Facility Audit Form

• Facility Audit

• Conducted on

  Date

• Prepared by

• Location
  Address

Recordkeeping Forms and Recording Criteria (1904.29)

• Yes

  No

  N/A

• 1. Are the past 5 years of OSHA logs maintained?

  YES

  NO

  NA

• 2. Are all the entries current (6 days for OSHA 200; 7 days for OSHA 300)?

  YES

  NO

  NA

• 3. Has privacy information remained confidential?

  YES

  NO

  NA

• 4. Are all entries complete and available?

  YES

  NO

  NA

• 5. Are there supplement reports (either First Report or OSHA 101 or 301) available for all entries?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 6. Are all entries current (6 day rule OSHA 200; 7 day rule OSHA 300)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 7. Are all entries complete and accurate?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

OSHA Annual Summary (1904.32)

• 8. Is the OSHA annual summary completed annually and posted between 2/1 and 4/30?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 9. Is it posted in a conspicuous place?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 10. Are the summaries kept for 5 years?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Fatalities/Multiple Serious Injuries (1904.39)

• 11. If an accident involved >3 injured employees which required their hospitalization, was it reported to OSHA within 8 hours?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 12. Has a fatality occurred at this location? If so, was it reported to OSHA within 8 hours?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Notice of OSHA Violations

• 13. Is the facility free of OSHA violations within the last three years? If not, did follow up and resolution occur? Did the issues noted remain resolved with no reoccurrences?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Accident Investigation (Formal MTI Reports)

• 14. Are all Managers and Supervisors trained in Accident Investigation?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 15. Are all accident reports completed?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 16. Do the report contents accurately reflect the situation?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 17. Are corrective actions noted?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 18. Are the corrective actions adequate to prevent future occurrences?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 19. Were all the corrective actions completed?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 20. Were the appropriate procedures and programs updated as a result of information learned from incidents?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 21. Do the appropriate personnel complete the reports?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Case Management

• 22. Is adequate information documented or available from the treating physician to be able to classify the case per OSHA criteria?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 23. Does the final physician report note the employee is released to work with no restrictions?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 24. Is the local clinic aware of the Light Duty policy (i.e., are the injury and illness records (e.g., the log) reflective of good case management)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Employee Safety Meetings (e.g., monthly modules)

• 25. Are meetings held at least monthly?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 26. Are they documented with Attendance Roster?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 27. Do all employees attend?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 28. If additional meetings are held and documented, are the meeting topics appropriate for work activities at the location?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Safety Committee Meetings

• 29. Are Safety Committee meetings held monthly?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 30. Are management or supervision and employees in attendance?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 31. Are the meeting minutes documented and posted on an employee bulletin board?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 32. Do the minutes meet the criteria of the Health & Safety Committee guideline?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Air Monitoring (1910.1000)

• 33. Does the facility have an Industrial Hygiene Plan that verifies a review has occurred of the current operations of the site, as per our IH guidelines?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 34. Has it been reviewed within the past year?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 35.* Has an industrial hygiene study been conducted to determine employee exposures?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 36.* Were the results greater than action levels or PELs? If yes, were appropriate actions taken?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 37.*. Were the Employee Exposure Records provided to the employee?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 38.*. Have the IH report corrective actions been achieved?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 39.*. If required by a substance specific standard, has the appropriate regulatory standard language signage been posted (e.g., Asbestos, Benzene, etc.)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 40.*. If required, have the employees received training as required per the applicable substance specific standards?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• * If exposure is anticipated and no monitoring has been conducted, questions 35-40 are to be marked as NO, not NA.

Medical Surveillance

• 41. Are employees accurately classified by exposure potential (i.e, Facility/Plant or Site/Technical Services)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 42. Per physical classification, are the PWOs current and on file?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 43. If physicals are conducted greater than annually, are annual audiograms being conducted for personnel who are exposed to >85 dB of sound?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 44. Are medical restrictions communicated and enforced by supervision and management?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 45. Are non-cleared personnel re-tested or cleared by their personal medical physician?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 46. Is substance specific monitoring conducted as needed (e.g., benzene, formaldehyde, asbestos, etc.)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Personal Protective Equipment

• 47. Is PPE available, maintained, and used properly?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 48. Do workers know its storage location?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 49. Are workers trained in the use/care of PPE?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 50.* Are the site-specific PPE hazard assessments documented for all hazardous job tasks current to the operations at the location? Including job tasks assigned to contractor personnel (e.g., mowing.)

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 51.* Are the PPE hazard assessments signed/certified by the Health and Safety Manager?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 52.* Do the PPE hazard assessments contain the appropriate specificity to chemical protective clothing (e.g., nitrile gloves, PE coated tyvek, specific chemical cartridge, etc.)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 53.* Are employee-training certifications available for the site-specific PPE hazard assessments?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 54.* Do employees wear the PPE for the job task as designated on the PPE hazard assessment (i.e., employees may upgrade but cannot downgraded PPE)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• * If PPE hazard assessments are not available, questions 50-54 are to be marked as NO not NA.

Respiratory Protection Basics

• 55. Are employees req’d. to wear a respirator clean shaven?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 56. Are employees trained in respiratory protection?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 57. Are employees fit tested at least annually for all types of APRs allowed to be worn per the PPE haz. assessments?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 58. Are supplied air respirators used for routine job tasks? If so, are respirator fit tests being conducted for the ASR type of mask?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 59. Are respirators approved for the job tasks conducted?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 60. Review PWOs. Have employees been cleared by a physician to wear a respirator?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 61. Are respirators stored appropriately after use and cleaning in an air-tight bag or container?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 62.* Has a site-specific chemical cartridge change-out schedule been prepared?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 63.* Do employees have sufficient amount of the appropriate cartridges available on-site?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 64.* Do the employees know the cartridge change-out schedule?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 65. Are respirators being worn correctly?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• * If a chemical cartridge change-out schedule is not available, questions 62-64 are to be marked as NO, not NA.

SCBA

• 66. Are SCBA units being inspected on a monthly basis? Is the inspection documented on the CHES form? Are SCBA units being inspected on a monthly basis? Is the inspection documented on the CHES form?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 67. Are SCBA regulators and alarms serviced according to the manufacturer’s specifications?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 68. Is the SCBA air cylinder hydrostatic test date current (3 years for composite/5 years for steel)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 69. Are any cylinders beyond their life (e.g., composite: 15 yrs)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 70. Do all cylinders of purchased breathing air have a certificate from the supplier stating that the breathing air meets the requirements for Grade D breathing air?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Airline respirators and cascade systems

• 71. Are alarms and regulators serviced per the manufacturer’s instructions?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 72. If on-site airline compressor is used, how often is the air quality tested?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 73. Does the compressor have a CO alarm?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Hearing Conservation Standard

• 74. Does the facility have any areas or job tasks which may expose employees to >85 dB? If so, has any noise monitoring been performed in the facility?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 75. If noise has been measured >85 dB, has the facility prepared site-specific information regarding the work areas or job tasks that require hearing protection?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 76. Are engineering controls, administrative controls, or HPDs used where levels exceed the PEL?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 77. Are exposed employees receiving audiometric testing?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 78. Is the OSHA hearing protection standard posted in the facility?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 79. Are signs posted where hearing protection is required to be worn or specific to the job tasks?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 80. Are HPDs being worn in designated areas or designated job tasks by personnel?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 81. Do the PPE hazard assessments match the site-specific information and facility work practices (e.g., signage, employee practices)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Training

• 82. Employees assigned work in a confined space have completed Entry training?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 83. Employee supervising confined space entry permits have completed Entry Supervisor training?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 84. Personnel working in vicinity of confined space work activities are made aware of the relevant hazards?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 85. Are Entry Supervisors and designated rescue personnel currently trained in First Aid and CPR?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 86. Have Entry Supervisors and designated rescue personnel completed annual rescue training (month/year)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Testing and Monitoring

• 87. Is entry prohibited until initial testing of the atmosphere is done from the outside?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 88. Are tests performed, including oxygen content, flammability, and appropriate toxic materials?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 89. Are the instruments calibrated and calibration records current?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 90. Is entry prohibited if oxygen deficient, flammable materials, or toxic parameters are not met?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Labeling and Posting

• 91. Appropriate signs are printed in English and in the predominant language of non-English reading workers?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 92. Signage posted on each permit-required confined space: Danger, Confined Space and Enter by Permit Only

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 93. Are emergency procedures, including telephone numbers, for emergency response conspicuously noted on the permit that was posted during entry?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Personal Protective Equipment

• 94. Entry permit specifies the type of PPE to be used?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Add location
  Address

• Corrective Action

• 95. Equipment available, clean, and serviceable?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 96. Appropriate respiratory protection equipment being used?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Work Practices

• 97. Documentation is available demonstrating that job safety briefings were held prior to any confined space work?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 98. Conditions that prevent confined space entry (IDLH, oxygen deficiency, etc.) are corrected prior to commencing work?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 99. Lockout/tagout procedures specified for each type of confined space?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 100. Is initial cleaning of tank done from outside?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 101. Is equipment used to conform to requirements listed in policy (i.e, intrinsically safe)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 102. Employees construct a protective barricade to prevent inadvertent entry for all permit required confined spaces?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Rescue Procedures/First Aid

• 103. Procedures specified for each entry on the permit?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 104. Was a trained standby person available and equipped with SCBA as documented on the permit?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 105. Lifeline and communication to confined space workers remain unobstructed?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 106. Rescue team member always in the area of the confined space who is currently trained in CPR, First Aid, and Bloodborne Pathogens?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 107. Employees are aware of the location of the nearest First Aid kit and how to obtain emergency assistance?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Written Programming and Recordkeeping

• 108. Has the facility prepared the site-specific information which documents all confined spaces on-site, both permitted and non-permitted, their locations, hazards, etc.?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 109. Are permits for the past 12 months available for review?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 110. Are the permits completed adequately?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 111. Is documentation available for the annual review of confined space permits?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Bloodborne Pathogens

• 112. If applicable, has the facility prepared a site-specific Exposure Control Plan?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 113. Have these employees been trained in the ECP?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 114. Have these First Aid/CPR employees been trained in Bloodborne Pathogens?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 115. Have BBP employees been given the Hepatitis B vaccination shot series?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 116. Are completed declination forms available for employees who declined the shot series?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Hazard Communication

• 117. Does the facility have a written chemical inventory?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 118. Is the facility chemical inventory updated as new chemicals are introduced and is it current?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 119. Does the facility have MSDSs available of the chemicals listed on the chemical inventory?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 120. Does the facility have a procedure in place to obtain a MSDS if it is not received at the time of shipment?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 121. Is a responsible person designated to conduct haz-com training?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 122. Are all chemicals, excluding hazardous waste, labeled with chemical name and health/physical hazards?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Laboratory Safety

• Laboratory Safety relevant?

  Yes

  No

  N/A

• Inspection Items

Lab Safety elements

• 123. Is waste stored and managed appropriately (e.g., not on every shelf, spilling when cabinet door is opened?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 124. Are volumes of chemicals kept to a minimum?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 125. Are chemicals stored properly and by compatibility (acids with acids, etc.)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 126. Is laboratory PPE available, maintained properly, and used?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 127. Do employees know the location of PPE storage?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 128. Are employees trained in the use/care of PPE?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 129. Are safety eyewashes functional and easily accessible?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 130. Are hoods and other ventilation devices operable and tested quarterly?Are hoods and other ventilation devices operable and tested quarterly?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 131. Are chemicals properly labeled per HazCom?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 132. Are gas cylinders secured so they won’t fall?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 133. Are First Aid kits properly stocked and accessible?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 134. Is a Chemical Inventory prepared for the Lab chemicals or is it included in the Hazard Communication Chemical Inventory?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 135. Are MSDSs readily available on all chemicals?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 136. Has a site-specific Chemical Hygiene Plan been prepared?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 137. Has it been reviewed within the past year?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 138. Have employees been trained on it?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 139. Has the workplace been monitored initially to test for contaminant levels?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Hazardous Energy

• 140. Is hazardous energy on-site that requires lockout/tagout? If yes, has at least one authorized employee been identified and trained?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 141. Has the facility prepared site-specific Energy Control Procedures or SOPs for multiple source energy equipment?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 142. Has a Hazardous Work Permit been completed for past 12 months of LOTO jobs?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 143. Were the Hazardous Work Permits for LOTO completed adequately?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 144. Does each authorized employee possess a lock and are they in control of 1 key during LOTO jobs?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 145. Are tags in place and completed with name of person, date, and the reason of LOTO?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 146. Has the LOTO program been audited at least annually?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Confined Space Vendor

• 156. Is the vendor currently approved to conduct confined space work at a CHES facility?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 157. For an approved confined space vendor ensure the following documents are current and on file:

• 158. - current HazWoper training (initial and refreshers)

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 159. - confined space entry supervisor and/or entrant training

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 160. - rescue training, if providing own rescue team

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 161. - First Aid/CPR training for rescue team

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 162. - current PWOs within 12-24 months; if applicable, respirator clearance

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 163.* Was a job safety briefing conducted by facility prior to entry?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 164.* Did the facility document an outbriefing for the contractor after the space entry?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 165.* Were all proper work permits (e.g., confined space, hot work) completed prior to commencing work?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 166.* Is documentation of calibration records for air monitoring equipment available?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 167.* Did the facility keep a copy of the completed contractor confined space entry permits?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• * Items 163-167 must also be completed for CHES Site Services personnel who conduct confined space entry at a CHES TSDF.

Contractors

• 168. Has a Pre-Project H&S Review Checklist been completed for major contracts on-site, as per HS 1.33 Appendix 1?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 169. Were Personal Protective Equipment requirements met?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 170. Were training requirements reviewed and acceptable?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 171. Were Medical surveillance records reviewed and acceptable?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 172. Were respirator clearances received?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 173. BWas a Certificate of Insurance received?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 174. Were appropriate work permits completed in accordance with applicable regulations and company policy?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 175. Did the contractors receive site orientation training regarding emergency evacuation, site requirements, etc.?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 176. Did the facility conduct and document a job safety briefing for the contractor jobs on-site?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Hot Work

• 177. Has hot work been conducted on-site within the past year? If so, were hot work permits are issued for each day of hot work being conducted?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 178. Has the facility designated personnel who are authorized to conduct hot work?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 179. Have workers been trained on hot work operations?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 180. Does the facility have designated areas for hot work to be conducted? If so, has a hot work permit been completed and posted in the area?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 181. Are employees conducting the hot work indicated on the permit?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 182. BDo the permits note the time limit of authorization?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 183. Does the permit describe the type of work?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 184. Have the permits been properly completed?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 185. Was air monitoring for O2 and LEL conducted and documented on the permit, and were other relevant contaminants (e.g., organic vapors/toxic metals, if applicable) monitored and documented on the permit?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 186. Was the area of hot work secured or barricaded?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 187. Was proper supervisory authorization been obtained from the work area supervisor prior to hot work being conducted?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 188. Were fire prevention precautions taken?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 189. Were fire watches established and utilized for each permit?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 190. Were all possible lines, valves, pumps, sumps, and conduits been checked for hazardous vapors and/or locked out?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 191. Are all hot work permits kept on-site for twelve months?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

TSDF Emergency Respnse

• 192. Does the RCRA Contingency Plan address all of the OSHA Emergency Response Plan requirements?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 193. If no to #181, did the facility develop a full Emergency Response Plan (ERP) or an addendum to the Contingency Plan to address the OSHA requirements?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 194. Is the ERP content current to current facility plans, practices, personnel names (if applicable), etc.?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 195. Are the requirements of the Employee Emergency Action & Fire Prevention Plans addressed in either the RCRA Contingency Plan or ERP?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 196. Does the facility have a list of designated Emergency Response personnel?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 197. Have the Emergency Response personnel received separate training from regular HazWoper for Emergency Response?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 198. Have annual Emergency Response refresher training requirements been met?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 199. Is an employee alarm system been installed? If not, how is an alarm sounded in the facility? Do employees know the sound of the alarm?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 200. Has the Emergency Response Plan rehearsed regularly (e.g., at least yearly)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 201. Has the rehearsal been documented?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 202. Do the employees know the names of the primary and alternate emergency coordinators?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 203. Do the employees know the primary and alternate assembly points?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 204. Is appropriate emergency response equipment available and serviceable?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 205. Have employees been trained on the use of the emergency response equipment?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Emergency Equipment

• 206. Are emergency shower and eye wash stations available?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 207. Are fire extinguishers available?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 208. - within 50-75’ travel distance per class of materials?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 209. - inspected monthly?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 210. - inspected annually?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 211. - cylinder is within hydrostatic test date?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 212. - proper types for usage in lab?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 213. - location marked with signage or red color?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 214. - hung on wall or post and not more than 5 feet above floor?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 215. If emergency fire overhead doors are available, have they had an annual drop test performed? Are the results documented and on file?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 216. Has the fire suppression system been tested annually? Are the results documented and on file?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 217. Have the fire pumps been tested annually?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 218. Are First Aid kit(s) available and stocked adequately per size of the facility?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 219. Are bloodborne pathogens kit available or the material contained within the First Aid kit?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 220. Is emergency means of communication available?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Training

• 221. 24 or 40 hour Initial HazWoper training given to employee with TSDF positions or field personnel?

  YES

  NO

  NA

• Yes

  No

  N/A

• Issue Statement

• Corrective Action

• 222. HazWoper training given annually to appropriate personnel (via monthly modules or in one session)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 223. Have the H&S for Administrative Personnel training requirements met both initially and annually?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 224 (A). Have temporary personnel been trained appropriately (i.e., HazWoper required if they working with waste)?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 224 (B). Have personnel that ship hazardous waste samples or rad shipments Fed-Ex received ET 2020 (IATA Training)

  YES

  NO

  NA

• Issue Statement

• Corrective Action

Postings (1903.2 and 1910.1200 and BMP)

• 225. Is the current OSHA Health and Safety Policy posted?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 226. Have appropriate state labor and safety posters been posted and are they current?

  YES

  NO

  NA

• Issue Statement

• Corrective Action

• 227. Are OSHA policies communicated to employees by management?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 228. Is the Corporate Environmental, Health, and Safety Commitment posted in a conspicuous location?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 229. Was Management attitude cooperative concerning Health and Safety compliance?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Fire Suppression/Alarms (1910.165 and 157)

• 230. Is the fire alarm system available & functional?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 231. Are fire alarm boxes, if available, readily accessible and within 200 feet of employee access?

  Select YES NO NA

  • YES
  • NO
  • NA

• Corrective Action

• Issue Statement

• 232. Are fire extinguishers available?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Exits, Aisles, Building, Evacuation (1910.36 - 38)

• 233. Are exits route doors free, unobstructed, unlocked to outside of building, and open out?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 234. Exits and exit routes are marked with signs?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 235. Are exit signs clearly visible?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 236. Are exit signs illuminated with at least 5 ft-candles?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 237. Aisles are clean and unobstructed?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 238. Are exit routes at least 7'6" in ht. & at least 28 in. wide?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 239. Are evacuation routes posted and current?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 240. Does the site have an employee alarm system? Is it operable?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Housekeeping (1910.141)

• 241. Are all places kept clean, dry, free of unsanitary conditions?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 242. Do trash receptacles in break rooms have a cover?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 243. Are toilet facilities and washing facilities kept clean and sanitary?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 244. Are scrap, waste and debris safely removed from work areas?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 245. Are accumulations of dust routinely removed?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 246. Is potable water provided in adequate quantities?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 247. Are solid wastes handled properly and disposed to prevent menace to public health?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 248. Are an adequate number of toilets/showers available for employees?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 249. Is the designated break/lunch room free of toxic contamination?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 250. Is there adequate change room and lockers?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Machinery & Machine Guarding (1910.212 and 215)

• 251. Machine guards affixed?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 252. Machines designed for a fixed location securely anchored to the floor and hard wired?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 253. Emergency cut off switches functional?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 254. Preventive maintenance performed to ensure machinery is safe to operate?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 255. Work rests appropriately adjusted (1/8”) for grinding?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 256. Do operators wear double eye protection (e.g., safety glasses/goggles and face shield) during the grinder operation?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 257. If equipped with a guard, is it operated as per the manufacturer’s specifications? Do operators conduct a ring test of new wheels prior to placing on machine? Do side guards cover the spindle, nut and flange and 75% of the wheel diameter?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 258. Are the tongue guards maintained within ¼” of the wheel?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Electrical (1910.303-305)

• 259. Is dust prevented from routinely entering or accumulating on or around electrical enclosures or equipment? Are electrical or breaker boxes maintained in an open position?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 260. Light fixtures and bulbs covered? Is clearance below requirements - 8ft (1910.305(j)(1)(I)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 261. 3’ x 3’ clearance in front of electrical panels?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 262. Live parts of electrical equipment operating at more than 50 volts guarded by approved enclosure?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 263. Electrical equipment properly marked with required information?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 264. Flexible cords and cables protected?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 265. Temporary cords are not used for permanently affixed equipment

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 266. Electrical cords are not frayed, pulled away from plug, in poor condition, etc.

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 267. Ensure connections prevent strain relief on the cords (1910.303).

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 268. Clearance sufficient distances from live parts according to regulation (1910.303)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 269. Cords approved (1910.304)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 270. Is there proper identification of circuits and grounds (1910.304)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 271. Is proper grounding installed (1910.304)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Hand Tools

• 272. Is all equipment in good, workable condition, and inspected before use?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 273. Are electrical tools double-insulated or grounded?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 274. Are power-actuated tools properly stored when not in use?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 275. Are guards in place on all hand tools?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 276. If compressed air is used and the nozzle is dead-ended, is the end pressure reduced to 30 psi?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Walking/Working Surfaces

• 277. Are covers/guard rails in place for open pits, tanks, ditches, vats, etc. (1910.22)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 278. Are floor loads properly marked with maximum capacity and not exceeded (1910.22)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 279. Are floor and wall openings properly guarded using railings, toe boards, or covers for stairways, manhole floor openings, etc. (1910.23)? Note: loading dock are not required to be guarded.

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 280. Do wood ladders meet specifications required by OSHA (1910.25)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 281. Do metal ladders meet specifications (1910.26)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 282. Are safety requirements met for scaffolding (1910.28)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 283. Are employees who work at heights >6 feet provided with fall protection?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Flammable Liquids/Compressed Gases (1910.106)

• 284. Are flammable liquids, including wastes, stored in flammable storage cabinets or safety cans?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 285. Are bulk containers of flammable liquids grounded and bonded to containers during dispensing?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 286. Are general exhaust ventilation systems functioning adequately to remove fumes?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 287. Are job specific mechanical ventilation systems operating properly?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 288. Sources of ignition controlled where flammable vapors may be present?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 289. Is the appropriate electrical classification followed in areas where flammables are stored or processed (e.g., radios, electrical cords)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 299. Does the facility have a written Decontamination Program?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 300. Have employee been trained on the site-specific program?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 301. Do employee follow the Decontamination Program?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Fixed Cranes

• 302. Is the rated load capacity marked on each side of the crane (1910.179.b.5)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 303. Is the lifting device inspected prior to use (1910.179.j.2)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 304. Is the lifting device inspected (and documented) as per the manufacturer’s specifications and as per local regulatory requirements (1910.179.j.3)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 305. Do the inspections address the OSHA requirements (1910.179.j)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Yes

  No

  N/A

• Issue Statement

• Corrective Action

• 306. Are the ropes inspected at least once a month? Are the ropes certified by the inspector (1910.179.m)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 307. Is the initial operational test available and on file (1910.179.k.1)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 308. Is the rated load capacity test available and on file (1910.179.k.2)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 309. Has a maintenance program been established per the manufacturer’s recommendations (1910.179.1)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 310. Prior to each operator’s shift, is the hoist limit switch tested without a load (1910.179.n.4)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Mobile Cranes

• 311. Is the load rating chart available to the operator while at the controls (1910.180.c.2)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 312. Is the lifting device inspected prior to use (1910.180.d.2)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 313. Is the lifting device inspected (and documented) as per the manufacturer’s specifications and as per local regulatory requirements (1910.180.d.4)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 314. Do the inspections address the OSHA requirements (1910.180.d)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 315. Do the inspection records contain a certification statement, identifier of the crane, and the signature of the inspector (1910.180.d.6)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 316. Are the ropes inspected at least once a month? Is it certified by the inspector (1910.180.g)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 317. Is the initial operational test available and on file (1910.180.e.1)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 318. Is the rated load capacity test available and on file (1910.180.e.2)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Powered Industrial Trucks

• 319. Are the operators trained initially when the job duty is assigned, including a performance evaluation?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 320. Are the forklift operators re-evaluated every 3 years?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 321. Have any accidents or near misses occurred with a forklift? If so, did the operator receive re-training?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 322. Do the forklifts have seat belts? If not, is a retrofit kit available from manufacturer? If not, has the facility documented their efforts to obtain a seat belt kit from the manufacturer?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 323. Do the operators wear seatbelts when operating forklifts?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 324. Are forklift procedures followed during operations and maintenance of the trucks?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 325. Are trucks used only in proper designated areas?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 326. Are procedures followed for battery/fuel handling?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 327. Are forklifts properly stored when not in use (i.e., forks down)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 328. Are trucks examined daily or per operational shift for problems?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 329. Are the inspections kept for 3 months?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 330. Is there a maintenance program for the forklifts?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 331. Are the repairs for equipment deficiencies recorded, documented, and traceable, and maintenance records maintained for 6 years?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 332. Are forklifts tagged out when not working properly?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 333. Have forklifts been improperly altered by the facility?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Heavy Equipment

• 334. Is the rollover protection structure in place?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 335. Are seat belts in working order and being worn?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 336. Are all turn signals and lights in working order?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 337. Are pre-operation inspections being completed?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 338. Have employees been trained in the operation of the equipment? Is the training documented?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Excavation

• 339. Have personnel been instructed on how to properly conduct excavation operations?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 340. Has there been rainfall in the past 24 hours?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 341. Is there a competent person on site to inspect?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 342. Has the soil been tested by a materials lab to determine the soil type, or has the competent person performed the appropriate manual and visual tests to determine the soil class, and therefore, the set back distance?Has the soil been tested by a materials lab to determine the soil type, or has the competent person performed the appropriate manual and visual tests to determine the soil class, and therefore, the set back distance?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 343. Is the spoil pile greater than 2 feet back from the trench?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 344. Is adequate shoring or benching available in the trench?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 345. When Appropriate, has the trench been tested as a permit required confined space?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 346. Does the trench have a ladder or exit every 25 feet?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Job Safety Analysis/Job Hazard Analysis

• 347. Operations Safety Evaluation (OSE) checklists completed for scheduled jobs?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 348. OSE Review with H&S documented?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 349. Work permits (either Hazardous Work; Hot Work; LO/TO; or CSE) completed for each project?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 350. Work permit form completed properly (includes proper dates and signatures)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 351. Mandatory Site plans: (completed for all ) Clean up operations required by govt. body; corrective actions at RCRA sites; voluntary clean-up operations at uncontrolled; work conducted at TSDFs; Emergency Response Operations?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 352. All site plans, mandatory or not, are complete?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Emergency Response

• 353. ER site plan completed for all responses?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 354. H&S contacted on all ERs, except where exceptions authorized?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 355. Plan is thorough and all sections complete?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 356. Chapters 1-12 available for all responses?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 357. Air monitoring conducted as required and necessary?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 358. Level A PPE inspected and tested?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 359. Personnel have received level A training?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Air Monitoring Equipment

• 360. Equipment calibrations documented and available?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 361. Factory calibrations (if required) are current?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 362. Colorimetric indicator tubes w/in expiration dates?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

High Pressure Water Jetting

• 363. All employees have received training in accordance with guidelines?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 364. HPWJ checklist completed for each project?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 365. Hoses and other equipment inspected and tagged in accordance with guidelines?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Injury and Illness Prevention Plans (8 CCR)

• 366. Does the facility or location have a written Injury and Illness Prevention Plan (IIPP)?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 367. Is the facility plan signed/dated and reviewed annually by the noted responsible administrators of the plan?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 368. Is the facility or location compliant with the major topics presented in the plan?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 369. Is a method established to ensure that 2-way and anonymous safety communication exists?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

OSHA Recordkeeping Requirements

• 370. If records are maintained at a central location, is a notice posted indicating location address and telephone number?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 371. For records maintained at a central location, is there a notice posted providing the name of a person available during normal business hours who can transmit records?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 372. For employees on payroll during the posting period who do not normally (at least weekly) report into the location (i.e., telecommute or home-based), are annual summaries mailed or presented individually to employees?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Proposition 65 Notice

• 373. Does the business unit ensure that no discharges of Proposition 65 Hazardous Chemicals pass onto land, waterways, or into drinking water supply?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 374. Does the facility warn visitors that the facility or location contains Proposition 65 Hazardous Chemicals?Does the facility warn visitors that the facility or location contains Proposition 65 Hazardous Chemicals?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 375. Does the facility have Proposition 65 signage posted?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Ergonomic Requirements

• 376. Has a worksite evaluation for each type of job, process, and/or operation been conducted to identify activities which can contribute to repetitive motion injuries?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 377. Having identified exposures by evaluation and/or injury/illness occurrence, have interventions been introduced to minimize future employee exposure?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

General H&S Issues

• 378. Are JHAs/JSBs or HWPs completed for all non-routine job tasks?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 379. Does the facility have SOPs for all routine job tasks in all operational areas? Are the SOPs routinely reviewed at least once every 3 years?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 380. Do SOPs meet company standards?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Ergonomics Design

• 381. Is the workstation designed to minimize physical stressors in performing normal duties?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 382. Are commonly used workstation control devices installed to reduce these stressors? See list Section 2.4 of HS SOP HS-19.

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Workstation Control Devices

• 383. Does the design of the work task adequately minimize the physical stressors?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 384. Are techniques or procedures in place for handling difficult materials?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

• 385. Are high rates of repetitive motion avoided?

  Select YES NO NA

  • YES
  • NO
  • NA

• Issue Statement

• Corrective Action

Site Pictures

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