AFRC 944th Fighter Wing Annual Ground Safety Assessment/Inspection - duplicate

• Document No.

• Audit Title

• unit

  Yes

  No

  N/A

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

POLICY and LEADERSHIP (Pillar 1)

• 1. Management & Supervisory Support for Safety

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• 1.1 SAFETY POLICY AND GOALS

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - Has the organization established mishap prevention goals, objectives and milestones? Please define.

  Yes

  No

  N/A

• - How has leadership communicated established policies and results-orientated goals and objectives for employee safety to employees?

  Yes

  No

  N/A

• - Do employees understand the goals and objectives for the safety and health program? Please explain.

  Yes

  No

  N/A

• 1.2 LEADERSHIP ENGAGEMENT

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - How are managers, supervisors and employees held accountable for meeting their responsibilities for workplace safety and health?

  Yes

  No

  N/A

• - Are there adequate resources (equipment, experts, budget etc.) dedicated to ensuring workplace safety and health? provide examples.

  Yes

  No

  N/A

• - Has the Commander been briefed on safety matters quarterly by the USR?

  Yes

  No

  N/A

• 1.3 AIRMAN PARTICIPATION

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - Has the organization established and implemented processes to ensure effective participation in the mishap prevention program by its Airman at all levels? provide examples.

  Yes

  No

  N/A

RISK MANAGEMENT (RM) ( Pillar 2)

• - Is risk management, integrating hazard reduction and safety policy into on and off duty operations and activities, evident in the organization? Provide examples.

  Yes

  No

  N/A

• - Is the unit inspected incorporating risk management into day to day mission planning and execution? Please explain

  Yes

  No

  N/A

• - Provide a summary indicating what JSA's are being used in the work enter and any RM processes documented on the AF Form 4437, Deliberate Risk Assessment Worksheet or equivalent?

  Yes

  No

  N/A

• - When purchasing new materials or equipment, or implementing new processes, what types of analysis are performed to determine their impact on safety and health? Is it adequate?

  Yes

  No

  N/A

• - When implementing/introducing non-routine tasks, materials or equipment, or modifying processes, what types of analyses are performed to determine their impact on safety and health? Is it adequate?

  Yes

  No

  N/A

• - Are Commanders and Supervisors trained in AF RM Fundamentals and other RM courses as appropriate and IAW AFI 90-802?

  Yes

  No

  N/A

• - Have Commanders and Supervisors ensured all personnel have been trained on AF RM Fundamentals?

  Yes

  No

  N/A

ASSURANCE (Pillar 3)

• 3.1 MISHAP and NEAR MISS EXPERIENCE and TRENDS

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - Are unit personnel aware of mishap and near miss reporting requirements?

  Yes

  No

  N/A

• - Did the organization take prompt action to address mishap findings and recommendations?

  Yes

  No

  N/A

• - Is the data from hazard reports or mishap investigations used to determine the potential for injuries and illnesses? Describe trend analysis, share there any discernible trends?

  Yes

  No

  N/A

• 3.2 COMPLIANCE WITH SAFETY PROGRAM DIRECTIVES

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - Have all findings/deficiencies from previous inspections/assessments been closed?

  Yes

  No

  N/A

• - Is the organization doing self assessments and uploading the required information into MICT?

  Yes

  No

  N/A

• - Does the USR conduct and document monthly spot inspections and follow up every 30 days for open discrepancies?

  Yes

  No

  N/A

• - Are there any open RAC's from identified findings or hazards? List items being tracked on the MHAP and status.

  Yes

  No

  N/A

• - Are supervisors conducting work center inspections and following up every 30 days for open discrepancies?

  Yes

  No

  N/A

• - Is there a minimally effective means for employees to report hazards and have them addressed?

  Yes

  No

  N/A

• - Have there been any hazards reported? We're the hazards mitigated or eliminated immediately?

  Yes

  No

  N/A

• 3.2.1. PERSONAL PROTECTIVE EQUIPMENT (PPE)

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center require PPE to perform tasks?

  Yes

  No

  N/A

• - Has the PPE been assessed and documented for all job tasks requiring its use?

  Yes

  No

  N/A

• - Are specific requirements from BIO Survey briefed?

  Yes

  No

  N/A

• - Are personnel aware of, and are they using proper PPE?

  Yes

  No

  N/A

• - Is PPE readily available, properly maintained and serviceable?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans adequate, used and available on PPE use, location, fit, care and limitations?

  Yes

  No

  N/A

• - Do lesson plans adequately cover the requirements of the PPE in the work center?

  Yes

  No

  N/A

• - Are assigned personnel receiving recurring medical examinations based on exposures in the work center? (E.g. Hearing conservation, blood work for fuel cell personnel, respiratory fit test)

  Yes

  No

  N/A

• 3.2.2. HAZARDOUS ENERGY CONTROL (LOCKOUT/TAGOUT)

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Is the work center exposed to hazardous energy control requirements?

  Yes

  No

  N/A

• - Has the supervisor identified all equipment in the work center requiring hazardous energy control?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans with step by step procedures adequate, used and available for each piece of equipment requiring LOTO?

  Yes

  No

  N/A

• - Are tags being kept for one year after removal and do they match the log?

  Yes

  No

  N/A

• - Are annual inspections accomplished?

  Yes

  No

  N/A

• - Are authorized personnel being evaluated?

  Yes

  No

  N/A

• - Does AFTO Form 244 match LOTO tag?

  Yes

  No

  N/A

• 3.2.3. HAZARD COMMUNICATION

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center have hazardous chemicals requiring a HAZCOM program?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans used and available to cover all hazardous material?

  Yes

  No

  N/A

• - Is Hazardous material properly labeled?

  Yes

  No

  N/A

• - Can shop personnel find information on Safety Data Sheets (SDS)?

  Yes

  No

  N/A

• 3.2.4. CONFINED SPACE PROGRAM

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center have requirements to enter confined spaces?

  Yes

  No

  N/A

• - Has the work center developed a Master Entry Control Plan (MEP) for recurring confined space entries?

  Yes

  No

  N/A

• - Have all required elements of the MEP been reviewed by the CSPT and meet applicable requirements?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans used and available for Entrant, Attendent, Supervisor, Monitor and Rescue Team?

  Yes

  No

  N/A

• - Do personnel performing tasks in confined spaces show adequate knowledge to ensure safe operations?

  Yes

  No

  N/A

• - Are the AF Form 1024, Confined Space Entry Permit, kept on file for one year?

  Yes

  No

  N/A

• - Are extraction exercises being performed?

  Yes

  No

  N/A

• - Is the emergency response plan adequate?

  Yes

  No

  N/A

• 3.2.5. MANUAL AND POWERED HOIST

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center have requirements to use manual and/or powered hoist?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans avalable?

  Yes

  No

  N/A

• - Is documentation of Inspections maintained? (Chains, hooks, etc)

  Yes

  No

  N/A

• - Are slings/Chains marked properly? (Load rating, manufacturers info, etc)

  Yes

  No

  N/A

• 3.2.6. RESPIRATORY PROTECTION PROGRAM

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center have requirements to use respiratory protection?

  Yes

  No

  N/A

• Is the work center under respiratory program?

  Yes

  No

  N/A

• - Is training and proper use and care adequate?

  Yes

  No

  N/A

• - Are personnel being Fit tested?

  Yes

  No

  N/A

• - Are respirators being stored properly?

  Yes

  No

  N/A

• 3.2.7. VEHICLE MOUNTED ELEVATED WORK PLATFORMS, SELF PROPELLED AND MANUAL PLATFORMS

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center have requirements to use vehicle mounted elevated work platforms, self propelled and manual platforms?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans used and available?

  Yes

  No

  N/A

• - Are fall protections requirements being adhered to?

  Yes

  No

  N/A

• - Is scheduled maintenance being performed and documented?

  Yes

  No

  N/A

• - Are manufacturers instructions on-hand?

  Yes

  No

  N/A

• 3.2.8. FALL ARREST SYSTEM(S)

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center have requirements to work at height?

  Yes

  No

  N/A

• - Are work center personnel aware of and are they using applicable Job Safety Analysis?

  Yes

  No

  N/A

• - Has Safety and applicable CC reviewed and approved?

  Yes

  No

  N/A

• - Are supervisors inspecting equipment and documenting the inspection quarterly?

  Yes

  No

  N/A

• - Is the competent person designated in writing?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans used and available?

  Yes

  No

  N/A

• - Are workers able to know the difference of the different types of system being used (fall arrest, positioning, restraint, etc?)

  Yes

  No

  N/A

• - Are workers inspection equipment prior to use?

  Yes

  No

  N/A

• - Are rescue plans adequate, available and exercised?

  Yes

  No

  N/A

• 3.2.9. FORKLIFT (MATERIAL HANDLING EQUIPMENT)

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center have requirements to use forklifts?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans adequate, used and available?

  Yes

  No

  N/A

• - Are pre-use inspections being performed and documented?

  Yes

  No

  N/A

• - Are forklift drivers re-certified every 3 years?

  Yes

  No

  N/A

• 3.2.10. PORTABLE and FIXED LADDER SAFETY

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• Does the work center have requirements to use portable or fixed ladders?

  Yes

  No

  N/A

• - Are individuals trained and are lesson plans used and available?

  Yes

  No

  N/A

• - Are ladders in a serviceable condition and stored properly?

  Yes

  No

  N/A

• 3.2.11. MOTORCYCLE UNIT SAFETY TRACKING TOOL (MUSTT)

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - Is MUSTT data up to date for the organization being assessed?

  Yes

  No

  N/A

• 3.3 PROVIDE ANY PROGRAM DEFICIENCIES OR POLICY SHORTFALLS AND REFERENCES

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - Identify potential hazards and confirm risks found during inspection/assessments.

  Yes

  No

  N/A

• - Did the organization meet its established mishap prevention goals, objectives and milestones?

  Yes

  No

  N/A

• 3.4. PROVIDE RECOMMENDATIONS FOR IMPROVEMENTS/COMPLIANCE

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - Evaluate inspection results and provide leadership recommendations for improvement/compliance.

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

• - Provide a measurement of the effectiveness of the units AFSMS.

  Not Applicable

  Below Standard

  Meets Standard

  Exceeds Standards

PROMOTION, TRAINING and EDUCATION (Pillar 4)

• - Do AF personnel (military, civilian) and advisory and assistance services contractors know the mishap prevention program requirements that apply to their daily duties?

  Yes

  No

  N/A

• - Do personnel understand AFSMS practices regarding possible hazard identifications, control and reporting procedures?

  Yes

  No

  N/A

• - Do personnel understand where and how they can practically participate in the AFSMS?

  Yes

  No

  N/A

• - Do employees feel free to participate in the AFSMS without fear of discrimination or reprisal? Please explain.

  Yes

  No

  N/A

• - Has the installation developed, implemented and integrated safety guidelines and standards into existing local level training programs?

  Yes

  No

  N/A

• - Are safety briefings and educational safety material provided to shop personnel?

  Yes

  No

  N/A

• - Are employees up to date on all safety training applicable to their duty section? (E.G. Supervisor Safety Training, JSTO, USR, Confined Space, Fall Protection, Lock Out Tag Out, HAZCOM, Forklifts, Aerial Lifts, Cranes, Hooks/Slings, etc)

  Yes

  No

  N/A

• - Have all personnel assigned received the required Traffic Safety Training? (E.G. Course II, Local Conditions Course, Course III, Traffic Safety Training)

  Yes

  No

  N/A

Safety Board

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

  Yes

  No

  N/A

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

  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?

  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