Title Page



  • Year conducted

  • Actual date of CASDAP

  • Prepared by

  • Name of OHN/OHT


PE 16 Occupational Health

  • PE16.1.1 Do you have a written medical surveillance program and local written SOPs for all programs and services required by regulation? 5 CFR 339, DOD 6055.05M, DA PAM 40-11, AR 40-5, AR 40-400, AR 40-66, 29 CFR 1910

  • PE 16.1.2 Do you have a written Medical Surveillance program? 5 CFR 339, DOD 6055.05M, DA PAM 40-11

  • PE 16.1.3 Are workers enrolled/disenrolled in/from hazard-based medical surveillance programs using data received from IH surveys that require action per regulatory guidance? NGR 40-5; DoD 6055.05M

  • PE 16.1.4 Are technician records initiated, maintained, and retired IAW regulatory requirements?AR 40-5, AR 40-400, AR 40-66

  • PE 16.1.5 Are you executing your budget according to the spend plan provided to NGB? Current NGB Budget Execution Guidance (BEG), DA PAM 40 -11

  • PE 16.1.6 Is the Occ Health module (or other tracking method) being used for data trend analysis of program elements and to validate the budget spend plan? DA PAM 40-11, NG PAM 40-11

  • PE 16.1.7 Are current resources utilized in alignment with national strategic priorities? DA PAM 40-11, NG PAM 40-11

  • PE 16.2.1 Does the state have adequate staffing with the appropriate training to execute the minimum requirements of a Occupational Health Program? DA PAM 40-11, NG PAM 40-11, 29 CFR 1960.55-58

  • PE 16.2.2 Does Occupational Health collaborate with key stakeholders (Safety, IH, HRO, State Surgeon, OHAC)? NGR 40-5, DA PAM 40-11, AR 385-10, 29 CFR 1960.25(d)

  • PE 16.4.1 Do you measure the effectiveness of the Occupational Health Program to ensure that it is fiscally and regulatory compliant? DA PAM 40-11, 29 CFR 1960.79

  • Is the OHN appointed to appropriate committees? AR 385-10; AR 40-21

  • RN license current?

Sign off

  • Notes

  • On site Representative

  • Auditor Signature

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