Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Blood Borne Pathogens

  • Has a designated first responder team been formed?

  • Has Blood Borne Pathogen training been provided to first responder team members?

  • Have team members been provided with the required personal protective equipment?

  • Are blood borne pathogen kits and labels in place? (gloves, aprons, biohazard disposal bags, bleach, etc.)

  • Are Blood Borne Pathogen evaluations and vaccinations available to team members? Is counseling provided if needed?

First Aid

  • Are first aid kits adequate for size of facility, readily available, easily accessible, weatherproof, have individually sealed package of each type of item and are all contents within current expiration dates?

  • Has the location manager formed a designated First Responder Team (individual) to respond to medical emergencies at the facility?

  • Is a list of First Responders maintained and posted at the facility?

Hearing Conservation

  • Has area monitoring been conducted where it is difficult to communicate at normal speech levels? Is it readily available to affected personnel?

  • Has personal monitoring been conducted where applicable?<br>

  • Has written plan been implemented for hearing conservation?

  • Has annual audiometric testing been conducted for affected employees?

  • Has affected employees received training on hearing conservation?

  • Is hearing protection available to affected employees

Heat/Cold Stress

  • Are employees aware of safety implications when working in temperatures (heat or cold) extremes? <br><br>

  • Have the working conditions and possible temperature extremes been assessed in each job function? (Hazard Aspect Registers/Assessments)

Hydrogen Sulfide (H2S)

  • Have areas or fields been identified where H2S may be present?

  • Have employees who will work in actual or suspected H2S areas been identified and appropriately trained?

  • Are affected employees familiar with site specific H2S hazards and precautionary information?

  • Has the respiratory protection program been implemented for employees working in H2S areas? (Medical evaluations, respirator fit test)

Industrial Hygiene

  • Has the work location been evaluated for medical surveillance requirements?

  • Has the medical surveillance been conducted?

  • Have personal test results been provided to the tested employee on request?

  • Does the location have a plan to comply with heightened focus on employee health?

Respiratory Protection

  • Have all employees required to wear respirators been given a medical examination and quantitative or qualitative fit test?

  • Have respirator wearers been trained on respirator selection/use and care? Are respirators wearers clean shaven {to ensure good fit}?

  • Have respirator users received an initial quantitative or qualitative fit test by a trained professional and there are records of this test performed annually thereafter?

  • Are respirators selected according to hazard exposure for each use?

  • Are respirators inspected, cleaned and maintained before and after use; or on a monthly bases (regardless of use)?

  • Do breathing air/oxygen and their containers and compressors meet quality specification and safety standards?

  • Are breathing air couplings incompatible with any other type of worksite air or gas systems?

Malaria Control

  • Is there a designated Local Malaria Control Officer (MCO) for the facility

  • Verify that inventories exist of Personal Protection kits, expendable supplies and Malaria Survival Kits.

  • Review Register of Malaria Survival Kits that records are complete and current.

  • Verify that BHI Declaration forms are signed and on file

  • Verify that a process exists for the issuance of Personal Protection Kits, expendable supplies, and Survival Kits.

  • Verify that mosquito control measures has been implemented.

  • Verify that quarterly inspection of mosquito control measures are conducted?

  • Verify employee training records?

  • Verify malaria cases are recorded in First Alert?

  • For locations providing services to ExxonMobil in malaria prone countries, verify the records to ensure that the ExxonMobil Attestation Form has been signed by employees?

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.