Title Page

  • Site conducted

  • Location of audit

  • Date audit conducted

  • Prepared by

  • Co-Auditor 1

  • Co-Auditor 2

  • Plant Security, Health and Safety Manager

Emergency Action Plans

  • Does the location have a written Emergency Action Plan that is reviewed annually

  • Procedures for employees who must remain behind for critical operations

  • Assigned duties for employees who are responsible for rescue

  • Assigned duties for employees responsible for medical care

  • Established procedures for employees to report emergencies

Emergency Notification Systems

  • Can the alarm be distinguished from other background noise sources

  • Are specific employees assigned to alert employees who may not recognize the alarm

  • Are the audible alarms different for evacuations, shelter-in-place, ammonia leak, etc.

  • Does your emergency notification system include a verbal notification to employees (i.e. radio or intercom)

  • Are emergency notification systems maintained and tested regularly per NFPA or Manufacturer's Recommendations

  • Are employees with specific functions within the emergency plan trained in correct methods of performing these duties

  • Are employees trained on evacuation routes at time of hire

  • Are employees retrained when the plan or their duties change

  • Does the plant have an annual building evacuation and severe weather drill

  • Is it documented on the "Emergency Drill Report and Assessment", with feedback collected and corrective actions put in place

Fire Prevention Plan and Housekeeping

  • Are sprinkler impairment procedures in place and are they followed

  • Is annual fire extinguisher training provided, documented for applicable personnel, and include hands-on practice

Exits Routes

  • Are emergency exit routes and discharge areas illuminated during power outage and hours of darkness

Written Assessment and Permit Required Confined Space Program

  • Does the location have a written Permit Required Confined Space Entry Program

  • Is the Permit Required Confined Space Entry Program reviewed annually

  • Does the plant have a list of all confined spaces and is it accurate, up to date, and reviewed annually

  • Does the plant have a written confined space hazard survey for each space on file, and is it accurate, up to date and reviewed annually

Permit Required Confined Space and Hazard Identification and Control

  • Are problems encountered during the entry noted on the permit and corrected before subsequent entries are authorized

  • Are procedures implemented to reclassify permit required confined spaces by eliminating hazards

  • Review 5 random reclassification documents - all must be accurate to receive a positive score

  • List the dates of the reclassification forms that were reviewed

Specialized Equipment, Testing and Monitoring and Emergency Procedures

  • Are air sampling instruments properly calibrated and bump tested before each use with calibration gas that is not expired

  • Are permit spaces tested and monitored to determine if the space is safe for entry and to ensure that conditions remain acceptable for the duration of the job

  • Are emergency/rescue procedures implemented and an attendant available outside the space for the duration of the entry

  • Have simulated rescues taken place on an annual basis

Permit System, Employee Training and Emergency Medical

  • Is annual training on using the gas meters in the facility provided to confined space entry personnel, emergency response personnel, etc.

  • Are Confined Space permits filled out completely for each entry

  • Are completed permits retained for a minimum of 1 year

  • Are duties and responsibilities identified for employees who have active roles in entry operations

  • Has annual training been provided and documented for all Rescue Personnel as required by their job function and responsibility

  • Have all affected employees been trained per the requirements in the SugarCreek Permit Required Confined Space Entry Program

  • Has the plant developed a plan for emergency rescue and medical treatment

Confined Space Program Review and Outside Contractors

  • Is there an annual review of the program including job site compliance to determine effectiveness and identify deficiencies

  • Are any deficiencies noted resolved through documented means including training

  • Does the plant coordinate the activities of contractors hired to perform work in a permit required confined space

Medical and First Aid Program

  • Is the facility operated by someone with at least a current certification in first aid/CPR/AED on all shifts

OSHA Poster and OSHA 300 Log

  • Does the plant keep an OSHA 300 log for all occupational injuries and illnesses

  • Has the OSHA 300 log been completed and signed for the previous five years and are they retained

  • Is the OSHA 300A Summary Form posted from February 1 - April 30 of each year

  • Are entries logged within seven calendar days of receiving information that a recordable injury or illness has occurred

  • Do plant personnel understand the criteria for logging injuries and illnesses and have a copy of the OSHA Recordkeeping Policies and Procedures Manual readily accessible

OSHA Form 301 Incident Reporting

  • Is the Recordable Incident form completed for each recordable injury

  • Is the Recordable Incident form numbered to correspond with each entry on the OSHA 300 log

  • Do plant personnel understand the OSHA reporting requirements for fatalities ,hospitalizations, amputations or loss of an eye

  • Do plant personnel understand who has access, upon request, to review the OSHA 300 log and OSHA 301 forms (Recordable Incident form)

  • Do plant personnel maintain calendars to track restricted and lost days

  • Is all documentation present for case file #1

  • What is the case number of the file reviewed

  • Is all documentation present for case file #2

  • What is the case number of the file reviewed

  • Is all documentation present for case file #3

  • What is the case number of the file reviewed

Access to Employee Exposure and Medical Records

  • Do plant personnel understand who has access to employee exposure and medical records

  • Do plant personnel understand the time frame (15 days) within which to provide access to medical records

  • Does the plant have a form for employees to fill out when requesting access to records in order to ensure that employees are provided the information within the standard time limits

  • Does the plant have a posting or other means to communicate employee's rights to access their medical records and is the information up to date

  • Are new employees informed of their rights to access their medical files and is this documented

  • Are existing employees informed of their rights to access their medical files on an annual basis and is this documented

Occupational Exposure to Bloodborne Pathogens (BBP)

  • Does the plant have a written control program for BBP

  • Does BBP training contain an accessible copy of the BBP regulation and exposure control plan

  • Does BBP training contain BBP epidemiology and symptoms

  • Does BBP training contain BBP modes of transmission

  • Does BBP training contain recognizing high exposure risk tasks

  • Does BBP training contain universal precautions, engineering & work practice controls ( to include specifics on housekeeping & laundry practices, products/PPE to be used, sharp handling/disposal, etc.)

  • Does BBP training contain PPE (types available, limitations, proper use, location, decontamination/disposal, etc.)

  • Does BBP training contain choice of appropriate PPE for situation

  • Is the BBP training Hepatitis B vaccination program consistent with CDC guidelines

  • Does BBP training program contain proper use of biohazard signs, labels and bags

  • Does BBP training allow for adequate time for Q&A

  • Do the training records contain the date of training, summary of training, names & qualifications of persons conducting training, names & titles of persons attending training

  • Are training records maintained for three years , along with a tracking log of BBP individuals trained annually with Hepatitis B forms

Personal Protective Equipment for BBP

  • Does the plant provide at no cost appropriate PPE to respond to a BBP incident

  • Does the plant assure appropriate PPE in proper sizes is issued and is readily accessible to employees

Biohazard Tags, Labels, Bags and Hepatitis B Vaccinations (HBV)

  • Has HBV been made available after training & within 10 days of initial assignment to employees who have occupational exposure

  • Have employees who have declined the HBV signed a declination form initially and annually

BBP Recordkeeping and Sharps Injury Log

  • Has the plant established & maintained an accurate record for each employee with an occupational exposure

  • Has the plant established a sharp's log and does it include the type and brand of the device involved, department where the incident occurred and an explanation of how the incident occurred

Noise Exposure Monitoring

  • Are noise level readings repeated whenever a change in process, equipment, or controls increase exposure

  • Has each employee who is exposed to noise at an 8-hour TWA of 85 decibels been notified of the results of the noise survey

Engineering or Administrative Controls

  • Are feasible engineering/administrative controls utilized to reduce sound levels to the permissible levels

  • If controls fail to reduce sound levels, is PPE provided to each exposed employee

Audiometric Testing and Evaluation

  • Has an audiometric testing program been established for employees exposed to a TWA of 85 decibels

  • Are audiometric tests performed by a technician who is responsible to an audiologist or physician

  • Has a baseline audiogram been established within six months of exposure (or 12 months if mobile testing unit is used)

  • Are annual audiograms obtained and submitted to an audiologist within one month of the date of the test and compared to baseline for all employees in the hearing conservation program (check report to ensure results are compared to baseline results)

  • Are employees retested within thirty days if an annual audiogram shows a standard threshold shift (STS)

  • Are employees notified of an STS in writing within 21 days of determination and referred for a clinical audio logical evaluation or otological examination

Hearing Protection Devices

  • Is hearing protection made available to all employees who require it

  • Is the hearing protection attenuation evaluated against the noise levels in the plant

Hearing Conservation Education, Training and Recordkeeping

  • Does the plant have annual hearing conservation training

  • Does the training include effects of noise on hearing

  • Does the training include the purpose of hearing protectors - advantages, disadvantages, and attenuation of various types

  • Does the training include instruction on selection, fitting, use, and care

  • Does the training include the purpose of audiometric testing and an explanation of the test procedure

  • Does the plant make available a copy of the standard

  • Are noise exposure measurements records retained for two years

  • Are audiometric test records retained for duration of the employee's employment

  • Are employees showing a STS (an average of 10 dB decrease from baseline in the2K, 3K and 4K frequencies (Hz) and a change of 25 dB or more from audiometric zero (averaged at 2000, 3000 and 4000 Hz) recorded on the OSHA 300 log

Lockout / Tagout - The Control of Hazardous Energy

  • Does the plant have a written Control of Hazardous Energy Program

  • Is the Control of Hazardous Energy program reviewed annually

  • Are procedures developed, documented, and utilized for the control of potentially hazardous energy for each piece of equipment/machinery

  • Are the energy control procedures reviewed annually to ensure that they are all present, accurate and up-to-date

  • Are locks only used to lockout equipment, of the correct color (stated in policy)

  • Does the plant conduct an annual inspection of the energy control procedures to assure that the procedures and the requirements of the standard are being followed

  • Are 100% of authorized lockout personnel audited annually and documented

  • Is the annual inspection performed by authorized employee(s)

  • Does the annual inspection include date, employees included in inspection, person performing inspection, equipment/machinery on which the inspection occurred

  • Has annual training been conducted to assure that the purpose and function of the LOTO program is understood by authorized and affected employees

  • Is retraining provided/documented when assignments or processes change (i.e. new equipment prior to start-up)

  • Is a list of authorized lockout employees maintained with annual training, annual audits, and lock serial numbers tracked

  • Are written procedures developed for all exceptions to the lockout program

  • Do the exception procedures list work procedures for each task in detail

  • Are all relevant employees trained on the lockout Minor Exceptions

  • Tags are not being utilized in lieu of locks, where applicable

  • Administrative lock system utilized in accordance with lockout policy

  • Procedures developed for removal of a LOTO device before energy is restored and procedures require the LOTO device be removed by the employee who applied it

  • Are procedures written for removal of a LOTO device when an employee has left the plant and are the forms being used to document application of this process

  • Are group LOTO procedures utilized

  • Are written specific procedures used during shift or personnel changes to ensure continuity of LOTO protection

Machine Guarding

  • Does the plant have a written Machine Guarding Program

  • Is the Machine Guarding program reviewed annually

  • New equipment approval completed and concerns addressed before start-up of equipment

  • Has a machine guarding checklist been performed on all equipment

Walking / Working Surfaces

  • Do plant personnel conduct housekeeping audits of the interior and exterior of the plant on a scheduled basis

  • Are the housekeeping audits documented

  • Are ladders inspected regularly and meet safety requirements

  • Are employees trained on the proper use of ladders

Fall Protection

  • Does the plant have a Fall Protection and Prevention Program

  • Is the Fall Protection and Prevention Program reviewed annually

  • Is training being performed and documented as required in the policy (slip/trip/fall, harness use/inspection, etc.)

  • Fall protection for roof in place and annually reviewed/certified per manufacturer's recommendations

  • Is fall protection equipment inspected annually by a competant inspector

  • Are scaffolds installed and inspected daily by a qualified person

  • Have all employees working on scaffolding received training from a qualified person

  • Have they been provided harnesses/lanyards where required

Powered Industrial Trucks

  • Does the plant have a written Powered Industrial Truck Program

  • Is the Powered Industrial Truck Program reviewed annually

Operation of Powered Industrial Trucks and Operator Training

  • Is there a licensing program for all powered industrial trucks at the facility and does the process include formal classroom training/quiz, hands-on training of equipment (employee is to drive), and evaluation of the powered industrial truck driver

  • Is refresher training provided every 3 years (and documented) or when an unsafe operation is recognized, accident or near miss incident, evaluation indicates need, different equipment is introduced or a change in workplace conditions

  • Have safe operating rules been established and enforced

  • Are trucks taken out of service when found to be unsafe or in need of repair

  • Is the filling of fuel tanks prohibited when the engine is running

  • Are repairs made only by authorized personnel

Hazard Communication

  • Does the plant have a written Hazard Communication Program

  • Is the Hazard Communication Program reviewed annually

  • Does the plant have a list of all hazardous materials that can be referenced to a SDS

  • Does a SDS exist for all hazardous materials

  • Are SDS's accessible at all times for employee's use

  • Do employees know how to obtain copies of the SDS

  • Do employees know how to read SDS's and find appropriate safety information

  • Are employees trained on hazardous chemicals, hazard communication, the new Global Harmonization requirements, and Safety Data Sheets in their work area upon initial assignment and annually thereafter and is the training documented

  • Are they trained whenever a new hazard is introduced to the work place

  • Is the location of the written HAZCOM program communicated to all employees; Are employees trained on methods and observations that may be used to detect the presence or release of hazardous chemicals

  • Are all personnel trained on common plant-wide chemicals (i.e. ammonia, alpet, foot foamer, dry quat, etc.)

  • Are employees retrained as necessary to emphasize this information (i.e. after an incident, lessons learned, or new info.)

Personal Protective Equipment

  • Does the plant have a written Personal Protective Equipment (PPE) Program

  • Is the Personal Protective Equipment (PPE) Program reviewed annually

  • Has the plant conducted an annual hazard assessment to determine whether hazards are present requiring the use of PPE

  • Based upon the assessment, has the plant selected appropriate and properly fitting PPE

  • Does the plant routinely check that defective or damaged PPE is not being used

  • Does the plant train employees on the use of PPE

  • Does the plant retrain when necessary

Electrical Safety

  • Does the plant have a written Electrical Safety Program

  • Is the Electrical Safety Program reviewed annually

  • Are qualified and unqualified persons trained on the policy upon assignment and at the prescribed frequency as outlined in the program with supporting documentation

  • Are electricians or other qualified personnel trained on lockout

  • Has an Arc Flash Study been conducted

  • Do all open items have an action plan

  • Has the study been updated for any electrical changes/projects that have occurred at the location

  • Are electrical/high voltage maintenance gloves tested and inspected according to manufacturer recommendations (i.e. every 6 months)

  • Are all electrical testing equipment and meters inspected for external defects and damage prior to use, calibrated annually, provided by the company, and category III rated or higher

  • Do personnel who are to work on exposed live parts over 600 volts or (voltage level determined by plant) perform the 3-point test prior to performing the work

Hot Work Program: Cutting, Welding and Brazing

  • Does the plant have a Hot Work Program

  • Is the Hot Work Program reviewed annually

  • Does the plant have a cutting/welding (Hot Work) permit system

  • Are the permits filled out completely and approved prior to welding or cutting

  • Are fire watches provided for all required permit work

  • Are Hot Work permits retained for 1 year after work completion

  • Has the facility completed hexavalent chromium industrial hygiene studies on welding activities as required by OSHA

  • Are all appropriate personnel trained on cutting/welding procedures and fire watch procedures upon assignment and annually thereafter and is this training documented

  • Are employees trained on the proper PPE required to use while welding, cutting and/or brazing

  • Have personnel performing Hot Work received HAZCOM training on hexavalent chromium and welding fumes

Contractor Safety

  • Does the plant have a written Contractor Health and Safety Program

  • Does the plant have a master list of "approved" contractors

  • Are the contractors audited on a frequent basis

  • Are they documented

  • Are contractor work permits being utilized for contractor work

  • Audit 3 contractor work permits that were completed within the last 14 days - Are they completed in their entirety

  • Are the contractors trained on the SugarCreek contractor policy before performing work or services at the facility

  • Do the contractor supervisors or SugarCreek designated trainer train the respective contractors on the SugarCreek contractor policy

  • Is there documentation to verify that the training occurred

  • Type of documentation

Compressed Air Safety

  • Are employees trained not to use compressed air to blow off selves and clothing

  • Is it documented

  • Do the air nozzles have the required OSHA nozzles to reduce pressure maximum of 30psi

  • Are employees required to wear eye protection while using compressed air

  • Are all compressed air lines outfitted with the appropriate connectors (i.e no worm-style clamps etc.)

Warehouse Racking

  • Does the facility conduct rack inspections on a frequent basis

  • Frequency of inspections

  • Does the facility have a system to repair or replace damaged racks

Emergency Showers / Eyewash

  • Are all emergency eyewash / showers inspected at least weekly

  • Are the inspections documented

X-Ray Equipment

  • Are all operational x-ray machines registered with the state, if applicable

  • Are all non-operational x-ray machines registered with the state, if applicable

Training Requirements

  • Is training conducted (all training materials) in employee's native language where applicable or a translator provided

  • Are quizzes utilized for appropriate training sessions or hands-on demonstration

  • If translator is used, are they signing off on all documents they were utilized for

Safety Footwear

  • Is the Safety Footwear Authorization form maintained and up-to-date

Safety Committe

  • Does the plant have a safety committee

  • Does the committee consist of employees from multiple shifts

  • Does the committee consist of hourly employees

  • Does the committee meet at least monthly

  • Is the meeting documented to include topics covered and employees in attendance

Floor Inspection

  • Plant has emergency evacuation routes posted in common areas

  • Are emergency contact numbers up-to-date and posted

  • Does the plant control the accumulation of flammable and combustible waste materials so they do not contribute to a fire emergency (i.e good housekeeping, 5S, good storage)

  • During audit tours were exit routes clear

  • Are two exits readily accessible for each occupant in required rooms

  • Are exit doors and doors leading to exits side-hinged type

  • Do rooms with more than fifty occupants have doors that swing in the direction of travel

  • Do all exit doors have free egress

  • Are exit routes clearly marked

  • Are exit routes designed to prevent travel through high-hazard areas

  • Do exit routes meet the minimum width of 28 inches and height of 90 inches

  • Do emergency exits discharge to safe areas

  • Are all exits marked by signs with lettering 6 inches in height

  • Are all doors that could be confused as an exit marked with a sign " NOT AN EXIT " or signage indicating the room name (eg. Conference room)

  • Are all permit required confined spaces posted with appropriate signage

  • Is required equipment (air sampling instruments, ventilation equipment, PPE, lighting, communication equipment, barriers and rescue devices) available and maintained

  • Are adequate first aid/AED supplies on hand and centrally located

  • Is the OSHA poster appropriately displayed in a conspicuous place in the plant

  • Are biohazard labels visible & firmly attached to appropriate containers of regulated waste

  • Are biohazard labels florescent orange or orange-red with letters or symbols in a contrasting color

  • Are storage racks securely fastened to the floor to prevent accidental tip-overs

  • Are the facility's storage racks in good repair

  • Flexible cords are not used as a substitute for fixed wiring

  • Are employees in the facility wearing hearing protection, if required in their area

  • Is the Hearing Conservation standard posted in the workplace

  • Are multiple energy source equipment/machinery isolation points clearly identified and marked

  • Were any LOTO violations observed during the tour of the facility

  • Have one or more machine guarding methods been provided to protect employees from hazards such as those created by point of operation, ingoing nip points, rotating parts, flying chips and sparks

  • Are guards affixed to the machine where possible and secured elsewhere if attachment to the machine is not possible

  • Is the machine guard designed so as not to create a hazard

  • Are special tools provided for placing or removing material without the operator placing a body part in the danger zone of the machine

  • Are precautions in place to assure tools are not used as a substitute for guarding

  • Machine guards should not be easily removed and must require a specialized tool to remove them or be interlocked

  • Have revolving drums, barrels, and containers been guarded by an interlocked guard so the equipment cannot revolve unless the guard is in place

  • Have fan blades less than 7 feet above the workstation been guarded

  • Have conveyors less than 7 feet above the workstation been underguarded

  • Are fan guards provided with openings no bigger than one-half inch

  • Does the guarding on pedestal grinders meet OSHA requirements

  • Are all machines that are designed for a fixed location securely anchored to prevent them from moving during use

  • Are working/walking surfaces kept clean

  • Are working/walking surfaces kept dry where practical

  • Are non-slip surfaces used in critical areas

  • Are standard handrails and toe boards used to protect floor changes, ditches, tanks, etc., with a drop of four feet or more

  • Are standard handrails and toe boards used to protect any drop where a hazard exists at the bottom

  • Are covers used to protect floor openings and hatchways

  • Are swing gates used to protect ladder openings in floors

  • Are standard handrails and toe boards used to protect all open sides of work platforms four feet from the floor

  • Are standard handrails and toe boards used to protect all open sides on work platforms to dangerous tanks or equipment

  • Are employees who work on platforms standing in a proper safe position

  • Are load rating limits marked and posted on top of mezzanines, storage areas, and similar surfaces

  • Is rail, roller, picket fence, half door or equivalent in place when a floor opening with a drop of four feet or more is not in use

  • Are chutes through walls protected

  • Are windows where the bottom opening is less than three feet above the floor guarded by a railing or slat <br>

  • Stairways less than 44" wide - Both sides enclosed - one rail preferably on the right side descending

  • Stairways less than 44" wide - One side open - rail on open side

  • Stairways less than 44" wide - both sides open - rails on both sides

  • Stairways 44" to 88" wide - rail on each side

  • Stairways greater than 88" wide - rail on each side and intermediate midway of width

  • Winding stairs - are they equipped with a rail offset to prevent walking on portion treads with less than 6" of width

  • Are ladders not in use stored horizontally or chained/ latched to a fixed object

  • Are ladders used by one person at a time

  • Are ladders not placed in front of door openings unless door is locked or guarded

  • Are ladders with missing rung, steps or cleats removed from service

  • Fall limiters in use for any work above 4 ft and below 18.5 ft

  • Are skylights protected in such a way to prevent a load of 200 lbs or greater from falling into them (openings should not be more than 4 inches in length or 2 inches in width)

  • Are scaffolds designed to hold more than four times their maximum intended load

  • Are scaffolds not moved horizontally while in use or occupied

  • Are scaffolds protected by rails and toe boards if more than ten feet above ground

  • Are mobile platforms at least 20" wide

  • Fixed Stairs riser height and tread width should be uniform, 22 inches wide (minimum), angle between 30 and 50 degrees, vertical clearance 7 feet, and tread less than 9 inches wide - risers must be open

  • Is the industrial truck of the proper classification for its operating environment

  • Are all industrial trucks equipped with an overhead guard, where applicable

  • Are seatbelts being worn, where applicable

  • Are unauthorized personnel prohibited from riding on powered industrial trucks

  • Are wheel chocks, jack stands, dock-locks, or other means of securing trailers utilized to prevent the trailer from moving away from the dock or upending during loading/unloading

  • Is there sufficient headroom under overhead installations, lights, pipes, etc. to prevent the PIT or loads from striking them

  • When lifting personnel on the forks is a safety platform equipped with standard guardrail, midrail, toeboard used; is the safety platform secured to forks; does the operator of the lift remain at the controls at all times; are employees in the safety platform equipped with a safety harness

  • Are only stable and safely arranged PIT loads handled

  • Are only loads within the rated capacity of the PIT handled

  • Are PIT operators not wearing any noise or audio headphones

  • Are operators not using any mobile device while operating a PIT

  • Are PITs inspected prior to each shift

  • Are bulk storage tanks, totes, barrels, drums and other chemical containers identified as to their contents according to GHS requirements

  • #1 - Does selected chemical have an SDS printed for employee awareness

  • #2 - Does selected chemical have an SDS printed for employee awareness

  • #3 - Does selected chemical have an SDS printed for employee awareness

  • Is appropriate eye protection being used and is in good condition to protect against flying particles

  • Is appropriate eye protection being used and is in good condition to protect against molten metals

  • Is appropriate eye protection being used and is in good condition to protect against liquid chemicals

  • Is appropriate eye protection being used and is in good condition to protect against acids or caustic chemicals

  • Is appropriate eye protection being used and is in good condition to protect against chemical gasses or vapors

  • Do the employees have the appropriate PPE for the task being performed

  • Are appropriate protective helmets being worn and in good condition where there is danger of falling objects

  • Are appropriate equipment items worn and in good condition to protect the employees torso against hazards such as (heat, cuts, impact, splash/sparks, chemicals

  • Is appropriate foot/leg protection being used and in good condition to protect against falling or rolling objects, objects that pierce the sole, or electrical hazards

  • Is arm/hand protection being worn and in good condition when hands are exposed to absorption of harmful substances

  • Is arm/hand protection being worn and in good condition when hands are exposed to severe cuts (i.e sharpening and handling equipment blades - slicers, packaging machines, etc.)

  • Is arm/hand protection being worn and in good condition when hands are exposed to abrasions

  • Is arm/hand protection being worn and in good condition when hands are exposed to punctures

  • Is arm/hand protection being worn and in good condition when hands are exposed to chemical or thermal burns

  • Is arm/hand protection being worn and in good condition when hands are exposed to harmful temperature extremes

  • Are all electrical panels labeled by a Nationally Recognized Testing Laboratory (UL or FM )

  • Are electrical disconnecting means identified as to voltage & function

  • Are electrical panels installed with sufficient clearance to allow safe repairs

  • Are all electrical panels properly labeled as to what each breaker controls

  • Are all electrical live parts with over fifty volts guarded

  • No cracked or missing electrical receptacle box covers

  • Is the fume extractor in place, in working condition, and filter being maintained per manufacturer's instructions

  • Are welding shields/curtains used to prevent exposure to arc's where needed

  • Is the employee/contractor performing all Hot Work in accordance to the Hot Work Program

  • Are all gas cylinders chained to a fixed object or secured to prevent accidental tip over

  • Are all gas cylinder valves closed when not being used

  • Do all gas cylinders not in use have a cap on them

  • Are gas cylinders stored in a well-protected, well-ventilated, dry location and at least 20 ft. from highly combustible materials

  • Propane cylinders stored properly so that relief valve is not blocked

  • Are oxygen cylinders separated from fuel-gas cylinders or combustible materials a minimum distance of 20 ft. or by a noncombustible barrier at least 5 ft. high having a fire-resistance rating of at least one half hour

  • Are gas cylinders transported in a secured vertical position

  • Are all emergency eyewash / showers maintained in operational condition

  • Are the emergency showers / eyewash accessible and free from clutter

  • Are emergency showers / eyewash units located within immediate area for battery charging stations

  • Where the eyes or body of employees may be exposed to corrosive or hazardous materials, are suitable facilities for quick drenching or flushing of the eyes and body readily available within the work area for immediate use

  • Are all employees who are identified through their job functions as outlined in the Safety Footwear Program wearing safety toed footwear in accordance with the program

  • Is the EHS Policy Statement posted in a conspicuous place within the facility

Employee Interviews

  • #1 - Interview one trained confined space entry employee to determine their knowledge of hazardous atmospheres

  • Name of employee interviewed

  • #2 - Interview one trained confined space entry employee to determine their knowledge of hazardous atmospheres

  • Name of employee interviewed

  • Did employee #1 know the lockout procedure for the machine they lockout

  • Did employee #2 know the lockout procedure for the machine they lockout

  • Is employee #1 trained on the chemicals they commonly use

  • Is employee #2 trained on the chemicals they commonly use

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.