A-Army hearing Program

1.00 Has the unit commander of noise exposed personnel appointed a Hearing Program Officer (HPO) / NCO to manage the Army hearing program?

2.00 Was this sub area surveyed when the program manager was appointed?

3.00 Has an Army Hearing Program SOP been published detailing procedures
to accomplish hearing program requirements?

4.00 Has a noise survey been conducted of all suspected noise-hazard areas and equipment, and are identified noise hazard areas posted with warning signs?

5.00 Are annual hearing tests (audiograms) performed on all soldiers and personnel who work in noise hazard environments and those who are occupationally exposed to impulse noise at 140dPB (or greater)?

6.00 Are hearing protection devices in use in the organization when required?

7.00 Do ALL noise exposed personnel receive hearing conservation health education annually?

Signatures
Program Manager
Evaluator

B-Fire Prevention

1.00 Has an individual been appointed to manage the fire prevention program?

2.00 Was this sub area surveyed when the program manager was appointed?

3.00 Has the unit established written procedures for the fire prevention program to include any procedures established to obtain fire prevention program support from other sources?

4.00 (WEIGHTED 2 POINTS) Are building fire risk management surveys
completed, documented, and records maintained (DA Form 5381 or
equivalent)?

5.00 (WEIGHTED 3 POINTS) Are fire extinguishers accessible, maintained in a fully charged and operable condition to include monthly & annual inspection, 6 year maintenance, & hydrostatic test, and kept in designated
places not obscured from view?

6.00 Are appropriate type and number of fire extinguishers available on the flight line?

7.00 Are safe aisles and passageways properly marked and is the width adequate for exits?
Are extension or flexible cords being utilized as a substitute for permanent fixed wiring?
Are grounding points properly inspected, tested, and marked?

8.00 Is paint and flammable or combustible liquids stored in approved containers or cabinets?

9.00 Is fire prevention training and fire extinguisher training conducted at least
annually?

Signatures
Program Manager
Evaluator

C-Hazards Communication

1.00 Has an individual been appointed to manage the hazards communication
program?

2.00 Was this sub area surveyed when the program manager was appointed?

3.00 Has a written hazard communication program (SOP) been implemented?

4.00 Is hazard communication training conducted and documented?

5.00 (WEIGHTED 2 POINTS) Are all hazardous materials present in the organization listed on the Hazardous Material list to identify required SDSs’ to have on hand?

6.00 (WEIGHTED 2 POINTS) Are all required Safety Data Sheets current (i.e.prepared by the manufacturer of the actual items that are currently on your hazardous materials list and in your hazardous materials lockers) and
located so the employees have access to them at all times?

7.00 Are hazardous material labeling procedures for portable containers of hazardous material in use in the organization covered in the SOP?

Signatures
Program Manager
Evaluator

D-Waste Management

1.00 Has an individual been appointed and trained to manage the waste
management program?

2.00 Was this sub area surveyed when the program manager was appointed?

3.00 Have written procedures been established in the unit SOP for the collection, management, and disposal of hazardous waste material to include operator level tasks?

4.00 Are appropriate records maintained for hazardous waste disposal?

5.00 Has a site specific spill prevention plan been developed and posted at oil
and hazardous material storage facilities?

6.00 Is secondary containment provided for the hazardous waste collection
area?

Signatures
Program Manager
Evaluator

E-Fod Prevention

1.00 Has an individual (who is neither the ASO/ASNCO nor the Maintenance Officer) been appointed to manage the FOD program?

2.00 Was this sub area surveyed when the program manager was appointed?

3.00 Is a FOD prevention program established in writing and include all the required items?

4.00 Are FOD inspections conducted as a minimum monthly by the FOD
prevention officer or NCO?

5.00 Is FOD prevention a topic of discussion at all monthly/quarterly aviation safety training meetings?

Signatures
Program Manager
Evaluator

F-Drivers Training and Education

1.00 Has an individual been appointed to manage the drivers training and licensing program?

2.00 Was this sub area surveyed when the program manager was appointed?

3.00 Are procedures established in the SOP for the following areas: selection, training, and licensing of vehicle and equipment operators in the unit?; driver endurance schedules?; safety precautions for vehicles transporting hazardous material such as flammables and munitions? ; convoy and off-road operations?

4.00 Does the unit conducting a drivers’ training and or education program have
written authority from the appropriate commander?

5.00 Are flight line/ramp drivers properly trained and are procedures established in the SOP and the driver’s training program for vehicle operations in the vicinity of parked or running aircraft?

6.00 Does the unit drivers’ training program include sustainment training?

7.00 Is a DA Form 348 and DA Form 348–1 (if necessary) maintained correctly
on every person in the unit who operates a vehicle or equipment owned or
leased by the U.S. Army?

8.00 Is the permit ledger maintained with required information and is the OF
346, or equivalent (5984), properly issued and controlled?

Signatures
Program Manager
Evaluator

G-Personal Protective Equipment

1.00 Has an individual been appointed to manage the PCE program?

2.00 Was this sub area surveyed when the program manager was appointed?

3.00 Are step by step procedures published in the organization to describe how
the personnel protective equipment program is implemented?

4.00 (WEIGHTED 2 POINTS) Has a job hazard assessment (Survey) been completed to determine if, and what hazards are present, or are likely to be present, which necessitate the use of personal protective equipment
(PPE)?

5.00 Has the employer determined the exact PPE (to include the specific types and size) necessary to protect the affected employee from the hazards identified in the hazard assessment?

6.00 Has the employer developed and implemented a training and certification program for employees required to use PPE identified in the workplace assessment?

7.00 (Weighted 2 Points) Has a respiratory protection program beenestablished where required?

8.00 Is adequate respiratory protection equipment available?

9.00 Have employees using respirators been fit tested and have completed
OSHA Respirator Medical Evaluations?

Signatures
Program Manager
Evaluator
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.