Title Page

  • Client:

  • Prepared by:

  • Conducted on:

Safety Program Audit

Hazard Communication (Right to Know)

  • Written Plan

  • Annual Training Documentation

  • New Employee Training Documentation

  • Training Outline

  • SDS’s Available for Employee Review

  • Chemical Inventory List

  • Secondary Container Labeling

  • Notes

AWAIR

  • Written Plan

  • Annual Training Documentation

  • New Employee Orientation Documentation

  • New Employee Orientation Outline Available

  • Safety Committee Organized and Periodic Safety Committee Meeting Held

  • Employee Request for Corrective Action Forms Available

  • Management, Supervisor & Employee Responsibilities

  • In-house Inspection Forms Available & Documented Periodically

  • Disciplinary Policy Outlined & Enforced

  • Safety Goals Set & Reviewed

  • Notes

Injury Log OSHA 300

  • Recordable Injuries Logged are Current

  • Injury Reports Available & Reviewed by Safety Committee

  • 300A Log Posted (Feb. 1st – April 30th Annually)

  • Columns Totaled

  • Corrective Action Taken if Applicable

  • Notes

Lockout Tagout

  • Written Plan

  • Annual Training for Authorized Employees

  • Annual Awareness Training for Affected & Other Employees

  • Annual Program Audit Checklist

  • Equipment Specific Energy Isolation Checklists

  • Equipment Sufficient to Isolate all Operating Energy Sources

  • Authorized Employees Equipped with Their Own Lock & Tag

  • One Key per Lock

  • Equipment Sign-out Sheet (Non-mandatory)

  • Procedure for Device Removal by Supervisor or Another Authorized Employee

  • Compliance with Plan Enforced

  • Notes

PPE

  • Written Plan

  • Annual Training Documented

  • Job Hazard Analysis

  • Plan Enforced

  • Required Areas Posted

  • Employees Fit Tested

  • Supplied for Employees by Employer if Required

  • Notes

Respiratory Protection

  • Written Plan

  • Annual Training Documented

  • Medical Evaluations Documented & Updated

  • Annual Fit Testing Documented

  • Air Quality Monitoring Documented for Respirable Hazards

  • Filter Changing Frequency Documented

  • Policy for Non-mandatory Use of Respirators

  • Proper Storage

  • Notes

Blood Borne Pathogens

  • Exposure Control Plan

  • Annual Employee Awareness Training Documented

  • Annual Safety Committee/ERT Training Documented

  • Safety Committee/ERT Vaccination or Declination Forms Updated

  • Notes

Hearing Conservation

  • Written Plan

  • Annual Employee Training Documented

  • Affected Areas Posted

  • Noise Map Developed (Dosimeter Testing)

  • Variety of Hearing Protection Available for Employees

  • Proper Use Enforced

  • Annual Audiological Testing Conducted for Affected Employees

  • Notes

Confined Space Entry

  • Written Plan

  • Annual Training Documented

  • List of Authorized Employees

  • List of Permit Required Confined Spaces

  • List of Space Specific Hazards

  • Physical

  • Mechanical

  • Atmospheric

  • Safe Entry Procedures

  • Hazard Control Procedures

  • Air Monitoring Requirements

  • Oxygen

  • Flammables

  • Toxics

  • List of Confined Space Entry Equipment

  • Calibration Requirements of Air Quality Monitor

  • On-Site/Off-Site Rescue Team Acquired

  • If On-site, CPR/First Aid Certification of at least One Team Member

  • If Off-site, Documentation of Availability, Competence, & Knowledge of On-site Confined Spaces

  • Permits Retained for 3 Years

  • Confined Spaces Posted & Entry Restricted

  • Hot Work Permit Available – if Applicable

  • Responsibilities of Authorized Attendant & Entrant Defined

  • Policy for Cancellation of a Permit

  • Safe Entry Procedures into Non-permit Required Confined Spaces

  • Notes

Emergency Response/Contingency Plan

  • Written Plan

  • Emergency Response Team (ERT) Assigned Titles & Job Duties

  • Evacuation Maps Developed & Posted

  • Emergency Contact List Developed & Posted

  • Plan Sent to Appropriate Agencies (Cover Letters Available)

  • Chemical/Waste Inventory in Plan

  • Periodic ERT Trainings Held and ERT Meetings Documented & Minutes Recorded

  • Spill Kits On-site & Contents Listed in the Plan (Including an Explanation of how to use PPE)

  • ERT has Written Authority to Act

  • Incident Reports Available in Plan & Completed as Necessary

  • Notes

Fire Prevention Plan

  • Written Plan

  • List of all major fire hazards

  • Proper handling and storage procedures for hazardous materials

  • List of potential ignition sources and their control

  • List of the type of fire protection equipment necessary to control each major hazard

  • Procedures to control accumulations of flammable and combustible waste materials

  • Procedures for regular maintenance of safeguards installed on heat-producing equipment to prevent the accidental ignition of combustible materials

  • Name or job title of employees responsible for maintaining equipment to prevent or control sources of ignition or fires

  • Name or job title of employees responsible for the control of fuel source hazards

  • Notes

Emergency Action Plan

  • Written Plan

  • Procedures for reporting a fire or other emergency

  • Procedures for emergency evacuation, including type of evacuation and exit route assignments

  • Procedures to be followed by employees who remain to operate critical plant operations before they evacuate

  • Procedures to account for all employees after evacuation

  • Procedures to be followed by employees performing rescue or medical duties

  • List of every employee who may be contacted by employees in need of more information about the plan, or an explanation of their duties under the plan

  • Notes

Industrial Lift Trucks

  • Written Plan

  • Authorized Employee Training Documented

  • Classroom Training

  • Written Testing

  • Practical Driving Evaluation

  • License Available On Person

  • Per Shift Inspections Documented

  • Proper Use of Seatbelts

  • Periodic Retraining

  • Every 3 Years and After Unsafe Driving is Observed

  • Classroom Training

  • Written Testing

  • Practical Driving Evaluation

  • License Available On Person

  • Policy for Removing Forklift from Operation if Unsafe

  • ID Plates Legible

  • Recharge Stations Equipped with Appropriate PPE – if Applicable

  • Notes

Notes

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