Information
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Document No.
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Dow - Deer Park
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Dow - La Porte
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Dow - Bayport
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Dow - Lonestar
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Dow - Texas City
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Employee
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Supervisor
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Manager
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Assessor
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Select date
Hazard Analysis
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Task analysis used correctly
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STAC score > 3
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STAC complete and score
At Risk Program
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Knowledgeable of Day's Key Learning
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Previous Day's Key Learnings
Personal Protective Equipment
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Correct Eye Protection
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Correct Foot Protection
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Correct Clothing Worn/Jewelry
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Wearing Correct Gloves for Task
Badges
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Badges on Person
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Safety Council Training Current
Escape Respirator
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Respirator on Person
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Date on Cartridge
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Proper Operating Condition
Process Safety
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Location of nearest Safety Shower/Eyewash
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Location of Phones/Intercoms
Evacuation
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Correct Wind Direction
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Correct Assembly Point
Work Area Hazard
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Janitor closet condition
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MSDS locator log
Equipment
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Equipment inspection
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GFCI
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Frayed Cords/Plugs W/O ground
JEP
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All employees signed on
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JEP accurate to scope and location
Incident/Injury Process
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Emergency #'s Understood
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Reason for calling ambulance
Building Inspection
Restroom/Changerooms
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Overall cleanliness
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Dispenser filled?
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Sink and fixture clean?
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Commodes clean
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Trash taken out?
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Floor swept/mopped?
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Showers
Office/Conference Room/Control Room
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Overall cleanliness
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Vacuum/Swept/Mopped?
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Dusting?
Kitchen
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Overall cleanliness
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Floors swept/mopped?
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Trash emptied
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Counters/Sinks/Fixture Clean?
