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Assessment - - DEMO ONLY

Gap Analysis

  • Client Name:

  • Location Name:

  • Location Address:

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  • Participants:

General Health and Safety Program

  • 1. Is there an active safety and health program in operation that deals with general safety and health program elements as well as management of hazards specific to your worksite?

  • 2. Is one person clearly responsible for the overall activities of the safety and health program?

  • 3. Do you have a safety committee or group made up of management and labor representatives that meets regularly and reports in writing on its activities?

  • 4. Does your facility have written safety policy(s) and procedure(s)?

  • 5. Are Safety Committee meetings documented with minutes and action items?

  • 6. Do you have a working procedure for handling inhouse employee complaints regarding safety and health?

  • 7. Is there a procedure in place to train newly hired employees?

  • 8. Is there a documented schedule of training?

(Part 1904) Posting requirements

  • 1. Is a current OSHA workplace poster displayed?

  • 2. Are emergency telephone numbers posted?

  • 3. Are country or state specific posters displayed?

  • 4. Are medical facilities for emergencies identified and posted?

(Part 1904) Recordkeeping

  • 1. Is the OSHA 300 log maintained as required? (5Years)

  • 2. Is the OSHA 300 Log posted from Feb 1 – April 30?

  • 3. Is the OSHA 301 form or equivalent, completed as required?

  • 4. Are employee records of exposures to hazardous substances maintained?

  • 5. Is the site aware of the new electronic reporting requirements?

Section 5 (a) (1) General Duty Clause


  • 1. Has management designated an Ergonomics Coordinator and established and Ergonomics Committee as necessary based on the size and risks of the operation?

  • 2. Have the Ergonomics Coordinator and committee members been assigned specific responsibilities based on the program?

  • 3. Have plant operations been reviewed to identify physical and environmental stress factors that may contribute to ergonomic injury or illness?

  • 4. Have action plans been developed to address operations presenting ergonomic hazards and do the action plans identify specific responsibilities and due dates?

  • 5. If action plans have been developed, have corrective measures been implemented in accordance with scheduled completion dates?

  • 6. Is ergonomics considered in the design of new processes, equipment, and work stations?

  • 7. Have safety and health records from at least the last 3 years been reviewed to identify injuries / illnesses potentially associated with ergonomic hazards?

  • 8. Have ergonomic injuries / illnesses been identified?

  • 9. Has appropriate medical case management been provided after an injury was diagnosed as ergonomically related?

  • 10. Are all employees (including managers, supervisors, and employees) trained in ergonomic principles?

Contractor Safety

  • 1. Are contractor's injury experience, health and safety records, and safety programs reviewed during the bid / selection process?

  • 2. Has an employee been assigned as the Subcom contact person for each project?

  • 3. Are safety responsibilities established for project supervisors, affected plant personnel, and contractor personnel?

  • 4. Is the contract reviewed to ensure the following items are included: contractor's safety program; termination clause for safety deficiencies; certification of insurance; PPE requirements; applicable indemnification clauses( i.e. use of onsite medical facilities, use of Subcom tools and equipment) ?

  • 5. Is onsite safety orientation provided to contractor management / supervision regarding the contracted work?

  • 6. Has the contractor been provided copies of contractrelated safety requirements?

  • 7. Has the contractor been provided with applicable information on internal safety and health procedures such as chemical substances handling, personal conduct, emergency equipment and procedures, etc. ?

  • 8. Is the contractor advised of hazards to which his / her employees may be exposed to while on site?

  • 9. Are contractors required to advise the location of work activities, equipment, materials, or anything which may adversely affect the safety of Subcom personnel or property?

  • 10. Is the contractor's safety performance periodically monitored while working onsite?

D Walking/Working Surfaces

  • 1. Is a documented, functioning housekeeping program in place?

  • 2. Are all worksites clean, sanitary, and orderly?

  • 3. Are work surfaces kept dry or is appropriate means taken to assure the surfaces are slipresistant?

  • 4. Are all spilled hazardous materials or liquids, including blood and other potentially infectious materials, cleaned up immediately and according to proper procedures?

  • 5. Are covered metal waste cans used for oily and paintsoaked waste?


  • 1. Are aisles and walkways marked and kept accessible, as appropriate?

  • 2 Are wet surfaces covered with nonslip materials?

  • 3 Are holes in the floor, sidewalk or other walking surface repaired properly, covered or otherwise made safe?

  • 4 Is there safe clearance for walking in aisles where motorized or mechanical handling equipment is operating?

  • 5 Are materials or equipment stored in such a way that sharp projections will not interfere with the walkway?

  • 6 Are spilled materials cleaned up immediately?

  • 7 Are changes of direction or elevation readily identifiable?

  • 8 Are aisles or walkways that pass near moving or operating machinery, welding operations or similar operations arranged so employees will not be subjected to potential hazards?

  • 9 Are standard guardrails provided wherever aisle or walkway surfaces are elevated more than 30 inches above any adjacent floor or the ground?

Elevated Surfaces

  • 1. Are surfaces elevated more than 30 inches above the floor or ground provided with standard guardrails?

  • 2. Are all elevated surfaces (beneath which people or machinery could be exposed to falling objects) provided with standard 4inch toe boards?

  • 3. Is a permanent means of access and egress provided to elevated storage and work surfaces?

  • 4. Is required headroom provided where necessary?

  • 5. Is material on elevated surfaces piled, stacked or racked in a manner to prevent it from tipping, falling, collapsing, rolling or spreading?

  • 6. Are dock boards or bridge plates used when transferring materials between docks and trucks or rail cars?

  • 7. Does management ensure that each walkingworking surface can support the maximum intended load for that surface ?

Portable Ladders

  • 1. Are all ladders maintained in good condition, joints between steps and side rails tight, all hardware and fittings securely attached, and moveable parts operating freely without binding or undue play?

  • 2. Are nonslip safety feet provided on each metal or rung ladder, and are ladder rungs and steps free of grease and oil?

  • 3. Are employees prohibited from placing a ladder in front of doors opening toward the ladder unless the door is blocked open, locked, or guarded?

  • 4. Are employees prohibited from placing ladders on boxes, barrels, or other unstable bases to obtain additional height?

  • 5. Are employees required to face the ladder when ascending or descending and maintain 3 points of contact at all times?

  • 6. Are employees prohibited from using ladders that are broken, have missing steps, rungs, or cleats, broken side rails, or other faulty equipment?

  • 7. Are employees instructed not to use the top step of ordinary stepladders as a step?

  • 8. When portable rung ladders are used to gain access to elevated platforms, roofs, etc., does the ladder always extend at least 3 feet (0.9144 meters) above the elevated surface?

  • 9. Are employees required to secure the base of a portable rung or cleat type ladder to prevent slipping, or otherwise lash or hold it in place?

  • 10. Are portable metal ladders legibly marked with signs reading "CAUTION Do Not Use Around Electrical Equipment" or equivalent wording?

  • 11. Are employees prohibited from using ladders as guys, braces, skids, gin poles, or for other than their intended purposes?

  • 12. Are ladders stored lying down or otherwise secured to prevent their falling over?

  • 13. Are ladders formally inspected for damage and are the inspections documented?

Fall Protection

  • 1. Are all employees employee on a walkingworking surface with an unprotected side or edge that is 4 feet (1.2 m) or more above a lower level is protected from falling by a guardrail system, safety net system or personal fall arrest system?

  • 2. Are employees protected from falling through any hole, stairway, or ladder way (including skylights) that is 4 feet (1.2 m) or more above a lower level by covers, guardrail systems, travel restraint, or personal fall arrest systems?

  • 3. Is each employee less than 4 feet (1.2 m) above dangerous equipment is protected from falling into or onto the dangerous equipment by a guardrail system or a travel restraint system, unless the equipment is covered or guarded to eliminate the hazard

  • 4. Fixed ladders that extend more than 24 feet (7.3 m) above a lower level are equipped with a personal fall arrest system, ladder safety system, cage, or well (Note: newly erected or modified ladders must incorporate a personal fall arrest system)

  • 5. Is each flight of stairs having at least 3 treads and at least 4 risers is equipped with appropriate stair rail systems and handrails ?

  • 6. Are employees exposed to falling objects, required to wear head protection?

  • 7. Are employees protected from objects falling from above by a prescribed control system such as toe boards, screens or barricading of the exposed areas?

  • 8. Are fall prevention systems permanently installed where feasible?

  • 9. Has training been completed for each employee who uses personal fall protection systems?

  • 10. Is training completed by a "qualified person" and has the training been documented?

  • 11. Is retraining provided when there is reason to believe the employee does not have the understanding and skill required to use the equipment, when changes in operations occur, or when changes to the fall protection equipment are implemented?

F Powered Platforms, Manlifts and Vehicle Mounted Lifts

  • 1. Is there specific operator training for lifts, etc.?

  • 2. Are personal fall arrest systems and harnesses used on lifts as required?

  • 3. Procedures for operation, inspection and records?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.