General Safety Evaluation -

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Walkways, floors, and wall openings

• 1a. Are aisle and passages kept clear?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1b. Are holes in floors and walkways covered and made safe for use?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1c. Are materials stored so they do not project into the walkway?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1d. Are walking surfaces kept clean and dry?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1e. Are guardrails used where walkways are 4 feet above flooring?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1f. Are floor openings guarded on all sides?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1g. Are grates and covers of sufficient strength for foot and motor traffic?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1h. Do stairs of 4 or more risers have handrails?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1i. Do steps or stairs have a slip resistant surface or edge?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1j. Are handrails 30-34 inches above the leading edge of the surface?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1k. Are work areas clean and orderly?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 1l. Are areas properly illuminated?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

2. PPE

• 2a. Are approved safety glasses/goggles used in work areas as required?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2b. Are signs posted warning of potential for eye injury where flying particles can be present?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2c. Are gloves, aprons, shields, or other means for protection against cuts, corrosives and chemicals?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2d. Are hard hats provided and used when needed?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2e. Are required safety shoes used while at work?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2f. Is electrical protection available when working around or with electricity?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2g. Is hearing protection provided for high noise areas?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2h. Are signs posted in areas requiring hearing protection?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2i. Is damaged PPE replaced in a timely manner?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2j. Is PPE stored and kept clean when not in use?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2k. Does the supervisor enforce the use of PPE?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2l. Are first aid and infection control kits (BBP) readily available?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2m. Are there employees trained and designated as first aid providers?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2n. Are there employees that clean up blood/OPIM and/or are designated as first aid providers trained in BBP Occupational Exposure (Clean-up)?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 2o. Have these employees been offered the Hep-B vaccine and signed the acceptance/declination form?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

3. Fire protection

• 3a. Are fire alarms inspected annually?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3b. Are fire doors and shutters operational and in good condition?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3c. Are sprinkler systems checked and records kept?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3d. Are portable fire extinguishers serviced and tagged at least annually?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3e. Are portable extinguishers inspected monthly?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3f. Are employees instructed in the use of fire extinguishers?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3g. Are fire extinguishers needing service removed from the work area and stored for recharging?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3h. Are emergency exits clear of obstructions?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3i. Are stairwells clear and free of obstructions?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3j. Are fire evacuations and emergency procedures current, posted and are employees aware of the procedures to follow?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3k. Are building evacuation maps posted throughout the building and on each floor?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3l. Do building evacuation maps identify Rally Points/Assembly Areas?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 3m. Are voice speaker systems and phones inspected monthly?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

4. Elevated surfaces

• 4a. Are platform areas guarded with rails and a 4 inch toe board for protection?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 4b. Is a means of access and egress provided to elevated surfaces?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 4c. Is material on elevated surfaces stored in a safe manner?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 4d. Do any elevated surfaces require fall protection equipment?

• Comments

5. Exits and means of egress

• 5a. Are all exits marked with a sign and illuminated?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 5b. Are the directions to exits marked with proper signage?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 5c. Are letters on exit signs at least 6 inches high and 3/4 inch wide?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 5d. Are all exit doors unlocked, accessible and free of obstruction while the building is occupied?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 5e. Do doors swing in the direction of egress if any of the following conditions exist? <br>The door serves a room or area with an occupant load of 50 or more, <br>The door assembly is used in an exit enclosure, <br>The door opening services a high-hazard contents area.

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 5f. Is the exit access at least 28 inches wide at all points?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 5g. Are exit signs and emergency lighting tested monthly for at least 30 seconds and annually for at least 90 minutes and are records of visual inspections and tests available?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

6. Ladders

• 6a. Have employees been trained in the proper use of portable ladders? Includes extension ladders, mobile ladder platforms & stands, fixed-length, articulated or multipurpose, and step ladders.

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6b. Are ladders maintained in good condition?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6c. Are non-slip safety feet provided on all extension ladders?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6d. Are employees prohibited from using ladders that are damaged or missing parts?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6e. Do extension or fixed-length ladders extend 3 feet above the landing surface when used?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6f. Are warning and weight capacity labels present and readable?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6g. Are all rungs and supports tight, without bends, twists or broken pieces?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6h. Are the locking mechanisms for mobile platform ladders or ladder stands work properly?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6i. Are metal ladders being prohibited for use for electrical work or around energized electrical lines?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 6j. Is a monthly ladder inspection being performed and documented for each portable and mobile ladder?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

7. Tools and Power Equipment

• 7a. Are all tools in good working condition?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7b. Are tool handles free from tape repair?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7c. Are employees prohibited from using chipped or cracked tools?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7d. Do power tools have proper safety guards?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7e. Are all belts, pulleys, chains and sprockets guarded?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7f. Are fans guarded?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7g. Are GFCIs used on temporary circuits?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7h. Are GFCIs used where water or moisture is present?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7i. Are hand grinders used with the proper guards in place?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7j. Is the tool rest on bench grinders adjusted to within 1/8 inch of the wheel?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7k. Is the tongue guard on bench grinders adjusted to within 1/4 inch of the wheel?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7l. Do side guards cover nut, spindle and 75% of the wheel?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7m. Is the maximum RPM rating of each abrasive wheel compatible with the RPM rating of the grinder motor?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7n. Are bench and pedestal grinders securely mounted?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7o. Are goggles and face shields used and warnings sings posted?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7p. Are tools, equipment and materials properly stored when not in use?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7q. Are hammers and screwdrivers checked for damage and chipped surfaces?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7r. Are electric power tools double insulated or is the cord equipped with a grounding plug?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 7s. Is gas powered equipment stored properly?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

8. Air compressors and compressed air

• 8a. Are air compressors equipped with relief valves and pressure gauges?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 8b. Are warning signs posted for the automatic starting feature?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 8c. If used for cleaning is pressure set to less than 30 psi at the discharge nozzle, an effective chip guard used, and proper PPE is worn? Employees are prohibited from using compressed air to clean themselves or their clothing.

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 8d. Are noise reducing nozzles or air guns used?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 8e. Is the belt drive system guarded?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 8f. Are compressed air receivers episodically drained of moisture and oil?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 8g. Are maintenance records kept and up-to-date?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

9. Welding, Cutting and Brazing

• 9a. Is the Hot Work Permit program being used?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9b. Are completed Hot Work Permits kept on hand for 1 year?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9c. Is care used in handling and storage or compressed gas?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9d. Are empty cylinders identified and stored away from full tanks?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9e. Are cylinder storage areas properly identified with signs?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9f. Are cylinders stored or used in an upright position chained, strapped, or otherwise secured to keep them from falling over?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9g. Are cylinders kept away from heat or ignition sources?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9h. Are Acetylene cylinders stored outdoors kept from reaching a surface temperature of 125f?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9i. Are welding electrodes removed from holders when not in use?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9j When the welding unit is not in use are the cylinders properly stored e.g. Gauges removed and the cylinder caps put on? In use means within a 24 hour period.

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9k. Does the area have proper ventilation?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9l. Is fire protection readily available?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9m. When welding is the area around the welding area protected with protection blankets?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9n. Is a fire watch being used when conditions warrant?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9o. Is proper PPE available and used?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 9p. Do welding helmets/shields/goggles/spectacles have the proper lens shade for the type of work being done?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

10. Lockout/Tagout

• 10a. Does the site have a written LOTO program?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 10b. Are all employees trained to the proper level in Lockout/Tagout (Authorized, Affected, Other)?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 10c. Are all electrical enclosures properly identified?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 10d. Are employees provided with proper LOTO equipment?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 10e. Are employees required to keep personal control of keys?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 10f. Does all equipment capable of Lockout/Tagout have an ECP?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 10g. Are periodic evaluations (at least annually) of ECP's being conducted and documented?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

11. Permit Required Confined Spaces

• 11a. Are permit required confined spaces properly identified and marked?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 11b. Are all employees trained in permit confined space entry procedures?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 11c. Is the proper PPE available?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 11d. Are all permit confined spaces checked with gas detection meters before entry?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 11e. Are attendants used to assist and watch for hazards trained?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 11f. Does the site perform self-rescue (Do they perform employee rescues themselves)?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 11g. If self-rescue is performed is the proper rescue equipment available for permit spaces?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 11h. If self-rescue is performed have designated employees been identified and trained in confined space rescue procedures to include first aid and CPR?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 11i. If rescue is performed by an outside agency has that agency been contacted and has the outside agency visited the site to assess any potential issues?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

12. Flammable and Combustible Substances

• 12a. Are proper containers with labels used for storage of flammable liquids?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12b. Are drums grounded and the receiving container either bonded or grounded during the transfer of materials?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12c. Are storage areas properly ventilated? Minimum of 6 complete air exchanges per hour at most sites.

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12d. Are No Smoking and Danger signs posted, regardless of the site smoking policy?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12e. Are fire extinguishers available within 75 feet of outside and 10 feet of inside storage areas?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12f. Are fire extinguishers charged, tagged, mounted and identified?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12g. Are appropriate lockers or containers used for storage?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12h. Are flammable lockers properly marked, closed when not in use, and have a 3-point closure system?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12i. Are bungs in place for flammable lockers that are not vented directly to the outside?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12j. Are spark arrestors in place/serviceable where flammable lockers are vented directly to the outside?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 12k. Are storage areas properly illuminated?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

13. Hazard Communication

• 13a. Is an SDS available for all chemicals used in the workplace ?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13b. Are SDS accessible to all employees at all times during their shift?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13c. Are proper labels used on all chemical containers?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13d. Is proper PPE available for employees?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13e. Are employees trained in the safe handling of chemicals?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13f. Are eyewash and drenching shower stations located on an unobstructed path within 10 seconds (55 feet) of the use of corrosive chemicals?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13g. Are plumbed eyewashes/showers being inspected and activated weekly? Tag annotated?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13h. Are portable eyewashes being inspected monthly? Tag annotated? Eyewash bottles do not meet the requirement for a portable eyewash but should be inspected for an expiration date.

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13i. Are eating and drinking prohibited in hazardous chemical use and storage areas?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13j. Are identified asbestos containing materials (ACM) in good condition?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13k. Are asbestos containing materials identified to prevent disturbance?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13l. If there is Asbestos containing materials in the facility has an asbestos survey been conducted by the customer and have we requested a copy of the survey?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 13m. If there is ACM in the building have employees been trained in Asbestos Awareness?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

14. Occupational Noise

• 14a. Is there a need for a Hearing Conservation Program in the workplace?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 14b. Do employees use hearing protection in high noise areas?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 14c. Are hearing protection required signs posted at entry areas with noise levels above 85 dBa or greater?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 14d. Are employees given a choice of hearing protection?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 14e. Have employees been trained in the proper use of hearing protection?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

15. Electrical

• 15a. Is all electrical equipment properly grounded?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15b. Are all cords with exposed wiring, damaged insulation, frays or taped splices removed from service or repaired?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15c. Are all switches and circuit breakers identified as to their use?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15d. Are all energized parts guarded against accidental contact?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15e. Are all boxes, plugs, switches and fittings properly covered?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15f. Are extension cords prohibited from bing used as permanent wiring?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15g. Are extension cords prohibited from being run under doors, through walls, or above drop-ceilings?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15h. Do all extension cords have a grounding prong?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15i. Is the use of an extension cord in combination with a surge protector prohibited?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15j. Do extension cords used in wet or damp areas use or have a built in GFCI?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15k. Do employees perform tasks with Arc-Flash hazards?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15l. Have employees who perform these tasks been properly trained?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 15m. Do employees have the correct Arc-Rated clothing/PPE for the hazard category they will be exposed to?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

16. Environmental

• 16a. Are there proper containers and labels for used oil/light bulbs and other universal or hazardous waste?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16b. Are employees trained on how to properly handle hazardous waste?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16c. If required, is the hazardous waste storage area and/or satellite accumulation point (SAP) properly marked and inspected?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16d. Are SAP accumulation containers marked with the words "Hazardous Waste" and the identity of the contents?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16e. Are universal waste containers marked with the words "Universal Waste", the contents, and the date accumulation began?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16f. Are storm drains appropriately marked?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16g. Are personnel aware of best management practices to prevent releases of wash/ mop water, oil, fuels, and chemicals to storm drains?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16h. Are employees trained to properly record releases of refrigerants?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16i. Are employees responsible for maintaining boilers, fire pumps, and emergency generators properly trained to comply with operating permit record keeping requirements?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16j. Are solvent cleaning containers and equipment kept closed and properly maintained?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16k. Is solid waste properly segregated and defaced for recycling?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16l. Are spill kits on hand for the types of material on hand?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16m. Have employees been trained in basic spill response (non-hazardous or incidental spills)?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16n. If expected to provide emergency response for an uncontrolled release of a hazardous substance have employees been trained to OSHA HAZWOPER standard 1910.120(q) for the level of response they are expected to provide?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16o. If not providing emergency response do employees know who to contact to provide response?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 16p. Are employees that apply pesticides (herbicides, fungicides, rodenticides, insecticides, nematicides, etc.) and/or fertilizer, licensed/certified applicators? State requirements differ.

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

17. PIT Equipment

• 17a. Do employees operate PIT equipment? Includes electric pallet jacks/trucks.

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 17b. Are operators trained in accordance with OSHA requirements?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 17c. Do operators slow down and honk at corners, intersections, and when entering or exiting buildings or trucks?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 17d. Are daily/pre-shift inspections being conducted and documented?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

18. Aerial Lifts & Fall Protection

• 18a. Do employees operate aerial lifts?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18b. Are operators trained in accordance with OSHA requirements?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18c. Are daily inspections being conducted and documented?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18d. Have operators been trained on the use of fall protection equipment?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18e. Are fall restraint lanyards used in aerial lifts?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18f. Other than for aerial lifts is there a need for fall protection?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18g. Are roof parapets at least 42 inches tall?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18h. Does the roof have fall protection anchors, horizontal life lines, guardrails or other fall protection/restraint/arrest equipment installed?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18i. Is fall protection equipment inspected by a designated Competent Person at least annually?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18j. Is equipment involved in a fall being taken out of service and replaced?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 18k. Is personal fall protection equipment being inspected before each use?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

19. Golf Carts/ORVs

• 19a. Do employees operate Golf Carts/Club Cars/Gators or ORV's?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 19b. Are operators trained in accordance with C&W requirements?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 19c. Do operators slow down and honk at corners, intersections, and when entering or exiting buildings?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 19d. Are daily inspections being conducted and documented?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 19e. Do operators have a valid state license?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

20. Respiratory Protection

• 20a. Do employees have exposures exceeding OSHA PELS?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 20b. Have employees that wear respirator's been medically cleared? Clearance documented?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 20c. Have employees that wear respirators been fit tested for the respirator(s) they use?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 20d. Fit tests current (within 1 year)?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 20e. Is the correct type of respirator being used for the type of hazard?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• 20f. Is the correct type of filter(s) being used for the substance(s) they are exposed to?

  Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

• Comments

Is Follow-up required

• Comments

• Yes

  No

  N/A

  Not Evaluated

  Needs Further Evaluation

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