Maine ANG Safety Program Assessment Checklist

• Conducted on

  Date

• Prepared by

• Location
  Address

Unit Safety Representatives (USR) should be conducting monthly spot inspections and documenting them IAW 91-202. Utilize the Monthly Spot Inspection Checklist to document and maintain records for one year. Findings/descrepancies require follow-up actions every 30 days until closed. Open findings also need to be forwarded to the Wing Safety Office after 30 days.

• Are USRs conducting monthly spot inspections?

  Yes

  No

  N/A

• Are USRs properly documenting spot inspections?

  Yes

  No

  N/A

Each shop/section/unit should maintain a Job Safety Training Outline (JSTO) or Job Safety Training Guide (JSTG) tailored to their individual shop/section/unit. See the Wing Safety SharePoint site for a template: https://intelshare.intelink.gov/sites/angsafety2/101ARW/SitePages/Home.aspx_

• Is the JSTO/JSTG in place and tailored to the shop/section/unit?

  Yes

  No

  N/A

• Has a supervisor reviewed the JSTO/JSTG and documented the review annually?

  Yes

  No

  N/A

• Is the JSTO/JSTG maintained in a central location that is readily accessible to both supervisors and individuals?

  Yes

  No

  N/A

• Have supervisors attend Supervisor Safety Training (SST) conducted by the Wing Safety Training (E-4 and above and civilians when assigned to a supervisory position).

  Yes

  No

  N/A

Each unit will have a primary and an alternate USR, Additional Duty Weapons Safety Representative (ADWSR), and/or Squadron Assigned Flight Safety Officer (SAFSO) as applicable. A USR is a liaison between the Unit Commander and the Wing Safety Office. See AFI 91-202 for information regarding USR duties and responsibilities.

• Has the USR completed all required training within 2 UTAs of appointment (USR CBT, RM Training).

  Yes

  No

  N/A

• Is the USR appointment letter current?

  Yes

  No

  N/A

• Has the USR conducted and documented quarterly unit safety briefings to the Unit Commander?

  Yes

  No

  N/A

• Has the USR competed the USR Responsibilities Communicator in MICT?

  Yes

  No

  N/A

• Has the shop level supervisor completed the Supervisor Responsibilities Communicator in MICT?

  Yes

  No

  N/A

• Does the USR ensure all mishaps are reported to the Wing Safety Office within 5 duty days and assist unit personnel and supervisors with mishap reporting?

  Yes

  No

  N/A

• Does the USR maintain a safety bulletin board? Is the information current and relevant?

  Yes

  No

  N/A

Refer to Bioenvironmental (404-7203) for questions regarding Respiratory Protection Program requirements.

• Are respirators (half- or full-face) required to accomplish assigned work?

  Yes

  No

  N/A

• Are only authorized respirators being utilized?

  Yes

  No

  N/A

• Have all personnel who are required to wear a respirator completed an annual fit test?

  Yes

  No

  N/A

• Is training provided and documented?

  Yes

  No

  N/A

Personnel who use ladders (portable and fixed) at any working height shall be adequately trained in the care and use of different types of ladders. See AFI 91-203 chapter 7 for more information.

• Are personnel required to use ladders (portable or fixed) at any working height?

  Yes

  No

  N/A

• Has a ladder safety lesson plan been developed for the specific ladders that personnel use?

  Yes

  No

  N/A

• Is the ladder safety lesson plan periodically reviewed?

  Yes

  No

  N/A

• Is ladder safety training documented IAW AFI 91-202?

  Yes

  No

  N/A

Fall Protection is required for workers working in elevated locations on open-sided floors and platforms and near floor and wall openings. Fall protection shall be provided when workers can fall: 4 feet for more for General Industry (29 CFR 1910); or six feet or more for Construction (29 CFR 1926). See AFI 91-203 chapter 13 for more information.

• Do workers work in elevated locations on open-sided floors and platforms and near floor and wall openings? Is there a potential for the worker to fall 4 feet or more (General Industry) or 6 feet or more (Construction)?

  Yes

  No

  N/A

• Has a unit/section/shop specific Fall Protection lesson plan been developed?

  Yes

  No

  N/A

• Is the Fall Protection lesson plan periodically reviewed and updated as required?

  Yes

  No

  N/A

• Has a supervisor been designated in writing, and is that person responsible for the procurement of required fall protection/fall arrest systems?

  Yes

  No

  N/A

• Does the supervisor ensure that each worker/qualified person/competent person using a fall protection/fall arrest system is trained and evaluated on proper use, application, and inspection of fall protection/fall arrest systems?

  Yes

  No

  N/A

• Is recurring training completed annually, when work conditions change or when new fall arrest systems are used? Is training documented IAW AFI 91-202?

  Yes

  No

  N/A

• Has a rescue plan been developed for fall protection activities? PFAS shall not be allowed if a means to rescue a fallen worker is not available.

  Yes

  No

  N/A

This section encompasses the use of power tools/powered equipment that is not covered during formal AFSC training (generator, snow blower, lawn mower, etc.).

• Has a lesson plan been developed for training personnel on the use of power tools/powered equipment?

  Yes

  No

  N/A

• Are personnel trained on the use of power tools/powered equipment, and is the training documented?

  Yes

  No

  N/A

• Do supervisors immediately remove defective tools/equipment from service?

  Yes

  No

  N/A

• Have all unit/section/shop personnel who ride motorcycles been accounted for?

  Yes

  No

  N/A

• Have all unit/section/shop motorcycle riders been entered in the Motorcycle Unit Safety Tracking Tool (MUSTT) Database?

  Yes

  No

  N/A

• Has the unit Commander appointed a Unit Motorcycle Representative, and is the appointment letter current?

  Yes

  No

  N/A

• Does the unit commander ensure that initial motorcycle safety briefings are conducted?

  Yes

  No

  N/A

• Does the unit commander ensure that annual preseason motorcycle safety briefings are conducted?

  Yes

  No

  N/A

• Does the unit/section/shop Vehicle Control Officer (VCO) maintain a list of all qualified and trained forklift operators?

  Yes

  No

  N/A

• Does the unit/section/shop VCO maintain a list of all special purpose vehicles, low-speed vehicles, and other government motor vehicles; a lesson plan for each vehicle type; a list of all qualified operators for each vehicle type; and is training documented IAW AFI 91-202?

  Yes

  No

  N/A

• Have all flight line drivers received annual training and has their AF Form 483 been signed off on an annual basis?

  Yes

  No

  N/A

Awareness level training is accomplished via the JSTO/JSTG. This program is required for personnel who are required to control hazardous energy and authorized to perform LOTO procedures.

• Are workers required to control hazardous energy and are they authorized to perform LOTO procedures?

  Yes

  No

  N/A

• Does the supervisor maintain a list of all equipment/machinery that requires LOTO procedures?

  Yes

  No

  N/A

• Does the supervisor maintain a list of all authorized workers?

  Yes

  No

  N/A

• Does the supervisor maintain sufficient LOTO supplies (tags, logs, etc.)?

  Yes

  No

  N/A

• Have procedures been developed to perform LOTO for each individual machine/piece of equipment?

  Yes

  No

  N/A

• Have all authorized personnel been trained on the Hazardous Energy Control Program and have they been trained on performing LOTO procedures?

  Yes

  No

  N/A

Awareness level training is accomplished via the JSTO/JSTG. This program is required for personnel who are required to enter and work in confined spaces. See AFI 91-203 for more information. A confined space is one that meets all of the following conditions: - Is large enough to so configured that a worker can bodily enter and perform assigned work. - Has limited or restricted means for entry or exit. - Is not designed for continuous worker occupancy. A Permit-Required Confined Space is one that has one or more of the following characteristics: - Contains or has the potential to contain, a hazardous atmosphere - Contains a material with the potential to engulf someone who enters the space - Has an internal configuration that might cause an entrant to be trapped or asphyxiated by inwardly converging walls or by a floor that slopes downward and tapers to a smaller cross section; and/or - Contains any other recognized serious safety or health hazards.

• Are personnel required to enter confined spaces to perform work?

  Yes

  No

  N/A

• Does the unit/section/shop maintain a list or map of the location of all permit required and non-permit required confined spaces?

  Yes

  No

  N/A

• Does the commander and/or functional manager ensure personnel who enter confined spaces are properly trained, equipped, and qualified?

  Yes

  No

  N/A

• Is confined space training documented on an AF IMT 55, Employee Safety and Health Record, or equivalent?

  Yes

  No

  N/A

• Does the commander and/or functional manager ensure required equipment is available and properly maintained?

  Yes

  No

  N/A

• Are entry permits (AF Form 1024), including those that are canceled or revoked, retained on file for one year?

  Yes

  No

  N/A

• Does a representative from the unit/section/shop attend Confined Space Program Team meetings?

  Yes

  No

  N/A

• Are MEPs reviewed and approved by the appropriate agencies annually (SE, BE, FD)?

  Yes

  No

  N/A

• Has the unit commander completed the New Commander Safety Orientation provided by the Wing Safety staff?

  Yes

  No

  N/A

• Are risk management principles incorporated into unit activities (mission oriented, off-duty, sports & rec, non-standard, etc.)? Is the risk management process documented?

  Yes

  No

  N/A

• Have all personnel completed AF Risk Management Fundamentals Training IAW AFI 90-802?

  Yes

  No

  N/A

• Do unit POCs complete applicable safety-related SACs in MICT? Are they reviewed periodically?

  Yes

  No

  N/A

• The Safety Assessment is complete.

• 3-Year Mishap Trend: Total number of mishaps: Mishap classes: Leading activity:

• The Safety/Mishap Prevention Program conformance/performance under the Air Force Safety Management System is:

  Met and Effective

  Met But Needs Minor Improvement

  Met But Needs Significant Improvement

  Was Not Effective

• Best Practices:

Units that store, handle, and/or transport Ammunition and Explosives (AE) will implement the applicable elements of AFMAN 91-201.

• Does the unit store, handle, or transport munitions/AE?

  Yes

  No

  N/A

• Has the commander appointed a primary and alternate Additional Duty Weapons Safety Representative (ADWSR) and have completed the required training?

  Yes

  No

  N/A

• Have written instructions been developed and approved by the commander and coordinated with Wing Safety?

  Yes

  No

  N/A

• Have all workers that handle, store, or transport AE received training initially and every 15 months thereafter?

  Yes

  No

  N/A

• If the area stores AE, has an AF 2047, Explosive License, been approved and posted in the area?

  Yes

  No

  N/A

• Has the AF 20147, Explosive License been reviewed annually?

  Yes

  No

  N/A