FS Insurance Agency Safety Compliance Audit 2017

• Member Company:

• Conducted on:

  Date

• Conducted by:

• Member Company Representative:

I. POSTING OF NOTICES (29 CFR 1903 & 1904)

• 1. "Safety and Health Protection on the Job" Poster (1903.2) is posted/on file.

  Yes

  No

  N/A

• 2. Current year's OSHA 300 Log and 5 years of previous Summary of Occupational Injuries (1904.5) is on file.

  Yes

  No

  N/A

• 3. Current OSHA 300A and 5 years of summary form posted (February-April).

  Yes

  No

  N/A

• 4. Emergency phone numbers are accurate and prominently posted.

  Yes

  No

  N/A

II. NEW EMPLOYEE ORIENTATION

• 1. Company has a New Employee Orientation Program.

  Yes

  No

  N/A

• 2. Documentation of training is available for new seasonal, part-time, full-time, and temp agency employees prior to exposure to job/task related hazards.

  Yes

  No

  N/A

III. ACCIDENT REPORTING (29 CFR 1904)

• 1. Communicated to employees the need to promptly report losses (all types).

  Yes

  No

  N/A

IV. EMERGENCY ACTION PLANS (29 CFR 1910.38)

• 1. Facility has a written, updated and current Action Plan.

  Yes

  No

  N/A

V. EMERGENCY PLANNING AND RESPONSE (PF-1) (29 CFR 1910)

• 1. Company has a written, updated, and current Emergency Response Plan.

  Yes

  No

  N/A

• 2. Elements of the plan have been communicated to outside agencies.

  Yes

  No

  N/A

• 3. PPE and emergency equipment identified.

  Yes

  No

  N/A

• 4. Media coordinator identified.

  Yes

  No

  N/A

• 5. Necessary emergency PPE is available (i.e. Emergency respirators, rain gear, eye wash/shower, first aid kit. Etc.).

  Yes

  No

  N/A

VI. HAZARD COMMUNICATION (29 CFR 1910.1200)

• 1. A written Hazard Communication Program has been implemented.

  Yes

  No

  N/A

• 2. A list of chemicals at the facility is available.

  Yes

  No

  N/A

• 2A. All employees are trained when a new hazard (chemical) is introduced or when job duties change.

  Yes

  No

  N/A

• 3. Safety Data Sheets are available for each chemical on site.

  Yes

  No

  N/A

• 4. Contractors are informed about chemicals on site and provide information about chemicals brought on site.

  Yes

  No

  N/A

VII. HAZARD ASSESSMENTS (29 CFR 1910.132)

• 1. Hazard Assessment program has been implemented.

  Yes

  No

  N/A

• 2. A PPE Matrix or equivalent is posted for employees to reference.

  Yes

  No

  N/A

VIII. INDUSTRIAL HYGIENE MONITORING (29 CFR 1910.94, 1910.95)

• 1. IH testing has been completed for Dust and control measures have been implemented.

  Yes

  No

  N/A

• 2. IH testing has been completed for Noise and control measure have been implemented.

  Yes

  No

  N/A

• 3. IH testing has been completed for Toxins and control measures have been implemented.

  Yes

  No

  N/A

IX. PPE (29 CFR 1910.132 Subpart I)

• 1. PPE is provided to employees.

  Yes

  No

  N/A

• 2. Procedures are in place to ensure defective or damaged PPE is not used and replaced.

  Yes

  No

  N/A

• 3. Procedures are in place to ensure employee-owned PPE is adequate.

  Yes

  No

  N/A

X. RESPIRATORY PROTECTION (29 CFR 1910.134)

• 1. When required, respirators are provided for employee use.

  Yes

  No

  N/A

• 2. When required, a written Respiratory Protection Program has been implemented.

  Yes

  No

  N/A

• 3. Program is reviewed at least annually or when new hazards are identified.

  Yes

  No

  N/A

• 4. Medical evaluations on file for applicable employees.

  Yes

  No

  N/A

• 5. Fit testing is conducted and documented.

  Yes

  No

  N/A

XI. HOT WORK PERMITTING (29 CFR 1910 Subpart Q)

• 1. Written Hot Work procedures have been implemented.

  Yes

  No

  N/A

• 2. Permit procedures document fire prevention and protection requirements.

  Yes

  No

  N/A

• 3. Procedures establish permanent Hot Work areas.

  Yes

  No

  N/A

• 4. Written procedures have been implemented for issuing Hot Work permit to outside contractors.

  Yes

  No

  N/A

XII. CONFINED SPACE (29 CFR 1910.146)

• 1. All Permit Required Confined Spaces have been identified.

  Yes

  No

  N/A

• 2. Written Confined Space program has been implemented and is on file.

  Yes

  No

  N/A

• 3. When Permit Required Confined Space rescue is necessary, rescue will be performed by outside agency.

  Yes

  No

  N/A

• 4. Outside agency has inspected Permit Required Confined Space for hazards, identified rescue equipment needed, and conducted rescue drill.

  Yes

  No

  N/A

• 5. Copies of completed entry permits on file.

  Yes

  No

  N/A

XIII. LOCKOUT/TAGOUT (29 CFR 1910 Subpart S)

• 1. Location has implemented a written LOTO program.

  Yes

  No

  N/A

• 2. Assessment of Energy Sources Evaluation has been completed.

  Yes

  No

  N/A

• 3. Location has equipment-specific energy control procedures for applicable equipment.

  Yes

  No

  N/A

• 4. Location has identified Authorized LOTO employees.

  Yes

  No

  N/A

• 5. LOTO devices are available for use by Authorized employees?

  Yes

  No

  N/A

• 6. Periodic job task assessments are completed to verify implementation.

  Yes

  No

  N/A

XIV. TRAINING DOCUMENTATION (29 CFR 1910)

• 1. Hazard Communication training is documented.

  Yes

  No

  N/A

• 2. Lockout/Tagout authorized employees training is documented.

  Yes

  No

  N/A

• 2A. Lockout/Tagout affected employees training is documented.

  Yes

  No

  N/A

• 3. Confined Space Entry Supervisors training is documented.

  Yes

  No

  N/A

• 3A. Confined Space Authorized Entrants training is documented.

  Yes

  No

  N/A

• 3B. Confined Space Attendants training is documented.

  Yes

  No

  N/A

• 4. Hot work training is documented.

  Yes

  No

  N/A

• 5. Personal Protective Equipment training is documented.

  Yes

  No

  N/A

• 6. Forklift formal training is documented (Safety Phase, computer program, lecture, etc.).

  Yes

  No

  N/A

• 6A. Forklift operator performance test is documented.

  Yes

  No

  N/A

• 7. Fire extinguisher annual training is documented.

  Yes

  No

  N/A

• 8. Grain handling operations training is conducted.

  Yes

  No

  N/A

• 9. Anhydrous ammonia competent attendant training is documented (annually or 3 years according to state regulation).

  Yes

  No

  N/A

• 10. Emergency action plan training is documented.

  Yes

  No

  N/A

• 11. First aid, CPR/AED training is documented (required when not close to medical facility).

  Yes

  No

  N/A

• 12. HAZWOPER training is documented.

  Yes

  No

  N/A

• 12A. HAZWOPER annual refresher is documented.

  Yes

  No

  N/A

• 13. DOT Reasonable Suspicion Supervisor training is documented.

  Yes

  No

  N/A

• 14. DOT Security Plan General Awareness level training is documented.

  Yes

  No

  N/A

• 14A. DOT In-Depth Security Plan training is documented.

  Yes

  No

  N/A

• 15. DOT Hazardous Materials training (Safety Phase 20 or equivalent) training is documented (every 3 years).

  Yes

  No

  N/A

• 16. DOT Entry Level Driver (Safety Phase 21) training is documented.

  Yes

  No

  N/A

• 17. Pesticide handlers under the Worker Protection Standard training is documented.

  Yes

  No

  N/A

• 18. Fuel (Safety Phase 5) training is documented.

  Yes

  No

  N/A

• 19. LP (Safety Phase 7) training is documented.

  Yes

  No

  N/A

• 20. Painting training is documented.

  Yes

  No

  N/A

• 21. Compressed gas & welding training is documented.

  Yes

  No

  N/A

• 22. New hire orientation training is documented.

  Yes

  No

  N/A

XV. DOT HAZARDOUS MATERIALS SECURITY PLAN (40 CFR 172.802)

• 1. A written copy of the DOT Security Plan is on file.

  Yes

  No

  N/A

• 2. All applicable appendices have been completed.

  Yes

  No

  N/A

XVI. DOT (40 CFR 391 Driver Qualification)

• 1. Application includes driving history.

  Yes

  No

  N/A

• 2. Current and previous 3 years of medical exam form are on file.

  Yes

  No

  N/A

• 3. Copy of road test for driver with tanker and current copy of CDL Drivers License.

  Yes

  No

  N/A

• 4. Copy of previous employer inquiry on file.

  Yes

  No

  N/A

• 5. Copy of current state motor vehicle abstract/MVR record on file.

  Yes

  No

  N/A

• 6. Copy of driver's report of violations for most recent year on file.

  Yes

  No

  N/A

• 7. Annual review of driver files is documented.

  Yes

  No

  N/A

• 8. Drivers receive training on motor carrier safety regulations and hazardous materials regulations every 3 years and documentation is on file. (Safety Phase 20).

  Yes

  No

  N/A

• 9. Driver files contain only required documents and are neat and orderly.

  Yes

  No

  N/A

• 10. Pre-employment drug testing is maintained.

  Yes

  No

  N/A

• 11. Random drug and alcohol testing is maintained.

  Yes

  No

  N/A

• 12. FSRIS is used to maintain driver information.

  Yes

  No

  N/A

XVII. Department of Homeland Security (6 CFR)

• 1. Documentation of Chemical Facility Anti-Terrorism System (CFATS) status available.

  Yes

  No

  N/A

XVIII. Department of Transportation Regulation (40 CFR)

• 1. Process to generate accurate shipping documents at the location.

  Yes

  No

  N/A

• 2. Record of shipping documents for the past two years.

  Yes

  No

  N/A

• 3. Emergency response information accompanies transfer of hazardous materials.

  Yes

  No

  N/A

• 4. Written drug and alcohol program implemented.

  Yes

  No

  N/A

• 5. Documentation of employee sign-off on the drug & alcohol policy.

  Yes

  No

  N/A

• 6. Current accident register and for the past three years.

  Yes

  No

  N/A

• 7. Procedures to keep proper logs and/or time records.

  Yes

  No

  N/A

• 8. Procedures for conducting pre- and post trip commercial motor vehicle inspections.

  Yes

  No

  N/A

• 9. Thorough vehicle maintenance files are maintained.

  Yes

  No

  N/A

XIX. GRAIN OPERATIONS (29 CFR 1910.272)

• 1. Implemented the written Grain Operations program.

  Yes

  No

  N/A

• 2. Documented and written Housekeeping Program available.

  Yes

  No

  N/A

• 3. Documented and written Preventive Maintenance Program available.

  Yes

  No

  N/A

• 4. The facility has a written Bin Entry policy and procedures.

  Yes

  No

  N/A

• 5. Facility has bin entry permits available and kept on file until the completion of the entry operations.

  Yes

  No

  N/A

• 6. Documented Sweep Auger entry policy and procedures.

  Yes

  No

  N/A

XX. POWERED INDUSTRIAL TRUCKS (29 CFR 1910.178)

• 1. Only authorized employees are permitted to operate forklifts.

  Yes

  No

  N/A

• 2. Training is conducted by certified trainers.

  Yes

  No

  N/A

• 3. Forklifts are examined daily.

  Yes

  No

  N/A

XXI. PORTABLE FIRE EXTINGUISHERS (29 CFR 1910.157)

• 1. Fire extinguishers are provided and intended for employee use? If No, skip to question 2.

  Yes

  No

  N/A

• 2. If fire extinguishers are not provided or intended for employee use, does the Emergency Action Plan provide for immediate and complete evacuation?

  Yes

  No

  N/A

• 3. Monthly fire extinguisher inspections are completed and documented.

  Yes

  No

  N/A

• 4. Annual service and maintenance are completed and documented.

  Yes

  No

  N/A