Hensley Field Annual Safety Inspection

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

SAFETY PROGRAM MANAGEMENT

Unit Safety Representatives (USRs)

• Are USRs appointed in writing?

  Yes

  No

  N/A

• Are USRs trained & documented?

  Yes

  No

  N/A

Safety Briefings & Inspections

• Are Supervisors and/or USRs conducting & documenting safety briefings?

  Yes

  No

  N/A

• Are Supervisors and/or USRs conducting & documenting periodic safety inspections?

  Yes

  No

  N/A

Job Safety Training Guide (JSTG)

• Is the JSTG developed and available?

  Yes

  No

  N/A

• Is the JSTG reviewed annually and documented?

  Yes

  No

  N/A

Safety Training Documentation (tracked in ARCNET)

• Are all Workcenter personnel loaded in ARCNET?

  Yes

  No

  N/A

• Is all job safety training documented in ARCNET?

  Yes

  No

  N/A

• Have all supervisors completed Supervisor Safety Training?

  Yes

  No

  N/A

• Have all personnel completed annual Fire Extinguisher training?

  Yes

  No

  N/A

• Are all personnel current on CPR training? (Annually for SCSP, every two years for others)

  Yes

  No

  N/A

• Have all personnel completed initial Hazard Communication (HAZCOM) training?

  Yes

  No

  N/A

• Have all personnel completed Ladder Safety training?

  Yes

  No

  N/A

Personal Protective Equipment (PPE) available in the workcenter

• Eye & Face Protection

  Yes

  No

  N/A

• Hand & Arm Protection

  Yes

  No

  N/A

• Head Protection

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Foot & Leg Protection

  Yes

  No

  N/A

Lockout/Tagout (LOTO)

• Is there a written LOTO program in the workcenter?

  Yes

  No

  N/A

• Is there an annual inspection/performance of Energy Control Procedures?

  Yes

  No

  N/A

Emergency Lights & Fire Extinguishers

Hoists/Cranes (SCSP & SCSV Only)

• Does the attached ID tag include: annual inspection, load test, capacity, & ID number?

  Yes

  No

  N/A

• Is there a written training outline/plan?

  Yes

  No

  N/A

• Is the training outline reviewed annually?

  Yes

  No

  N/A

• Is a list of approved instructors retained on file?

  Yes

  No

  N/A

• Does the user maintain a record of all tests performed on hoists/cranes?

  Yes

  No

  N/A

• Are emergency lights tested monthly for 30 seconds and documented?

  Yes

  No

  N/A

• Are emergency lights tested annually for 90 minutes and documented?

  Yes

  No

  N/A

• Are fire extinguishers mounted, charged, and in working order?

  Yes

  No

  N/A

• Are fire extinguisher monthly inspections documented?

  Yes

  No

  N/A

Safety Bulletin Board

• Is AFVA 91-301 posted?

  Yes

  No

  N/A

• Is AF Form 457 (Hazard Reporting Form) available?

  Yes

  No

  N/A

FACILITIES

Industrial Work Centers

• Compressed Air Lines

  Safe

  At Risk

  N/A

• Compressed Gas Cylinders

  Safe

  At Risk

  N/A

• Hand Tools

  Safe

  At Risk

  N/A

• Ladders

  Safe

  At Risk

  N/A

• Machines firmly secured to floors, bases, or stands

  Safe

  At Risk

  N/A

• Grinding Machines

  Safe

  At Risk

  N/A

• Machine Guards

  Safe

  At Risk

  N/A

• Hydraulic Floor Jacks - lubricated & inspected

  Safe

  At Risk

  N/A

HAZMAT

• Are MSDSs availalble?

  Yes

  No

  N/A

• Are chemical inventories available in the workcenter?

  Yes

  No

  N/A

Office Equipment

• Are file drawers closed when not in use?

  Yes

  No

  N/A

• Is the area clear of trip hazards? (cords, etc.)

  Yes

  No

  N/A

• Are areas kept in a neat manner?

  Yes

  No

  N/A

Circuit Breakers/Disconnects

• Plainly marked?

  Yes

  No

  N/A

• Accessible?

  Yes

  No

  N/A

• Guarding Live Parts?

  Yes

  No

  N/A

Electrical Cords

• In good condition?

  Yes

  No

  N/A

• Extension cords NOT used as permanent wiring?

  Yes

  No

  N/A

• Workcenter free of multiple plug adapters?

  Yes

  No

  N/A

Receptacles/Outlets/Switches

• Workcenter free of broken, cracked, or missing receptacles/covers?

  Yes

  No

  N/A

• GFCI receptacles where required?

  Yes

  No

  N/A

General Housekeeping

• Are floors/walkways clean, free of oil, grease, water?

  Yes

  No

  N/A

• Are areas kept in a neat manner?

  Yes

  No

  N/A

• Are combustible materials NOT accumulating?

  Yes

  No

  N/A

• Are cabinets kept clear from stacked material?

  Yes

  No

  N/A

Break Areas

• Is the refrigerator used for food ONLY?

  Yes

  No

  N/A

Emergency Shower & Eyewash Stations

Permanently Installed

• Are monthly inspections documented?

  Yes

  No

  N/A

Self-contained Units

• Is fluid level checked monthly?

  Yes

  No

  N/A

• Is fluid replaced IAW manufacturer's instructions

  Yes

  No

  N/A

• If tap water is used, is fluid replaced monthly?

  Yes

  No

  N/A

• Is tag/label w/fluid change schedule available?

  Yes

  No

  N/A

Other

• Is the workcenter free of other safety concerns?

  Yes

  No

  N/A