Annual Program Review - Slips, Trips, Falls

• Audit Title

• Site Name

• Conducted on

  Date

• Auditor

• Location
  Address

• Site EHS Manager

Applicable Standards

• Select those standards that apply.

  Select EHS&S standard 19 "Fall Prevention" 29CFR1910 Subpart D "Walking-Working Surfaces"

  • EHS&S standard 19 "Fall Prevention"
  • 29CFR1910 Subpart D "Walking-Working Surfaces"

Documents Reviewed

• Site Slip, Trip, Fall Assessment

• Training Program

• Training Records

• Site specific documents reviewed:

Program Execution

• Is there an IOSS program leader on site?

  Yes

  No

  N/A

• Has the site completed a slip, trip, fall assessment using the “J&J Slips, Trips and Fall Prevention Site Risk Assessment” or equivalent tool in the past three years?

  Yes

  No

  N/A

• What is the date of the last assessment?

• Has the organization established, implemented, and maintained a process to ensure that action items from the hazard identification/risk assessment are documented in a facility action plan?

  Yes

  No

  N/A

• What tool do they use to track actions?

Training

• What is the frequency of training?

  Select Initial Annual Every 3 Years Initial Only

  • Initial
  • Annual
  • Every 3 Years
  • Initial Only

• Does the training program cover the required program elements?

  Yes

  No

  N/A

• Has the organization conducted analyses of accident logs and incident records that involved slips, trips or falls in order to provide input for potential improvements in the facility’s Fall Prevention Program?

  Yes

  No

  N/A

Employee Discussions

• Discussions were held with the following groups or employees on site. List number of people when applicable.

Plant Tour

• Are signs posted advising not to walk and text?

  Yes

  No

  N/A

• Is signage present in stairwells to use handrails?

  Yes

  No

  N/A