• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

IH Qualitative Survey

Description of Site Operations

  • Overview of site production activities (annual tonnage, products, shipping methods, etc...)

  • Number of employees, typical job tasks, mining method (stone quarry, excavated S&G, dredge, etc...)

  • Insert rough sketch of site layout here:

  • Add media

Air Contaminants and Chemical Hazards

Respirable Crystalline Silica (RCS)

  • Is there any visible dust generated through site activities?

  • If yes, what are the primary sources of visible dust?

  • What are the primary controls the site uses to control dust (water truck, spray bars, enclosed transfer points, etc...)?

  • What are the primary housekeeping practices at the site (water hose, dry shoveling, compressed air blow down, vacuum, other)?

  • Does all mobile equipment have enclosed cab and if so do operators keep windows and doors closed?

  • Does the QC lab have controls in place to control dust during sample processing?

  • Is respiratory protection available at the site?

  • If so, what type(s) of respiratory protection are available for employee use?

Other Air Contaminants & Respiratory Hazards

  • What are the typical welding methods and applications at the site (basic plant maintenance, mobile equipment wear parts, etc...)

  • Are all welding tasks done in open air with adequate natural or mechanical ventilation?

  • If welding is conducted in enclosed or confined spaces ( chutes, bins, hoppers, etc..) is supplemental mechanical ventilation provided during the task?

  • Are MSDS available for all chemicals defined as hazardous under MSHA 30 CFR Part 47?

  • Is a list of all hazardous chemicals available for the site as required under MSHA 30 CFR Part 47?

  • Add media

Noise and Physical Hazards

  • What are the primary noise sources at the site? (plant - screens, crushers, mobile equipment, etc...)

  • What are the secondary noise sources at the site? (customer trucks, tools/maintenance, etc...)

  • Is hearing protection available at the site?

  • What type primarily (plugs or muffs) and noise reduction rating (NRR)?

  • Is hearing protection worn by employees working in high noise areas (>85 dBA)?

  • Have any standard threshold shifts been identified through audiometric testing or hearing loss claims been made through workers compensation system?

  • If yes, was appropriate follow up and retraining provided in accordance with MSHA 30 CFR Part 62?

  • Does the site have practices in place to address thermal stress (heat or cold) such as hydration and work-rest regimens?

  • Add media

Audit of Group Standards Related to IH/OH

Group Standard - Respirable Crystalline Silica and Total Dust

  • Has a qualitative and quantitative risk assessment been conducted in accordance with the Group H&S risk management standard to determine exposure potential for every job classification and task?

Group Standard - Workplace Noise

  • Has a site noise survey been conducted?

  • Has a noise map been developed for the site?

  • Has noise dosimetry been conducted for employees anticipated to be exposed above 85 dBA?

  • Has the hierarchy of controls (HOC) been applied in cases where TWA noise exposures exceed 85 dB?

Other Group Standards - Ergonomics, Whole Body Vibration, Hand-Arm Vibration

  • Any ergonomic or other risks identified during survey? (QC sample collection & processing, maintenance, mobile equipment operation, etc...)

  • Have any musculoskeletal injury/illness claims been reported to Health Bridge that are could be attributable to repetitive motion or other ergonomic risk factors?

Summary & Overall IH Risk Perception

Summary and Perception of Overall IH Risk

  • Summary of Observations

  • What is the perception of the overall risk for the site?

  • Any significant safety-related issues or compliance deficiencies?

  • Any best practices or other notable accomplishments the site has made with respect to H&S?

  • Signature of H&S Professional Who Lead Survey/Audit

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