Information

  • Audit Title

  • Conducted on

  • Prepared by

  • Location

  • Personnel

  • Business Unit

  • Function/Entity

  • Workgroup

  • Job Title

Accountability

  • 1a. When was the last time you were coached from a member of management on safety?

  • 1b. Can you describe the situation, and did you consider it to be an effective coaching moment?

Safety Commitment

  • 2a. On a scale of 1-10, with 10 being the best, how committed are you to safety?

  • Select from range

  • 2b. On a scale of 1-10, with 10 being the best, how committed is your leadership to safety?

  • Select from range

Human Performance

  • 3a. On a scale of 1-10, with 10 being the best, how effective do you consider Human Performance to be?

  • Select from range

  • 3b. On a scale of 1-10, with 10 being very often, 5 being sometimes, and 1 being never, how often do you use Human Performance?

  • Select from range

Conservative Decision Making

  • 4a. Prior to making a decision, do you think Likelihood or Consequences?

  • 4b. What factors do you consider when making a decision?

Close Call / Good Catch Reporting

  • 5a. When is the last time you reported a Close Call / Good Catch? What was the CC/GC pertaining to?

Office Inspection Questions

  • 1. Where is the shelter in place location at this office/facility?

  • 1E.j.1 - 1E.j.22

  • 2. Where is the assembly point, outside of the facility, for emergency evacuations?

  • 1E.j.1 - 1E.j.22

  • 3. Do you know who is responsible for checking your name off of the employee list once you arrive at the assembly point? If yes, name that person(s).

  • 4. Where is the AED located?

  • 1E.j.15

  • 5. Where is the first aid kit located?

  • 1E.j.14

  • 6. Where is the nearest fire extinguisher located?

  • 1E.i.12, 1E.i.17, 1E.i.18

  • 7. Are pointed or sharp objects kept in sheaths or sharp point side down when not in use?

  • 1D.5

  • 8. Describe how you are notified to evacuate the building in case of emergency.

  • 1Ej.1 - 1E.j.22

  • 9. Describe how you are notified to find shelter in place for a weather event.

  • 1Ej.1 - 1E.j.22

  • 10. Describe the primary and secondary route you would take to get to the assembly point for an emergency evacuation.

  • 1Ej.1 - 1E.j.22

  • 11. Is the means of egress blocked, or is the general area where employee works clear of any hazards or debris that could impede evacuation?

  • UNWEIGHTED: 1E.c.1, 1E.c.3, 1D.12, 1E.a.1, 1E.d.1,
    1E.i.2, 1E.j

  • 12. Do you know who is trained in CPR and first aid onsite? If yes, provide at least 2 names if applicable.

  • 1E.j.13

  • 13. Do you know what information is contained on a Safety Data Sheet (SDS)? If yes, provide example and where SDS’s are located at your facility.

  • 1K.1 - 1K.11

  • 14. Can you describe a situation where you would need to access the information from the SDS book?

  • 15. Do you know who in this facility you could ask a safety question and/or who could assist with a safety issue? If yes, provide name.

  • 16. Describe where the Federal Labor law poster and bulletin board area for OSHA notices are located.

  • 17. How often do you attend safety meetings? What were some recent topics from the safety meetings?

  • 18. Can you give me an example of how you would encourage your fellow workers to choose safe office practices?

  • 19. Can you give me an example of how you have used topics from the safety meetings in your home or personal life?

  • 20. What is the proper sitting and standing ratio? 30/30

  • 1F.4 30/30 as a rule of thumb

  • 21. What is the protocol in place for workplace violence? (Run, hide, fight)

  • 1E.k.5.a - 1E.k.5.g

  • Comments

  • Inspector Signature

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