Information
Safety and Health Assessment Program Evaluation (SHAPE)
Company Name
Type of Visit
Status
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- Complete
- Cancelled
- Rescheduled
- Follow-Up
Retro Group
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- MBA-GRIP
- Individual
- Smart Dream Team
- Smart A Team
- Smart Advantage
- Smart Healthcare
- PITB
- PITB Platinum
- WSHL
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Safety Review Visit Conducted by:
Follow Up Scheduled:
-
Follow up scheduled (if Applicable):
General Information
Number of Employees:
Contact Name
Wisha Poster (WAC 296-800-200)
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1.) Does the employer have posters dated 12-2012?
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1a.) Notice to employees-If a Job Injury Occurs (F242-191-909)
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1b.) Job Safety and Health Law (F416-081-909)
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1c.) Your Rights as a Worker (F700-074-909)
Accident Prevention Program (WAC 296-155-110)
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2.) Is there an effective and practical ACCIDENT PREVENTION PLAN Present?
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2a.) A description of the employer total safety and health plan?
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2b.) An orientation showing employees what they need to know to perform their initial job assignments safely?
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2c.) How and when to report on the job injuries and the location of first aid facilities?
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2d.) How to report unsafe conditions?
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2e.) The use and care of personal protective equipment (PPE)?
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2f.) What to do in an emergency, including exit routes?
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2g.) Identification of hazardous gases,chemical, or materials used on-the-job and instructions on safe use emergency actions to take in the event of an accident exposure?
Safety Committee/Meetings (WAC 296-800-13025)
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3.) Is there an established Safety Committee?
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3a.) Did the employer with 11 or more employees establish a safety committee that meets at least monthly?
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4.) Is there established weekly safety meeting?
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4a.) Does the employer conduct at least monthly safety meetings (weekly on job sites)?
Weekly Inspections (construction) (WAC 296-155-110)
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5.) Is the company completing walk around inspections at the beginning and at least weekly on every job? (construction)
OSHA 300 LOG
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6.) Does company keep an OSHA 300 LOG
Personal Protective Equipment (WAC 206-800-160)
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7.) Has a hazard assessment been conducted?
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8.) Is there an effective written PPE Program?
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8a.) Are the employees trained?
Lockout/Tagout Control of Hazardous energy (WAC 296-803)
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9.) Is there a written LO/TO Program
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9a.) Are the employees trained?
First-Aid and CPR (WAC 296-155-120)
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10.) Are First-Aid kits available on every job?
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10a.) Are effective first-aid supplies available?
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11.) Does the company have valid CPR/First Aid trained employees?
Hazard Communication Program (WAC 296-155-17613)
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12.) Is there a written HAZCOM Program?
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12a.) Are employees trained?
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12b.) Is training documented?
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13.) Is there an MSDS
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13a.) Do employees have reasonable access?
Hearing Conservation (WAC 296-155-145)
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14.) Is there a written hearing conservation plan?
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14a.) Are employees trained?
Permit Required Confined Space Program (WAC 296-809)
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15.) Has the employer evaluated the workplace to determine if confined spaces are present?
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16.) Is there a Written Confined Space Program?
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16a.) Are employees trained?
Respiratory Protection (WAC 296-155-17613)
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17.) Has the employer conducted a Hazard Assessment
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18.) Is there a written Respirator Protection Program?
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18a.) Are employees trained in the RPP?
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18b.) Were medical evaluations and questionnaires administered?
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18c.) Were qualitative FIT tests performed?
Fall Protection (WAC 296-155 Part C-1 Construction) (296-800 General Industry)
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19.) Has employer conducted a hazard assessment
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20.) Is there a Written Fall Protection Plan?
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20a.) Are employees trained?
Welding and Cutting (WAC 296-155-400 thru WAC 296-155-420)
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21.) Does company have a Hot Work program established?
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21a.) Are employees trained?
MISC TOPICS
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22.) Does company conduct new hire orientation?
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23.) Does company have an employee discipline program?
