1. Management & Supervisor Support for Safety

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?

1.2 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

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

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

2. Confined Space Program

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

3. Lock-out / Tag-out Program

3.1 Does the unit have a Lockout Tagout Program?

4. Fall Protection Program

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 & 24.16.4

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

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, &

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

4.5 Does the JSA include specific items? AFI 91-203, Para -

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

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

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

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

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

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

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

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

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

5. Ground Safety Lesson Plans

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

6. Job Safety Training (JSTG)

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

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

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

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

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?

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

7. Hazard Abatement

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

8. Risk Management Program

8.1 Does the unit have a Risk Management Program?

9. Supervisor Safety Training (SST)

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

10. Motorcycle Safety Program

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

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

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

10.4 Have Unit Commanders taken proactive measures in promoting motorcycle safety?
(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.)

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

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?
AFI 91-207, para 4.5.1

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

11. USR Responsibilities

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

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

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

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

12. Local Purchase Program

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)

13. Hazardous Communications Program

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

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

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

13.4 Does the employee know where the MSDS’ are located for the chemicals used in the work?

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

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

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

14. Spot Inspection Program

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

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

14.3 Does the spot inspection form contain minimum items?

15. Mishap Prevention Program

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

16. Powered Industrial Trucks Program

16.1 Does the unit operate forklifts?

16.2 Is the training documented on an AF Form 55, or equivalent?

16.3 Have the individuals completed recertification every three years?

17. Fire Evacuation Plans & Fire Drills

17.1 When was the last fire drill performed?


Where there any mishaps reported since last assessment?


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

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

VA 91-202, Unit Ground Mishap Notification Roster

944FW Mishap Reporting Guide

Commanders Safety Policy?

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

OSHA Poster, 3165-12

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

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

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

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

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

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

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

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

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