Title Page
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Site conducted
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Conducted on
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Prepared by
Untitled Page
1.0 Training Program
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Does the site have a training program for employee(s) exposed to hazardous chemicals under a laboratory setting and the contents within the lab? 1910.1450(f)(1)
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Has the water treatment employee been trained and certified as a water treatment technician?
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Is the ERT team trained in emergency response to a chlorine leak?
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Has the employee been trained on the proper PPE or other controls for handling the hazardous materials in which they are exposed?
2.0 Chlorine Safety Guidelines
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Does the site have accidental release measures in place for chlorine?
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Does the site have storage requirements for chlorine?
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Does the site have handling requirements for chlorine?
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If there is potential exposure to splash or contact, is there an eyewash and safety show immediately available?
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Does the site list required PPE when handling chlorine or/and chlorine containing containers?
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Do emergency release procedures describe how to properly contain water contaminated with chlorine so it does not get dicharged into waterway, sewer or drains?
3.0 Chlorine Safety Practices (Visual Inspection)
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Is there a chlorine alarm to indicate a potential leak?
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Is there an emergency respiratory kit for escape? Any air purifying full-face respirator
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Is chlorine stored in an area that is cool, dry, well-ventilated, out of direct sunlight and away from heat and ignition sources?
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If there is potential exposure to splash or contact, is there an eyewash and safety shower immediately available?
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If there is potential exposure to splash or contact, is there an eyewash and safety shower immediately available?
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Is chlorine stored in an area that is locked? (per the SDS)
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Is chlorine stored in a segregated area? (per the SDS)
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Are chlorine cylinders or tanks stored secure and separate from work areas?
4.0 Employee Knowledge (Employee Questions)
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Do employee know of their potential exposure to chlorine?
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Are employees aware of the emergency procedures in case there is a release of chlorine?
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Are employees aware of the hazards associated with chlorine?
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Do employees know what controls are in place to eliminate potential exposure to chlorine?
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Are employees familiar with the warning sounds in case a chlorine leak occurs?
5.0 Documentation and Retention (Safety/Medical)
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Documents for employee training are maintained for the period of employment per the century aluminum document retention program?