• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1.0 - Respirable Crystalline Silica (RCS)

1.1 - General

  • What is the predominant geological formation (limestone, granite, sand & gravel)?

  • Percent silica (SiO2) in material (estimated or confirmed through bulk sampling)?

  • Overview of production activities (type of plant, annual tonnage, etc...) that will impact risk of employee exposure to RCS:

  • Number of employees potentially exposed to RCS (regardless of control measures implemented)?

  • Add media

1.2 - Plant & Process Sources

1.3 - Work Task Sources

1.4 - Mobile Equipment & Haul Roads

1.5 - Control Measures

  • Add media

2.0 - Noise & Hearing Conservation

2.1 - Noise Sources

  • Has a site noise level survey been conducted to determine noise sources and areas > 85 dB?

  • Has full shift noise dosimetry been conducted for employees anticipated to be exposed at or above 85 dB?

  • What are the primary noise sources at the site?

2.2 - Noise control methods

  • Is signage posted to identify noise sources/areas that are > 85 dB?

2.3 - Hearing Conservation Program

  • Are all employees potentially exposed > 85 dB included in hearing conservation program?

  • Are all employees included in HCP offered an annual audiogram? Is this documented?

  • Have all potential hearing threshold shifts been followed up on to determine persistence and report ability?

  • Have employees with confirmed STS been advised of this in writing, provided/retrained on HP, and been advised of operators plan to control noise exposure?

  • Add media

3.0 - Other IH issues (welding fume, vibration, ergonomics, confined space, etc...)

  • Add media

  • Add signature

4.0 - IH Risk Assessment Tool

  • GEOLOGY: What is the anticipated silica content within the geological formation that is being mined?

  • EXPOSED POPULATION: What number of employees are potentially exposed to RCS and/or noise?

  • PLANT OPERATIONS: What is the size and scope of the operation?

  • QUALITATIVE ASSESSMENT: What is the status of exposure control measures in place?

  • EXPOSURE HISTORY: Have historical over exposures to RCS been identified?

  • Overall risk rating?

5.0 - Comments & Observations

  • Ryan J. Langton, CIH, CSP

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.