Title Page
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Audit Title
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Office Name
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Conducted on
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Prepared by
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Address
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Administrations/Programs included
Kudos
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Select "Add Kudos." Then select "In Place & Effective." Then add the description of the Kudos in the notes, and add photos if desired.
Kudos
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Preparation Work
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Has the previous SHPA been reviewed?
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Has the previous Corrective Action Plan (CAP) been reviewed?
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Have all CAP actions been completed?
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How many injuries were reported in the previous 12 months?
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Is the injury trend improving?
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Has the site been free from L&I Citations for the last 3 Years?
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Describe any L&I Citations:
Main Assessment
GENERAL SAFETY [WAC 296-800]
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There is a written Accident Prevention Program that covers the requirements [WAC 296-800-14005]
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Job Hazard Analyses (JHAs) adequately address job tasks, possible hazards, and mitigation of those hazards. [DSHS AP 9.07, WAC 296-800-11010]
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JHAs are updated and reviewed by employees annually (for job classes with a high potential for injury/illness) or every three years (all other job classes) [DSHS AP 9.07]
ACCIDENT INVESTIGATION [DSHS AP9.07, WAC 296-800, 296-27]
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All incidents are reported and investigated using the Safety Incident/Near Miss reporting process [DSHS AP 9.07]
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All serious employee accidents are investigated, documented and sent to Headquarters (Fatality, Inpatient Hospitalization, Amputation, Loss of an eye) [WAC 296-800-32020]
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OSHA 300A forms are completed and have the highest ranking official on-site certified [WAC 296-27-02105(1)(c), (6)] The OSHA 300A Summary is posted Feb 1 through April 30
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OSHA 300 Log, 300A Summaries are retained for the current year plus five previous years [WAC 296-27-02107]
BBP STANDARD [WAC 296-823]
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There is a written exposure determination that includes job titles and tasks that may have exposure to blood and OPIM [WAC 296-823-11005]
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There is a written Bloodborne Pathogens (BBP) exposure control plan that is updated at least annually [WAC 296-823-11010]
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Documented training is conducted for all exposed employees in Bloodborne Pathogens annually [WAC 296-823-12005]. There is BBP awareness training for all other employees upon initial hire [DSHS AP 9.06, 18.34]
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Hepatitis B vaccines are offered to all exposed employees. Documented declination forms are completed for employees who do not want the HBV vaccine [WAC 296-823-13005]
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There is an investigation for each exposure incident and proper medical follow up with employees [WAC 296-823-16005]
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*Feasible controls, including appropriate equipment and safer medical devices, are used to eliminate or minimize occupational exposure (Sharps containers, splash guards, Needless systems, blunt suture needles, no-hands procedures etc.) [WAC 296-823-14005]
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*All containers used to store, transport, or ship blood or other OPIM are properly labeled [WAC 296-823-14025]
ELECTRICAL SAFE WORK PRACTICES [WAC 296-24, NFPA 70E]
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*Electrical panels are properly labeled to identify disconnecting means, i.e., which equipment each breaker controls [WAC 296-800-28022]
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*Electrical fittings, boxes, cabinets are maintained in good condition [WAC 296-800-28025]
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*Electrical rooms are maintained in a clean state of housekeeping to permit ready & safe operation & maintenance of the equipment [WAC 296-800-28027(1)]
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*Electrical cabinets have the proper clearance 30" wide and 36" in front [WAC 296-800-28027(2)]
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*Flexible cords are not frayed or improperly spliced [WAC 296-800-28030(1)]
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*Power strips used as listed (not daisy-chained, overloaded, etc.) [WAC 296-800-28010]
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*Flexible cords are not used as a substitute for permanent wiring [WAC 296-800-28030(4)]
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*Electrical cords are not running through doors, windows or wall openings [WAC 296-800-28030(4)]
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*Electrical enclosures and covers do not have openings [WAC 296-800-28035] Any unguarded electrical parts?
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*Electrical equipment is properly grounded [WAC 296-800-28040]
EMERGENCY ACTION AND FIRE PREVENTION PLAN [WAC 296-24-567, 296-800-310, Life Safety Code 101]
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There is a written emergency action plan/fire prevention plan for the facility [WAC 296-24-567(1)]
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The facility conducts and documents training for all employees in the emergency action plan [WAC 296-24-567(1)(e)]
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There is documented training for portable fire extinguisher use annually [WAC 296-800-30025]
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The facility annually verifies and documents that emergency alarms are audible/visible throughout the facility [WAC 296-800-31080]
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There is a documented annual fire drill are conducted according to the 2018 edition of the International Fire Code, adopted by reference in WAC 51-54A-003 <br>
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*The location has posted emergency escape procedures and escape routes [WAC 296-24-567(1)(b)(i)]
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*Adequate first aid supplies are available, clearly marked and easily accessible for the location (periodic documented inspection) [WAC 296-800-15020]
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*Portable fire extinguishers indicate a monthly inspection to verify that they are maintained fully charged and in operable condition and kept in their designated places [WAC 296-800-30020]
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*Exit routes are large enough [WAC 296-800-31010]
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*Exits are free from obstructions [WAC 296-800-31025]
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*Exits are adequately marked [WAC 296-800-31050]
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*There is adequate lighting for exit routes and signs [WAC 296-800-31053]
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*Illuminated exit lights and emergency lighting are tested according to (must be documented) [LSC101 7.9.3]:<br>1) Functional test once per month for 30 seconds;<br>2) Functional test annually for 1.5 hours;<br>3) Lighting must be operational for the full duration of the test;<br>4) Must have written records of the visual inspection and test
HAZCOM PROGRAM [WAC 296-901]
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There is a written site-specific Chemical Hazard Communication program [WAC 296-901-14010]
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There is a hazardous chemicals list for the facility and it is current [WAC 296-901-14010(1)(a)]
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Safety Data Sheets (SDSs) are available for all chemicals used on site and are current [WAC 296-800-14014(7)] SDSs are archived for all discontinued chemicals
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Documented HAZCOM training is conducted for all employees [WAC 296-901-14016]
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*Employees have easy access to the hazard communication program, chemical list, and SDSs [WAC 296-901-14010(4)] (Employee Demonstration)
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*All containers, storage tanks, and secondary containers have proper labeling [WAC 296-901-14012]
LADDERS [WAC 296-876]
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Documented ladder inspection is performed on all ladders [WAC 296-876-30005]
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Documented ladder training is conducted for employees that use ladders (performed by a competent person) [WAC 296-876-15005]
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*Ladders are supported and protected where they are stored [WAC 296-876-30015]
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*Ladders are in good, usable condition [portable WAC 296-876-30005; fixed WAC 296-876-700] (Only Type IA, I or II ladders allowed)
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*Ladders are used for their intended purpose [WAC 296-876-40005]
PPE [WAC 296-800]
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The facility conducts and documents written PPE hazard assessments [WAC 296-800-16005] (can be included in JHA)
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Documented PPE training is conducted to ensure that each employee understands the limitations, use, care and disposal of the PPE [WAC 296-800-16025]
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*Required PPE is available [WAC 296-800-16020]
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*PPE is maintained in a sanitary and reliable condition [WAC 296-800-16045]
RESPIRATORY PROTECTION [WAC 296-842, WAC 296-841]
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There is a written Respiratory Protection program [WAC 296-842-12005]
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An exposure evaluation has been conducted to determine if employees are exposed to airborne contaminants above the Permissible Exposure Limit, or other airborne hazards, such as biological hazards. [WAC 296-841-20005]
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Feasible exposure controls have been implemented to reduce or eliminate employee exposure to airborne contaminants, including elimination, substitution, engineering, or administrative controls [WAC 296-841-20010]
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There is a requirement for all employees that voluntarily wear dust masks to complete an initial "Voluntary Use of Dust Masks Information Sheet" [WAC 296-842-11005 Table 2]
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Initial Respirator Medical Evaluation Questionnaires are completed for each employee required to wear a respirator [WAC 296-842-14005] (Documented)
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Annual fit testing is conducted for all employees required to wear tight fitting respirators [WAC 296-842-15005]
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Documented respirator training is conducted that covers respirator limitations, use, care, and storage [WAC 296-842-16005]
SAFETY COMMITTEE/MEETINGS [WAC 296-800-130]
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Does the location have more than 10 employees?
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The safety committee conducts regular meetings as determined by the committee [WAC 296-800-13020(1)(c)]
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The safety committee assists in the evaluation of the Accident Prevention Program [WAC 296-800-13020(2)]
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The safety committee reviews safety inspection reports to help correct safety hazards [WAC 296-800-13020(2)]
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The safety committee evaluates accident investigations to determine if the cause(s) of the unsafe situation were identified and corrected [WAC 296-800-13020(2)]
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Safety Committee meetings are documented and attendance is recorded [WAC 296-800-13020(2,3)]
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Safety meetings are held monthly for all staff and have at least one management representative [WAC 296-800-13025(1)
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The safety meetings review safety inspection reports to help correct safety hazards [WAC 296-800-13025(2)]
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The safety meetings evaluate accident investigations to determine if the cause(s) of the unsafe situation were identified and corrected [WAC 296-800-13025(2)]
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Safety meeting subjects discussed are documented and attendance is recorded [WAC 296-800-13025(2)]
STORAGE & HOUSEKEEPING [WAC 296-800, 296-24, 246-360]
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*All areas of the workplace, passageways, storage rooms, and service rooms are in a clean, orderly and sanitary condition [WAC 296-800-22005]
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*Materials are stored so they do not create a hazard [WAC 296-800-22035]
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*Storage designed to minimize ergonomic injuries [WAC 296-800-11010]
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*Materials are stored at least 18 inches below sprinkler heads or 24 inches from ceiling in non-sprinkled buildings [WAC 296-24-60705(10)]
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*Flammable or combustible liquids are stored in flammable storage cabinets or in flammable storage rooms [WAC 296-24-33011(2)(b)]
WORKPLACE VIOLENCE [DSHS Administrative Policies; RCW 72.23.400; RCW 49.19]
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The facility has developed a plan to reasonably prevent and protect employees from workplace violence [DSHS AP 9.12; AP 18.67]
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A Physical Security Survey & Vulnerability Assessment that identifies existing/potential hazards for workplace violence is conducted at least annually [DSHS AP 9.12]
Best Practices and Additional Findings (NOTE - These Items are Not Scored)
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Calendar year goals have been established and are monitored throughout the year (Best Practice - Not Scored)
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Injury trends are used to prevent recurrence of injuries (Best Practice - Not Scored)
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Select "Add Additional Finding." Then select "In Place & Effective, Needs Improvement, or Not in Place." Then add the description of the additional finding in the notes, and add photos if desired.
Additional Finding
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