspection at least quarterly and the inspection is documented and maintained for at least one year? TO 00-25-245, Para 2.4.3 & 91-203, Para 13.4.6.10.3<br> <br>

  Yes

  No

  N/A

• 4.14 Are periodic inspections due dates affixed crossways on free ends of belts, harnesses, straps, etc., using black or white stencil ink, dates recorded in chronological order? (Example: "INSP due JAN 2007. Each subsequent inspection due date will appear below preceding date.) TO 00-25-245, Para 2.7

  Yes

  No

  N/A

• 5. Ground Safety Lesson Plans

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 5.1 Does the unit have any ground safety lesson plans, JSAs Etc?

  Yes

  No

  N/A

• 6. Job Safety Training (JSTG)

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 6.1 Has the work center supervisor developed a Job Safety Training Outline that is work center/ environment specific? (SEG 55 #4) 1.5.21.4

  Yes

  No

  N/A

• 6.2 Does the JST cover the 16 mandatory items listed in AFI 91-202, Attachment 5?

  Yes

  No

  N/A

• 6.3 Does the JST cover Job Specific Training Items as listed in AFI 91-202, Attachment 5 as required for the work center?

  Yes

  No

  N/A

• 6.4 Does the supervisor update the JST immediately when there is a change in equipment, processes or safety, fire and health requirements? 1.5.21.3, 1.5.21.5

  Yes

  No

  N/A

• 6.5 Does the supervisor utilize the JST when training new personnel to the work center, prior to the start of work for the new personnel? 2.3.3.1

  Yes

  No

  N/A

• 6.6 Does the Supervisor review and update the JST guide annually or when there is a change? 2.3.3.2

  Yes

  No

  N/A

• 7. Hazard Abatement

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 7.1 Does the Commander/USR report the status of all open RACs to the Wing Safety office monthly? 1.5.20.5, 3.4.2.3

  Yes

  No

  N/A

• 8. Risk Management Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 8.1 Does the unit have a Risk Management Program?

  Yes

  No

  N/A

• 9. Supervisor Safety Training (SST)

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 9.1 Have supervisors attended Supervisor Safety Training? (SEG 55 #10) 1.5.21.14, 2.3.2.1

  Yes

  No

  N/A

• 10. Motorcycle Safety Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 10.1 Is the Motorcycle Safety Representative appointed in writing? AFI 91-207, para 1.3.3.14

  Yes

  No

  N/A

• 10.2 Is the Motorcycle Safety Representative trained? AFI 91-207, para 1.3.5.7

  Yes

  No

  N/A

• 10.3 Are Installation/Base/Wing Commanders ensuring Motorcycle Safety Foundation (MSF) training or other DoD recognized training made available to DoD personnel who operate a motorcycle? AFI 91-207, para 1.3.3.7

  Yes

  No

  N/A

• 10.4 Have Unit Commanders taken proactive measures in promoting motorcycle safety?<br>(These actions include, but are not limited to face-to-face time with riders promoting positive riding attitudes/behaviors, and encouraging Ride Your Bike to Work Days, mentor rides, maintenance/safety workshops, sport bike classes, and similar activities, etc.)

  Yes

  No

  N/A

• 10.5 Are Commanders ensuring military riders are informed of motorcycle mentorship club benefits and their opportunity to join?<br>AFI 91-207, para 3.4.3.1

  Yes

  No

  N/A

• 10.6 Are Unit Commanders and Supervisors allowing personnel who operate a motorcycle on a roadway, and operators of government owned motorcycles to attend and complete an approved motorcycle rider education course?<br>AFI 91-207, para 4.5.1<br> <br>

  Yes

  No

  N/A

• 10.7 Does the MSR have a MUSST account in AFSAS to update motorcycle information?

  Yes

  No

  N/A

• 11. USR Responsibilities

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 11.1 Is a Primary & Alternate USR appointed in writing by the Commander? (SEG 54 #3) AFI 91-202 para. 2.2

  Yes

  No

  N/A

• 11.3 Was the Primary & Alternate USR trained within 2 UTA’s of appointment. 2.2

  Yes

  No

  N/A

• 11.5 Have the appointed USR's completed an Air Force Level ORM Training Course and do they maintain their certificates. 2.2.1

  Yes

  No

  N/A

• 11.8 Did the USR document the completion of the quarterly safety review on safety related matters? 8.5.1

  Yes

  No

  N/A

• 12. Local Purchase Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 12.1 Has the commander ensured requests for equipment, products, and services using purchase orders and/or GPC are reviewed for potential safety and health impact? (SEG 54 #6) 1.5.20.6

  Yes

  No

  N/A

• 13. Hazardous Communications Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 13.1 What processes/chemicals present hazards in this work area?

  Yes

  No

  N/A

• 13.2 Does the employee know how to interpret hazard symbols/ wording on hazard labels?

  Yes

  No

  N/A

• 13.3 Does the employee know what precautions are required when working with hazardous chemicals?

  Yes

  No

  N/A

• 13.4 Does the employee know where the MSDS’ are located for the chemicals used in the work? 2.5.3.2<br>center?

  Yes

  No

  N/A

• 13.5 Can the employee gain access to MSDS’? 2.5.1, 2.5.3.1, 2.5.3.4

  Yes

  No

  N/A

• 13.6 Can the employee demonstrate how to find knowledge on an MSDS? 2.7.2.1.5

  Yes

  No

  N/A

• 13.7 Does the Supervisor document initial worker HAZCOM Training? 91-203 A5.4

  Yes

  No

  N/A

• 14. Spot Inspection Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 14.1 Has USR conducted at least one spot inspection a month? 3.5.2

  Yes

  No

  N/A

• 14.2 Has the supervisor(s) conducted at least one spot inspection per month?

  Yes

  No

  N/A

• 14.3 Does the spot inspection form contain minimum items?

  Yes

  No

  N/A

• 15. Mishap Prevention Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 15.1 Has the USR ensured unit personnel are aware of mishap reporting procedures? 2.2.4.3

  Yes

  No

  N/A

• 16. Powered Industrial Trucks Program

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 16.1 Does the unit operate forklifts?

  Yes

  No

  N/A

• 16.2 Is the training documented on an AF Form 55, ARC.net or equivalent?

  Yes

  No

  N/A

• 16.3 Have the individuals completed recertification every three years?

  Yes

  No

  N/A

• 17. Fire Evacuation Plans & Fire Drills

  Yes

  No

  N/A

• 17.1 When was the last fire drill performed?

  Yes

  No

  N/A

MISHAP EXPERIENCE AND TRENDS

• Where there any mishaps reported since last assessment?

  Yes

  No

  N/A

SQUADRON SAFETY BOARD

• Air Force Visual Aid 91-307 - Air Force Occupational Safety & Health Program Poster? 8.5.9

  Yes

  No

  N/A

• AF Form 457, USAF Hazard Report Form (WITH EXAMPLE)? 4.3

  Yes

  No

  N/A

• VA 91-202, Unit Ground Mishap Notification Roster

  Yes

  No

  N/A

• 944FW Mishap Reporting Guide

  Yes

  No

  N/A

• Commanders Safety Policy? 1.5.14.13

  Yes

  No

  N/A

• CA-10, What Employees Should Do On The Job When Injured

  Yes

  No

  N/A

• OSHA Poster, 3165-12

  Yes

  No

  N/A

Facility Inspection

• Are areas where personnel walk and work, free of potential tripping and slipping hazards such as tools, electrical cords, air lines and packaging materials? 5.1

  Yes

  No

  N/A

• Are Exit signs in good working order and are tests documented monthly?

  Yes

  No

  N/A

• Are Emergency Lights in good working order and are tests documented monthly?

  Yes

  No

  N/A

• Are electrical receptacles and cover plates free of cracks that expose the interior of the receptacle and securely mounted? 8.2

  Yes

  No

  N/A

• Are cords that show signs of fraying, cracking, wearing or damage removed from service? 8.4.1.2

  Yes

  No

  N/A

• Are there any roll-up doors and are they in compliance? AFI 91-203

  Yes

  No

  N/A

• Are there any shelving units and are they in compliance to include shelf ratings? AFI 91-203

  Yes

  No

  N/A

• Are End of Day inspections documented on a Standard Form 701?

  Yes

  No

  N/A

SIGNATURE BLOCK

• Robert W. Taylor, SMSgt Ground Safety Manager 944 Fighter Wing Luke AFB, AZ 85309 DSN: 896-5361

  Sign