GVEP Health and Safety Audit

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• District Nane

• Address
  Address

• Conducted on

  Date

• Auditor Name

  Sign

• Health and Safety Contact

  Sign

• This is a paperwork Audit.
  Its intention is to inform the audited districts on the necessary paperwork that might be asked for by an auditor from a government agency.
  An in depth field audit would further ensure compliance with the requirements. Some responses are based solely on the feedback from the H&S contact person.

• Rating Scale for Each Program Area
  5 is excellent
  1 is poor

Blood Born Pathogens

• Does the school have a Exposure Control Plan

  Yes

  No

  N/A

• Does school have a readily available printed copy of the Exposure Control Plan

• Has the Exposure Control Plan been recently evaluated? 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Deduction Bypass -6

• Is H&S Contact believes compliance with staff immunization program requirements for Hepatitis B are up to date 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Record Storage Location

• Pertinent staff have received the annual refresher 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Medical Waste bags are available for use by nurse and other trained employees

  Yes

  No

  N/A

• Procedure is in place for safe and legal disposal of medical waste in a timely fashion

  Yes

  No

  N/A

• Post Exposure Evaluation and Follow Up Procedures are Established

• Additional Notes

Confined Spaces Entry

• District has Confined Space Entry Plan

  Yes

  No

  N/A

• District has printed Confined Space Entry Plan readily available

• Has the Confined Space Entry Plan been recently evaluated? 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Deduction Bypass -6

  Off

  On

• Confined Spaces have been labelled appropriately 5 - 100% 4 - 85% 3 - 75% 2 - 50% 1 - Less then 50%

• Additional Notes

Emergency Preparedness

• Does District Have a SAVE Emergency Preparedness Plan?

  Yes

  No

  N/A

• District has printed Emergency Preparedness Plan readily available

• Has the Emergency Preparedness Plan been recently evaluated? 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Deduction Bypass -6

• District completed the required emergency drills for sheltering and early dismissal during the previous school year. 5 - 100% 4 - 85% 3 - 75% 2 - 50% 1 - Less then 50%

• Administrators have ICS Training 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact feels District Emergency Procedures are know by staff 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

AED's

• The District has a signed PAD Agreement

• District has an AED available in each required building. 3 - All buildings 2 - Most buildings 1 - Few Buildings 0 - No Buildings

• The H&S Contact believes that the district has adequate staff trained to use the AED for emergencies with all student age groups 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Signs indicating the location of AED's are posted at all main entrances

• Additional Notes

Fire Inspections

• H&S Contact believes a current certificate of occupancy is posted in all buildings 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes Exit Doors and Windows are kept clear year round 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes Emergency Lighting and Exit Signs are illuminated year round. 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

Hazard Communications/Right-to-Know

• The H&S Contact believes efforts are made to keep the district's written inventory of chemical products current 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• The H&S Contact has attendance sheet for refresher training dated within the last year.

  Yes

  No

  N/A

• The H&S Contact believes that efforts to collect Safety Data sheets for the areas in the district where chemical products are used. 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• The H&S Contact believes records of chemical disposals are accurately kept 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Location where chemical records are kept

• The H&S Contact believes that Secondary labels are properly maintained 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

Asbestos

• The 3 Year AHERA asbestos inspection was completed

  Yes

  No

  N/A

• District has printed AHERA Management Plan readily available

• Has the AHERA Management Plan been recently evaluated? 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Deduction Bypass -6

• All custodial and maintenance workers who work around asbestos have completed initial and annual refresher 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Have all Subcontractors been Given Notice of Asbestos Locations and Signed Documentation Stating that this information was made available to them. 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional notes

Bulk Petroleum Storage Tanks

• Tanks are registered

• H&S Contact believes Printed copy of tank registration is posted near the tank

• H&S Contact believes that tightness testing and leak detection checks are preformed as required 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes that Inventory control by proper record keeping is being completed 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes that Monthly monitoring of above ground tanks is being completed and documented 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

Chemical Hygiene Plan

• District has a completed Chemical Hygiene Plan

  Yes

  No

  N/A

• Printed copy of Chemical Hygiene Plan is readily available

• Has the Chemical Hygiene Plan been recently evaluated? 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Deduction Bypass -6

• H&S Contact believes Science staff have been appropriately trained regarding the plan 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes that Science rooms are neat and orderly 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

Pesticides

• District has pesticide business license and certified applicatiors.

• H&S Contact believes that Safety Data Sheets and Product labels are on file

• H&S Contact believes that district is in compliance with requirements of the Neighbor Notification Law and has documentation on file.

• H&S Contact believes that pesticide reports and record keeping are completed routinely 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes that District applicators annually submit reports to DEC

  Yes

  No

  N/A

• Additional Notes

Hearing Conservation

• District has a Hearing Conservation Plan

  Yes

  No

  N/A

• District has a printed Hearing Conservation Plan readily available

• Hearing Conservation Plan has been recently evaluated 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Deduction Bypass -6

  Off

  On

• Equipment has been evaluated for sound levels periodically 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes that effected employees have received training, have annual hearing tests, and wear hearing protection when needed or exposure time to loud noises are limited. 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

Lockout/Tagout Program

• District has a written Lockout/Tagout Plan

  Yes

  No

  N/A

• District has a printed Lockout/Tagout Plan readily available

• Lockout/Tagout Plan has been recently evaluated 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Lockout/Tagout Plan includes Elevators, RTU's, Fan units, Hydraulic forces, and Steam systems. 1 point given for each of the above categories being Complete

• Deduction Bypass -11

  Off

  On

• H&S Contact Believes that necessary areas are properly labeled 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes supervisors document employees use of the Lockout/Tagout system 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

Electronic Partitions

• The H&S Contact believes all Electronic Partitions have been upgraded according to SED approved specifications or rendered inoperable

• The H&S Contact believes signs describing safe operation and supervision are posted on both sides of partition adjacent to operating mechanism

• The H&S Contact believes Staff training records are current 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• The H&S Contact believes Electronic Partition inspection records are on file.

• Additional Notes

Personal Protective Equipment

• District has a Personal Protective Equipment Plan

  Yes

  No

  N/A

• District has a printed Personal Protective Plan readably available

• Personal Protective Equipment Plan has been recently evaluated 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Deduction Bypass -6

  Off

  On

• H&S Contact believes that necessary personal protective equipment has been purchased 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• H&S Contact believes that appropriate staff have been trained in the use of PPE and training has been documented 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

Reparatory Protection Plan

• District has evaluated the need for Respiratory Protection Plan

  Yes

  No

  N/A

• District has a printed Respiratory Protection Plan readably available

• Respiratory Protection Plan has been recently evaluated 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Deduction Bypass -6

  Off

  On

• District Staff Requiring respirators for personal protection have been fit tested within the last 12 months

• H&S Contact believes that district staff has had a physical in the last 12 months

• The H&S Contact Believes that Respirators are properly Stored by employees

Pool Regulations

• The District's Pool Permit & Pool Plan are updated annually

• H&S Contact believes that Life Guards have 1st Aid, AED, and CPR cards up to date. 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

Backflow Preventers

• The Districts Backflow preventers have been tested

• The Districts Backflow test records have been sent to DOH and water suppliers

• Additional Notes

Cafeteria and Concessions

• The Districts Cafeteria's & Concession stands have DOH Permits

• H&S Contact believe Cafeteria workers have had safe food handling training 5 - 90% or better 4 - 80% 3 - 60% 2 - 50% 1 - Less then 50%

• Additional Notes

RESCUE ( Comprehensive Public School Building Safety Act)

• The District has a Health and Safety Committee which reviews health and safety complaints reported to administration

• Building condition surveys and annual visual inspections reports for all occupied buildings have been filed with the SED

• The Preventive Maintenance Plan is current 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• The Five Year Capital Facilities Plan is current 5 - Evaluated within the last year 4 - Evaluated over a year ago 3 - Evaluated over two years ago 2 - Evaluated over three years ago 1 - Evaluated over four or more years ago

• Printed copy of the FIve Year Capital Facilities Plan is readily available

• Additional Notes

SOSHA

• The H&S Contact believes the DOSH-908 Poster Identifying Employee Rights and Responsibilities for Job Safety is currently posted in each building

• The H&S Contact believes the DOSH-900 Occupational Illness/Injury Log is maintained in each facility

• The H&S Contact believes the summary of DOSH-900 was posted in each facility from Feb-April as required and is currently on file

• Additional Notes