Information
Safety and Health Assessment Program Evaluation (SHAPE)
Company Name
Contact Name
Contact Email
Type of Visit
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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Conducted on
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Safety Review Visit Conducted by:
General Information
Employees
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Field Employees:
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Office Employees:
Required Postings
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1a.) Does the employer have posters dated 12-2012?
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1b.) Notice to employees-If a Job Injury Occurs (F242-191-909)
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1c.) Job Safety and Health Law (F416-081-909)
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1d.) Your Rights as a Worker (F700-074-909)
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1e.) Does the company maintain an OSHA 300 LOG for the current year in addition to the previous 3 years?
Accident Prevention Program (WAC 296-155-110)
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2a.) Is there an ACCIDENT PREVENTION PROGRAM Present?
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2b.) A description of the employer total safety and health plan?
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2c.) Does the company conduct an orientation for new hires including the process for performing work safely and the hazards associated?
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2d.) How and when to report on the job injuries and the location of first aid facilities and how to report unsafe conditions?
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2e.) What to do in an emergency
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2f.) Does company have an employee discipline program?
Safety Meetings (WAC 296-155-110)
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3a.) Are there safety meetings at the beginning of each job?
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3b.) Is there an established weekly safety meeting
Weekly Inspections (WAC 296-155-110)
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4a.) Is the company completing walk around inspections at the beginning and at least weekly on every job?
Personal Protective Equipment (WAC 296-155-200)
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6a.) Is there a policy informing employees of the use and care of personal protective equipment (PPE)?
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6b.) Are the employees trained?
First-Aid and CPR (WAC 296-155-120)
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8a.) Are First-Aid kits available to employees on each job?
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Locations:
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8b.) Are the first-aid supplies effective for job-site conditions?
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8c.) Does the company have valid CPR/First Aid trained Supervisors?
Globally Harmonized Systems (WAC 296-901)
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9a.) Is there a written HAZCOM (GHS) Program?
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9b.) Is there an MSDS/SDS?
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9c.) Are employees trained?
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9d.) Is training documented?
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9e.) Do employees have reasonable access?
Hearing Conservation (WAC 296-817)
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10a.) Is there a written hearing conservation plan?
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10b.) Are employees trained?
Permit Required Confined Space Program (WAC 296-809)
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11a.) Has the employer evaluated the workplace to determine if confined spaces are present?
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11b.) Is there a Written Confined Space Program?
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11c) Are employees trained?
Respiratory Protection (WAC 296-842)
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12a.) Has the employer conducted a Hazard Assessment
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12b.) Is there a written Respirator Protection Program?
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12c.) Are employees trained in the RPP?
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12d.) Were medical evaluations and questionnaires administered?
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12e.) Were qualitative FIT tests performed?
Excavation and Trenching (WAC 296-155 Part N)
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13a.) Is the company involved in trenching & excavation activities?
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13b) Does the company have an identified competent person?
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13c.) Does the company have documentation for its protective systems?
Fall Protection (WAC 296-155 Part C-1)
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14a.) Is there a Written Fall Protection Plan?
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14b.) Are employees trained?
MISC TOPICS
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99a.) Does the company have a ladder training program?
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99b.) Does the company conduct hand & power tool training?
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99c.) Does the company conduct machinery & equipment training?
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99d.) Has the company trained employees on powered industrial lift trucks? (WAC 296-863)
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99e.) Has the company trained employees on aerial work platforms? (WAC 296-869)
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99f.) Has the company conducted training when employees work around cranes?
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99g.) Does company have a Heat Related Illness Program? (WAC 296-62-095)
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99h.) Has the company developed a Fire Protection Program/Plan? (WAC 296-155-260)
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99i.) Has the employer identified and developed a Exposure Control Program? (WAC 296-823-11010)
Comments
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Status
