Information
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Client / Site
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Conducted on
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Prepared by
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Location
Ensure that the workplace is safe in the following areas:
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AWAIR Safety Program Contains 5 elements; updated annually with goals and objectives.
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Potential OSHA Citation:
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Safety Committee MN: Regular Meetings? Documented Meetings? Management & employee equally represented?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Bloodborne Pathogens: Training? BBP clean up kits?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Employee Right To Know / GHS / SDS: Annual training? SDS available to employees? Labeling of Containers?<br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Chemical Hygiene: Employees trained, Properly labeled, Stored properly (25+ gallons flammable liquid inside cabinet), SDS readily available, PPE in use as required.
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Potential OSHA Citation
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Compressed Air Use: Not used for cleaning personnel/clothing, For cleaning equipment nozzle pressure reduced to 30 psi if dead ended (regulated or relief ports on nozzle), chip guarding/PPE in place.
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Electrical Wiring & Equipment: Cords not used for permanent wiring? Damaged Cords? 3 feet clearance in front of panels?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Emergency Action Plan: Notification system, Maps developed/posted? Drills? Emergency lighting tested monthly? Exit Signs/Not an Exit signs in place?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Fire Prevention: Extinguisher Training? Monthly inspection? Labeled? Not Blocked/Obstructed? Mounted properly?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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First Aid & CPR: Trained personnel if no EMS Response within 4 minutes, Training every 2 years? Eye Wash Station Tested Weekly?<br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Injury & Illness Record Keeping: OSHA 300 Log Accurate? Log posted (February 1 - April 30)? Posters?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Ladders: Trained on proper use, in good condition, labels are legible, being used properly (Extension Ladder - secured, set up at a 4:1 ratio, and extends 3' above access point. Step Ladder - spreader bars locked, personnel not standing above the second step from the top).
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Lock Out Tag Out: Procedures developed for equipment? Authorized/Affected training? Procedures evaluated?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Machine Guarding: AUTO Interlocks? Light curtains? Two hand controls?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Overhead Cranes: Documented Inspections? Safety latch? Controls labeled? Limit switches tested?<br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Permit Required Confined Space: Signs? Training? Rescue plan?<br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Personal Protective Equipment: Trained, Proper Use, Hazard Assessments
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Power Tools: In good condition, cords not damaged, guards/shields in use, proper PPE?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Powered Industrial Trucks: Classroom Training? Written Test? Hands on evaluation, every 3 years? Quarterly Monitoring for CO?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Respiratory Protection: Required Use (Trained, Medically Qualified, Fit Tested) Voluntary Use (Signed Form, Medically Qualified for Elastomeric APR)<br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Rigging (Chains & Slings): Inspected? Rated? Good condition?<br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Walking & Working Surfaces: Personnel exposed to a fall hazard are protected (4' trigger height, guardrail system, personal fall arrest system or safety net system). <br><br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Woodworking Machines: Guards in place? Push Sticks? Anti restart?<br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Compressed Gas Cylinders: Secured? Valve Caps in place? <br>
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
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Musculoskeletal/Cumulative Trauma Hazard: Workstations height adjustable? Are lifting aids in use? Job rotations?
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
Additional observations: Air Quality, Combustible Dust, Ergonomics, Hot Work Permit Program, Servicing Rims & Wheels, Mechanical Power Presses, Lab Safety, Process Safety Management, Welding (weld fume, hex chrome), etc.
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Describe the observation:
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Observation finding:
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Potential OSHA Citation:
- de minimus ("A" technical violation of OSHA rules that have no direct impact on health or safety) - $0
- Non Serious ("B" minor injury or illness) - $750
- Serious ("C" serious physical harm) - $1,750
- Serious ("D" serious physical harm) - $2,750
- Serious ("E" serious physical harm) - $4,000
- Serious ("F" serious physical harm) - $6,250
- Serious (death or serious physical harm) - $7,000
- Willful (employer intentionally and knowingly commits) - $70,000
- Repeat (same violation within three-year period) - $70,000
- Not Applicable
ADDITIONAL SAFETY EFFORTS
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Any examples of best practices, or pro-active safety efforts observed during the site visit (ergonomic improvements, pre-task planning, near miss reporting, safety suggestion system, perception surveys, incentive program, return to work program, etc.)?<br>
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Summarize the observation:
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Have there been any injuries or incidents since the previous jobsite inspection?<br>
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Summarize the incident, results of the investigation and any corrective actions that were implemented:
STANDARD OF CARE:
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The services performed by Marsh & McLennan Agency (MMA) on this project have been conducted with that level of care or skill ordinarily exercised by reputable members of the profession, practicing in the same locality under similar budget and time constraints. No other warranty is expressed or implied.