MEDDAC AK Army Safety and Health Management Systems Inspection

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• ADSO and NCOIC Email Address

• All deficiencies are to be corrected within 30 days of the completion of this inspection. RAC I and RAC II deficiencies will require immediate corrective action or DD 2977 signed by the Hospital Commander. If any corrective action is unable to be completed a DD form 2977 will be filled out and submitted to the Hospital Commander for approval; DD 2977 will remain on file in the section safety binder until corrective action has been completed. All corrective actions will be validated by the Safety Manager.

Safety Program Administration

• Is an Additional Duty Safety Officer or Collateral Duty Safety Officer appointed on orders?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is a safety binder maintained IAW MEDDAC-AK 385-10-1?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Do the staff know where to locate the safety Binder?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is the Commanders Safety Policy posted?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is the section using FM 5-19 and DD 2977 to identify hazards and reduce risk?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is a current DD 2272 posted?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is a current OSHA poster posted?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is the department safety SOP current? Must contain department specific actions for personnel in the event of a fire. Must be reviewed each year.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is the ADSO or CDSO conducting monthly inspections? Must have 12 months of inspection checklists in the safety binder.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is the SDS binder current? Must have a memo of review every twelve months.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Does the SDS binder and inventory match?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

Army Safety and Health Management Systems

• Can the staff explain the 4 Elements and 29 Sub elements of ASHMS?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff articulate the Commanders Safety Policy?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff articulate the Commander's Safety Awards policy?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff explain the Safety Management Plan and the goals?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff explain the process for reporting accidents or hazards?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are the staff participating in providing monthly safety training?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff articulate their OSHA Rights?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff articulate 3 things that they do to participate in Occupational Safety?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Do the staff receive section safety training prior to performing duties?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Have the staff been provided a copy of the section Base Line Hazard Analysis?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Have the staff been provided a copy of the section Job Safety Analysis?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

Training

• Have the staff completed all required online safety training? Is this documented? Risk Management, employee safety course, supervisors safety course. SSC is for E-5 and above and all supervisors.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Does the staff receive monthly safety training? Is this documented?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Have military staff members 26 and under first duty station completed the National Safety Center online driving course? Documentation?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is HAZCOM training being conducted annually? Is this documented?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

Fire Safety

• Are daily inspections of the section being conducted by the NCOIC or ADSO? Documentation.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff explain the features of the building? E.G. How does the building protect from the spread of smoke and fire?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are all fire doors, corridors, and exit kept clear and well illuminated?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Do exit doors open in the direction of travel, and have panic hardware installed?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are all self closing doors operational? Door wedges are prohibited. Doors must completely latch.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff demonstrate knowledge of the nearest fire extinguisher?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is the department participating in fire drills? Must have documentation of at least one drill per shift per quarter for a 12 month period.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is there documentation to prove each staff member has participated in at least one fire drill annually?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Where are the fire pull stations? Can the staff explained the location of them?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are the fire extinguishers being inspected monthly by the ADSO or CDSO? Month day year format.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Can the staff explain the use of the fire extinguisher? PASS

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are decorations compliant with MEDDAC- AK 450-4? 10% maximum covering of non fire rated interior furnishings, all decorations must have approval letter from Safety Manager and Chief of Facilities Management.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are doors that may be mistaken for an exit marked NOT AN EXIT?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are any personal appliances in use? MEDDAC 450-4 The use of personal appliances is not authorized in any USA MEDDAC-AK facility e.g.. refrigerators, coffee makers, and microwaves

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are all exit signs properly illuminated and tested for power failure? Battery operated backup must be tested for 30 seconds each month.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Is all storage at least 18 inches below the lowest point of sprinkler heads?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are portable space heaters in use?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are there storage rooms that are not 1 hrs fire rated with a 45 min fire door?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are flammables properly stored?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

Personal Protection

• Are eye wash stations adequate for the work being performed?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are eye was stations inspected weekly by the ADSO or CDSO? Can the process be explained?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Do the staff use PPE? Is it in good repair? Can the staff explain how to use the PPE?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

Compressed Gasses

• Are compressed gasses properly stored, separated, and tagged?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

Electrical

• Is there any use of flexible cords, extension cords, or daisy chaining?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are GFCI outlets in areas required by NFPA 70E?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are GFCI outlets being tested monthly? Documentation

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

General Condition

• Other observations that need to be noted?

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible

• Are there more than three non toxic plants displayed? Max size 20 inches tall and 12 inches in diameter.

  Safe

  At Risk Rac I Catastrophic

  At Risk Rac II Critical

  At Risk Rac III Moderate

  At Risk Rac IV Negligible