Audit

EVALUATION/ASSESSMENT

1.1 Does the installation commander provide adequate funding and support for the safety and occupational health program (e.g., funding for required CEU safety training)? AFI 91-202 1.5.14.16

1.2 Does the ground safety office/staff: (applies to host/tenant safety staff) conduct safety program assessments and inspections of subordinate, tenant and geographically separated units (GSU) safety programs IAW Support Agreements?" AFI 91-202 1.5.15.4., & 8.4.2

1.3 Does the ground safety office/staff: (applies to host/tenant safety staff) track open findings and discrepancies until closure? AFI 91-202 1.5.15.4., 3.4.2.3., & 8.4.2. Evaluation/Assessment

1.4 Does the ground safety office/staff: (applies to host/tenant safety staff) provide identified potential Interim Safety Board (ISB) and SIB members training annually on the basics of mishap investigation? AFI 91-202 1.5.15.14., & 8.4.2

1.5 Does the ground safety office/staff: (applies to host/tenant safety staff) developed a Mishap Response Plan, addressing all disciplines (ground)? AFI 91-202 1.5.15.15., & 8.4.2

1.7 Does the ground safety office/staff: (applies to host/tenant safety staff) maintain consolidated occupational illness and injury logs to satisfy the OSHA requirement for single-point access to occupational illness and injury cases? AFI 91-202 1.6.4., & 8.4.2

1.8 Do qualified safety personnel assess the safety program management of each organization below installation level annually and conduct a program assessment on organizations with subordinate GSUs, Detachments or Operating Locations (OL) at least once every 36 months? AFI 91-202 3.3., & 8.4.2

1.6 Does the ground safety office/staff: (applies to host/tenant safety staff) review emergency plans and procedures to ensure safety concerns, procedures, notification, etc., are addressed? AFI 91- 202 1.5.15.15., & 8.4.2

1.7 Does the ground safety office/staff: (applies to host/tenant safety staff) maintain consolidated occupational illness and injury logs to satisfy the OSHA requirement for single-point access to occupational illness and injury cases? AFI 91-202 1.6.4., & 8.4.2

1.8 Do qualified safety personnel assess the safety program management of each organization below installation level annually and conduct a program assessment on organizations with subordinate GSUs, Detachments or Operating Locations (OL) at least once every 36 months? AFI 91-202 3.3., & 8.4.2

1.9 Do qualified safety personnel address the areas of command and functional manager support, compliance with program directives and the effectiveness of the mishap prevention program in program assessments? AFI 91-202 3.3.1., & 8.4.2

1.10 Do qualified safety personnel prepare a written report for each assessment and send a copy of the report to the commander and safety staff of the organization evaluated? AFI 91-202 3.3.2., & 8.4.2

1.11 Do qualified safety personnelty ensure checklists are available to all assigned personnel and are checklists reviewed at least annually for accuracy and relevancy? AFI 91-202 3.4.1.3., 8.4.2

1.12 Does the HOST safety staff inspect units that do not have an authorized full-time safety position? AFI 91-202 3.4.1.4

1.13 Has the safety staff developed and published an annual inspection schedule and distribute it to units? AFI 91-202 3.4.2., & 8.4.2

1.14 Does the safety staff provide an out brief to the commander and a formal written report after completion of inspection? AFI 91-202 3.4.2.2., & 8.4.2

1.15 Does the safety staff ensure the formal inspection report contains the following items as outlined in AFI 91-202, para 3.4.2.2.1.-3.4.2.2.9.? AFI 91-202 3.4.2.2., & 8.4.2

1.16 Has the safety staff identified high interest areas and if identified, has the COS designated them in writing and are they inspected and documented monthly? AFI 91-202 3.6., & 8.4.2

1.17 Does the safety staff conduct special inspections of installation child development centers, approved day care homes and play grounds that are part of real property? AFI 91-202 3.8.1

1.18 Does the safety staff coordinate with Services to inspect at least 10 percent of all approved home-day-care providers annually? AFI 91-202 3.8.1

1.19 Has the safety staff coordinated with Services to jointly conduct pre and post season inspections of seasonal areas and conducted post season inspections to identify any additional hazards, which should be corrected before operation? AFI 91-202 3.8.2

1.20 Does the safety staff ensure support agreements identify and delineate responsibilities IAW DoDI 4000.19, Interservice and Intragovernmental Support, and AFI 25-201, Support Agreements Procedures? AFI 91-202 8.1.3., & 8.4.2

1.21 Does the safety staff budget for training and safety promotional campaigns and budget, acquire and distribute safety education materials? AFI 91-202 8.3.6., & 8.4.2

1.22 Does the safety staff coordinate mishap investigation information with the ICPA and provide a representative to actively participate in the FECA Working Group? (if applicable) AFI 91-202 8.3.9., & 8.4.2

1.23 Does the safety staff conduct newcomers’ safety orientation (Local Conditions Course II)? AFI 91-202 8.3.15., & 8.4.2

1.24 Does the safety staff ensure local hazard information is developed and available for personnel
on extended (greater than 30 days) TDY to the base? AFI 91-202 8.3.15

1.25 Does the safety staff ensure unless otherwise specified in support agreements, will assist COS in new commander safety orientations in units without full-time safety staff? AFI 91-202 8.3.17

1.26 Does the safety staff inspect all workplace/facilities annually? AFI 91-202 3.4.1

1.27 Does the safety staff conduct annual workplace inspection on GSU's without fulltime safety
personnel (unless a support agreement specifies otherwise) and forwards a copy of report to the GSU and the parent organization? AFI 91-202 3.4.1.5., & 8.4.2

1.28 Does the safety staff ensure coverage of the spot inspection program developed by the COS of on and off duty activities that occur on and controlled by the installation? AFI 91-202 3.5.1

1.29 Does the safety staff ensure spot inspection documentation include all required information identified in AFI 91-202, para 3.5.3.1. - 3.5.3.8.? AFI 91-202 3.5.3.1. -3.5.3.8

1.30 AFRC SUP: Has the CSPT completed an annual review of all MEP's, and assessment of training, rescue procedures, qualification of entry supervisors, and a review of all (cancelled, revoked, completed) AF Form 1024 permits? AFI 91-203 23.2.5.7

MISHAP INVESTIGATION

2.1 Has the safety staff ensured the appropriate POC is notified, actively manage the recommendation through closure and provide status updates as outlined in AFI 91-204 for any open safety mishap recommendations that identify installation OPRs or OCRs? AFI 91-202
1.5.15.5., & 8.4.2

2.2 Does the safety staff ensure mishaps are properly investigated and reported in accordance with AFI 91-204 and discipline specific manuals (e.g., AFMANs 91-224)? AFI 91-202 1.5.15.11., & 8.4.2

2.3 Does the medical wing/group commander ensure timely notification to installation safety office for any injury producing events that occurred to military members (both on- and off-duty), and DoD civilians on duty IAW AFI 44-102, Medical Care Management? AFI 91-202 1.5.17.3

2.4 Does security forces provide a copy of SF blotter entries involving injury or death resulting from a mishap, motor vehicle mishaps (GMV/PMV), property damage as a result of a mishap, and any others as deemed appropriate by SFS? AFI 91-202 1.5.19.1

2.5 Are safety investigations completed within 30 days of the mishap? AFI 91-204 5.2

2.6 Does the Services Human Resources Office (HRO) forward copies of Form LS 1, Request for Examination and /or Treatment; Form LS 201, Notice of Employee's Injury or Death; and Form LS 202, Employers First Report of Injury or Occupational Illness involving NAF employees. AFMAN 91-224 2.5.2

2.7 Does the safety staff ensure the annual summary of work-related injuries and illnesses (OSHA 300A) is posted in a conspicuous place and remain in place until 30 April? AFMAN 91-224 6.7.1

HAZARD ABATEMENT

3.1 Does the safety staff process hazard reports, manages the hazard reporting process and assigns RACs to hazards and coordinate with health and fire protection officials when required? AFI 91-202 1.5.15.7.,8.4.2

3.2 Does the HOST GSM maintain the installation master hazard abatement file, including AF Form 3, Hazard Abatement Plan, covering safety, fire and health hazards & deficiencies? AFI 91-202 8.6.4

3.3 Does the HOST GSM ensure fire hazards are included in the master hazard abatement plan and fire deficiencies are excluded from the master hazard abatement plan? AFI 91-202 8.6.7

3.4 Do the Safety, Fire or Health officials assist functional managers in preparation of AF Form 3? NOTE: Enter only one hazard on each copy of the AF Form 3. AFI 91-202 12.9.2

3.5 Does the safety staff ensure a completed hazard abatement project is certified by the appropriate agency; safety, fire, or health, to ensure the hazard was abated properly? AFI 91-202 12.9.4.2

3.6 Does the safety council review the installation hazard abatement plan at least once a year? AFI 91-202 12.9.5

3.7 Does the COS send a written copy of the installation hazard abatement plan to the installation commander once a year for review and approval of priorities for projects? AFI 91-202 1.5.21.8

3.8 Does the safety staff ensure to incorporate safety, fire and health requirements into construction and modernization projects? AFI 91-202 12.10.1

3.9 Does the safety staff safety submit an End-of-FY Annual Hazard Abatement Survey report to their MAJCOM by 15 Oct each year? AFI 91-202 12.11

3.10 AFRC SUP: Are any hazards identified by an AF Form 1118 added to the JST Guide and employees trained on the interim control measures and documented? AFI 91-202 1.5.21.8

HAZARD REPORTING

4.1 Has the COS ensured that all requirements are met to validate hazards? AFI 91-202 4.3.4.1. - 4.3.4.5

TRAFFIC SAFETY

5.1 Has the GSM establish the local safety education program ? AFI 91-207 1.3.5.1

5.2 Does the GSM ensure to budget and manage funds for implementation of traffic safety program ? AFI 91-207 1.3.5.2

5.3 Has the GSM developed and implemented local programs which encourage the use of occupant protective devices (safety belts, air bags, child safety seats, helmets, etc.) ? AFI 91-207 1.3.5.3

5.4 Does the GSM ensure fully qualified, proficient, andcertified personnel perform instructor duties for the traffic safety courses required by this instruction? AFI 91-207 1.3.5.4

5.5 Does the GSM actively participate with the installation Traffic Safety Coordination Group (TSCG)? AFI 91-207 1.3.5.6

5.6 Does the GSM ensure coordinatation with unit commanders to ensure appointment of Motorcycle Safety Representatives (MSR) with units having motorcycle riders? (if applicable) AFI 91- 207 1.3.5.7

5.7 Does the GSM ensure the unit MSR is trained within 30 days of appointment on duties and responsibilities (e.g., MUSTT, program and training requirements, licensing and registrations, etc.)? (if applicable) AFI 91-207 1.3.5.7

5.8 AFRC SUP: Is Traffic Safety Course III or Alive at 25 being taught to all first term AF personnel? AFI 91-207 4.4

CONTRACT SAFETY

6.1 Does the safety staff take part in predesign, design reviews, preconstruction conferences, and preacceptance inspections? AFPAM 91-210 5.5

6.2 Does the safety staff review statements of work or performance work statements to ensure applicable safety requirements are included in service contracts? AFPAM 91-210 6.4

6.3 Does the safety staff attend pre-award surveys for services contract? AFPAM 91-210 6.4

6.4 Does the safety staff have established procedures to ensure they review selected local purchase requests for safety requirements and provide technical consultation when requested? AFPAM 91-210 AFI 91-202 7.1.4. 8.3.7

COUNCILS AND MEETINGS

7.1 Does the installation commander or vice commander chair the installation Safety Council and/or Environmental, Safety and Occupational Health Council (ESOHC)? AFI 91-202 AFI 90- 801 1.5.14.7. 4.3

7.2 Does the HOST safety staff provide a safety office member as an active participant of the Federal Employees Compensation Act (FECA) working group and lend support to specific issues and assist with problem solving at other base meetings (e.g., Aerospace M) AFI 91-202 1.5.15.2

7.3 Does the safety staff meet at least semi-annually to participate in the Environmental, Safety, and Occupational Health Council (ESOHC) to review policies and programs, establish goals, monitors progress and advises leadership? AFI 91-202 AFI 90-801 2.6.1. 5.1.1

EDUCATION AND TRAINING

8.1 Does the safety staff ensure all personnel with access to privileged safety information are trained annually on the proper handling procedures and maintain training documentation? AFI 91- 202 1.5.15.12., & 8.4.2 Education and Training

8.2 Does the safety staff provide mishap prevention and education material to subordinate and tenant units? AFI 91-202 1.5.15.16., & 8.4.2

8.3 Has the assigned COS completed the Chief of Safety Course (WCIP05B) within 90 days of assuming the COS position? AFI 91-202 2.1.1.2

8.4 Do fulltime safety professionals, maintain continuation proficiency by completing at least three safety related continuing education units (CEU) per year? AFI 91-202 2.1.2.1

8.5 Has the GSM completed the Senior Safety Professional course prior to assuming duties or completed the course within 1 year? AFI 91-202 2.1.3

8.6 Do units have a primary and alternate USR and have they received training within 30 days after appointment? AFI 91-202 2.2

8.7 Does the COS provide face-to-face training to new commanders within 60 days of their arrival or appointment on the safety and health of the organization and does the training include items addressed in AFI 91-202, para 2.3.1.1. -2.3.1.9.? AFI 91-202 2.3.1., 2.3.1.1. - 2.3.1.9. & 8.3.17

8.8 Does the supervisor conduct and document initial evaluations within 60 days of assignment to include a review of previously certified tasks? AFI 36-2201 6.5.3.7

8.9 Has the safety staff developed a Master Training Plan (MTP) or electronic equivalent to ensure completion of all work center duty position requirements? AFI 36-2201 6.7.1.2., & 6.7.1.2.1. - 6.7.1.2.4

8.10 Are supervisors conducting and documenting work center orientations within 60 days of assignment and as a minimum include the following information in AFI 36-2201, para 6.7.1.12.1. - 6.7.1.12.5.? AFI 36-2201 6.7.1.12

8.11 Do trainers and certifiers meet minimum requirements and have they attended formal training for their duties and responsibilities? AFI 36-2201 6.7.2., & 6.7.3

8.12 Do supervisors conduct and document an initial training evaluation of trainee qualifications within 60 days of initial assignment covering all required areas identified in AFI 36-2201, para 6.7.1.14.1. - 6.7.1.14.6.? AFI 36-2201 6.7.1.14., & 6.7.1.14.1. - 6.7.1.14.6

8.13 Does the AF Form 623 contain the following documents identified in AFI 36-2201, para 6.8.1.3.1. - 6.8.1.3.7., and any locally determined requirements? AFI 36-2201 6.8.1.3., & 6.8.1.3.1. - 6.8.1.3.7

VARIANCES

9.1 Does the ground safety staff maintain a master file of approved safety, fire protection, and health standards variances? AFI 91-202 8.3.11

OSHA COORDINATION

10.1 Is the HOST safety office the base POC for all Department of Labor’s (DoL) OSHA visits? AFI 91- 202 1.5.15.19

10.2 Does the installation have established procedures to meet OSHA and escort them during visits? AFI 91-202 8.8.1.2

10.3 Does the safety staff treat DoL OSHA notices of hazards in the same manner as an Air Force inspector report and does the safety staff evaluate and assign a RAC code to each hazard identified by OSHA inspectors? AFI 91-202 8.8.2

10.4 Does the safety staff ensure that DoL personnel conducting the inspection receive response to DoL inspection reports from the local level? AFI 91-202 8.8.4

10.5 Does the safety staff transmit a report on investigations or inspection visits within two working days after receiving a DoL OSHA citation to the following identified in AFI 91-202, para 8.8.5.1. - 8.8.5.8.? AFI 91-202 8.8.5., & 8.8.5.1. - 8.8.5.8

TREND ANALYSIS

11.1 Does the safety staff conduct an annual analysis and develop specific actions to reverse adverse trends? AFI 91-202 5.5.1.1

11.2 Does the analysis target specific problem areas with recommendations for commander approval and appropriate actions? AFI 91-202 5.5.1.1

11.3 Does the safety staff ensure analysis programs identify successes or problem areas and trends, measure safety program effectiveness and guide prevention actions? AFI 91-202 5.5.1.2

SAFETY AWARDS PROGRAM

12.1 Does the installation safety office (host) administer the Safety Awards Program? AFI 91-202 1.5.15.21., & 8.3.18

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.