Periodic Hazard Assessment Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Work Environment

• Are all worksites clean and orderly?

  Yes

  No

  N/A

• Are work surfaces kept dry or appropriate means taken to assure the surfaces are slip-resistant?

  Yes

  No

  N/A

• Are all spilled materials or liquids cleaned up immediately?

  Yes

  No

  N/A

• Are the minimum number of toilets and washing facilities provided?

  Yes

  No

  N/A

• Are all toilets and washing facilities clean and sanitary?

  Yes

  No

  N/A

• Are all work areas adequately illuminated?

  Yes

  No

  N/A

• Are pits and floor openings covered or otherwise guarded?

  Yes

  No

  N/A

Personal Protective Equipment & Clothing

• Are protective goggles or face shields provided and worn where there is any danger of flying particles or corrosive materials?

  Yes

  No

  N/A

• Are approved safety glasses required to be worn at all times in areas where there is a risk of eye injuries such as punctures, abrasions, contusions or burns?

  Yes

  No

  N/A

• Are protective gloves, aprons, shields, or other means provided against cuts, corrosive liquids and chemicals?

  Yes

  No

  N/A

• Are hard hats provided and worn where danger of falling objects exists?

  Yes

  No

  N/A

• Are hard hats inspected periodically for damage to shell and suspension system?

  Yes

  No

  N/A

• Is appropriate foot protection required where there is risk of foot injury from hot, corrosive, poisonous substances, falling objects, crushing or penetrating actions?

  Yes

  No

  N/A

• Are approved respirators provided for regular or emergency use when needed?

  Yes

  No

  N/A

• Is all protective equipment maintained in a sanitary condition and ready for use?

  Yes

  No

  N/A

• Do you have eye wash facilities and a quick drench shower within the work area where employees are exposed to injurious corrosive materials?

  Yes

  No

  N/A

• When lunches are eaten on the premises, are they eaten in areas where there is no exposure to toxic materials or other health hazards?

  Yes

  No

  N/A

• Is protection against the effects of occupational noise exposure provided when sound levels exceed those of the Cal/OSHA noise standard?

  Yes

  No

  N/A

• Is personal protective clothing or equipment, that employees are required to wear or use, of a type capable of being easily cleaned and disinfected?

  Yes

  No

  N/A

• Are employees prohibited from interchanging personal protective clothing or equipment, unless it has been properly cleaned?

  Yes

  No

  N/A

Walkways

• Are aisles and passageways kept clear?

  Yes

  No

  N/A

• Are aisles and walkways marked appropriate?

  Yes

  No

  N/A

• Are wet surfaces covered with non-slip materials?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are changes of elevation readily identifiable?

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

• Is adequate headroom provided for the entire length of any aisle or walkway?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Floor & Wall Openings

• Are floor openings guarded by a cover, guardrail, or equivalent on all sides (except at entrance to stairways or ladders)?

  Yes

  No

  N/A

• Are toe boards installed around the edges of a permanent floor opening (where persons may pass below the opening)?

  Yes

  No

  N/A

• Is the glass in windows, doors, glass walls that are subject to human impact, of sufficient thickness and type for the condition of use?

  Yes

  No

  N/A

• Are grates or similar type covers over floor openings such as floor drains, of such design that foot traffic or rolling equipment will not be affected by the grate spacing?

  Yes

  No

  N/A

• Are unused portions of pits and pits not actually in use either covered or protected by guardrails or equivalent?<br>

  Yes

  No

  N/A

Stairs & Stairways

• Are standard stair rails or handrails on all stairways having four or more risers?

  Yes

  No

  N/A

• Do stairs have atleast a 6'6" overhead clearance?

  Yes

  No

  N/A

• Are steps on stairs and stairways designed or provided with a surface that renders them slip resistant?

  Yes

  No

  N/A

• Where stairs or stairways exit directly into any area where vehicles may be operated, are adequate barriers and warnings provided to prevent employees stepping into the path of traffic?

  Yes

  No

  N/A

Elevated Surfaces

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is required headroom provided where necessary?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Exiting or Egress

• Are all exits marked with an exit sign and illuminated by a reliable light source?

  Yes

  No

  N/A

• Are the directions to exits, when not immediately apparent, marked with visible signs?

  Yes

  No

  N/A

• Are doors, passageways or stairways, that are neither exits nor access to exits and which could be mistaken for exits, appropriately marked "NOT AN EXIT", "TO BASEMENT", "STOREROOM", and the like?

  Yes

  No

  N/A

• Are all exits kept free of obstructions?

  Yes

  No

  N/A

• Are there sufficient exits to permit prompt escape in case of emergency?

  Yes

  No

  N/A

Portable Ladders

• Do our duties require the use of any ladders?

  Yes

  No

  N/A

• Note: if yes, please answer the following questions.

• 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?

  Yes

  No

  N/A

• Are non-slip safety feet provided on each ladder?

  Yes

  No

  N/A

• Are non-slip safety feet provided on each metal or rung ladder?

  Yes

  No

  N/A

• Are ladder rungs and steps free of grease and oil?

  Yes

  No

  N/A

• Are employees instructed to face the ladder when ascending or descending?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are employees instructed not to use the top 2 steps of ordinary stepladders as a step?<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Hand Tools & Equipment

• Do our duties require the use of any machines?

  Yes

  No

  N/A

• Note: if yes, please answer the following questions.

• Are all tools and equipment (both company and employee-owned) used by employees at their workplace in good condition?

  Yes

  No

  N/A

• Are appropriate safety glasses, face shields, and similar equipment used while using hand tools or equipment that might produce flying materials or be subject to breakage?

  Yes

  No

  N/A

• Are tools stored in dry, secure location where they won't be tampered with?

  Yes

  No

  N/A

Portable (Power Operated) Tools & Equipment

• Do our duties require the use of any power tools or equipment?

  Yes

  No

  N/A

• Note: if yes, please answer the following questions.

• Are power tools used with the correct shield, guard or attachment recommended by the manufacturer?

  Yes

  No

  N/A

• Are rotating or moving parts of equipment guarded to prevent physical contact?

  Yes

  No

  N/A

• Are all cord-connected, electrically operated tools and equipment effectively grounded or of the approved double insulated type?

  Yes

  No

  N/A

• Are effective guards in place over belts, pulleys, chains, and sprockets, on equipment such as concrete mixers, air compressors, and the like?

  Yes

  No

  N/A

• Are portable fans provided with full guards or screens having openings 1/2 inch or less?

  Yes

  No

  N/A

• Are ground-fault circuit interrupters provided on all temporary electrical 15 and 20 ampere circuits, used during periods of construction?

  Yes

  No

  N/A

• Are pneumatic and hydraulic hoses on power-operated tools checked regularly for deterioration or damage?

  Yes

  No

  N/A

Machine Guarding

• Do our duties require the use of any machines?

  Yes

  No

  N/A

• Note: if yes, please answer the following questions.

• Is there a training program to instruct employees on safe methods of machine operation?

  Yes

  No

  N/A

• Is there adequate supervision to ensure that employees are following safe machine operating procedures?

  Yes

  No

  N/A

• Is there a regular program of safety inspections of machinery and equipment?

  Yes

  No

  N/A

• Is all machinery and equipment kept clean and properly maintained?

  Yes

  No

  N/A

• Is there a power shut-off switch within reach of the operstor's position at each machine?

  Yes

  No

  N/A

• Can electric power to each machine be locked out for maintenance, repair, or security?

  Yes

  No

  N/A

• Are foot-operated switches guarded or arranged to prevent accidental actuation by personnel or falling objects?

  Yes

  No

  N/A

• Are manually operated valves and switches controlling the operation of equipment and machines clearly identified and readily accessible?

  Yes

  No

  N/A

• Are all emergency stop buttons colored red?

  Yes

  No

  N/A

Lockout / Tagout

• Do our duties require the de-energization of equipment for servicing or entry to be inspected?

  Yes

  No

  N/A

• Note: if so, lockout/Tagout programs must be designed for each specific piece of equipment. Please refer to the Safety Manual for assistance

Compressed Gas & Cylinders

• Are there any compressed gas and cylinders in our work area?

  Yes

  No

  N/A

• Note: if yes, please answer the following questions.

• Are cylinders legibly marked to clearly identify the gas contained?

  Yes

  No

  N/A

• Are compressed gas cylinders stored in areas which are protected from external heat sources such as flame impingement, intense radiant heat, electric arcs, or high temperature lines?

  Yes

  No

  N/A

• Are cylinders located or stored in areas where they will not be damaged by passing or falling objects, or subject to tampering by unauthorized persons?

  Yes

  No

  N/A

• Are cylinders stored or transported in a manner to prevent them creating a hazard by tipping, falling or rolling?

  Yes

  No

  N/A

Confined Spaces

• Are our employees exposed to any confined spaces, or permit-required confined spaces as defined in the Safety Manual and by OSHA?

  Yes

  No

  N/A

• Note: if exposure exists, a confined space program must be developed. See the Confined Space section in the Safety Manual, and answer the following questions.

• Are confined spaces thoroughly emptied of any corrosive or hazardous substances, such as acids or caustics, before entry?

  Yes

  No

  N/A

• Before entry, are all lines to a confined space, containing inert, toxic, flammable, or corrosive materials valved off and blanked or disconnected and separated?

  Yes

  No

  N/A

• Is it required that all impellers, agitators, or other moving equipment inside confined spaces be locked-out if they present a hazard?

  Yes

  No

  N/A

• Is either natural or mechanical ventilation provided prior to confined space entry?

  Yes

  No

  N/A

• Before entry, are appropriate atmospheric tests performed to check for oxygen deficiency, toxic substance and explosive concentrations in the confined space before entry?

  Yes

  No

  N/A

• Is adequate illumination provided for the work to be performed in confined space?

  Yes

  No

  N/A

• Is the atmosphere inside the confined space frequently tested or continuously monitored during conduct of work?

  Yes

  No

  N/A

• Is there an assigned safety standby employee outside of the confined space, whose sole responsibility is to watch the work in progress, sound an alarm if necessary, and render assistance?

  Yes

  No

  N/A

• Is the standby employee or other employees prohibited from entering the confined space without lifelines and respites equipment if there is any questions as to the cause of the emergency?<br>

  Yes

  No

  N/A

• In addition to the standby employee, is there at least one other trained rescuer in the vicinity?

  Yes

  No

  N/A

• Are all rescuers appropriately trained and using approved, recently inspected equipment?

  Yes

  No

  N/A

• Does all rescue equipment allow for lifting employees vertically from a top opening?

  Yes

  No

  N/A

• Are there trained personnel in First Aid and CPR immediately available?

  Yes

  No

  N/A

• Is there an effective communication system in place whenever respiratory equipment is used and the employee in the confined space is out of sight of the standby person?

  Yes

  No

  N/A

• Is approved respiratory equipment required if the atmosphere inside the confined space cannot be made acceptable?

  Yes

  No

  N/A

• Is all portable electrical equipment used inside confined spaces either grounded and insulated, or equipped with ground fault protection?

  Yes

  No

  N/A

• Whenever combustion-type equipment is used in confined space, are provisions made to ensure the exhaust gases are vented outside of the enclosure?

  Yes

  No

  N/A

• Is each confined space checked for decaying vegetation or animal matter, which may produce methane?

  Yes

  No

  N/A

• Is the confined space checked for possible industrial waste, which could contain toxic properties?

  Yes

  No

  N/A

• If the confined space is below the ground and near areas where motor vehicles will be operating, is it possible for vehicle exhaust or carbon monoxide to enter the space?

  Yes

  No

  N/A

Environmental Controls

• Are all work areas properly illuminated?

  Yes

  No

  N/A

• Are employees instructed in proper first aid and other emergency procedures?

  Yes

  No

  N/A

• Are hazardous substances identified which may cause harm by inhalation, ingestion, skin absorption or contact?

  Yes

  No

  N/A

• Are employees aware of the hazards involved with the various chemicals they may be exposed to in their work environment, such as ammonia, chlorine, epoxies, and caustics?

  Yes

  No

  N/A

• Has there been a determination that noise levels in the facilities are within acceptable levels?

  Yes

  No

  N/A

• Are caution labels and signs used to warn of asbestos?

  Yes

  No

  N/A

• Do you know if the facility has asbestos present?

  Yes

  No

  N/A

• Is personal protective equipment provided, used and maintained wherever required?

  Yes

  No

  N/A

• Are there written standard operating procedures for the selection and use of respirators where needed?

  Yes

  No

  N/A

• Are restrooms and washrooms kept clean and sanitary?

  Yes

  No

  N/A

• Is all water provided for drinking, washing, and cooking potable?

  Yes

  No

  N/A

• Are all outlets for water not suitable for drinking clearly identified?

  Yes

  No

  N/A

• Are employees instructed in the proper manner of lifting heavy objects?

  Yes

  No

  N/A

• Where heat is a problem, have all fixed work areas been provided with spot cooling or air conditioning?

  Yes

  No

  N/A

• Are employees screened before assignment to areas of high heat to determine if their health condition might make them more susceptible to having an adverse reaction?

  Yes

  No

  N/A

• Are employees working on streets and roadways where they are exposed to the hazards of traffic, required to wear bright colored (traffic orange) warning vest?

  Yes

  No

  N/A

Flammable & Combustible Materials

• Are combustible scrap, debris and waste materials (I.e. oily rags) stored in covered metal receptacles and removed from the worksite promptly?

  Yes

  No

  N/A

• Is proper storage practiced to minimize the risk of fire including spontaneous combustion?

  Yes

  No

  N/A

• Are approved containers and tanks used for the storage and handling of flammable and combustible liquids?

  Yes

  No

  N/A

• Are all connections on drums and combustible liquid piping, vapor and liquid tight?

  Yes

  No

  N/A

• Are all flammable liquids kept in closed containers when not in use (I.e. parts cleaning tanks, pans)?

  Yes

  No

  N/A

• Are fire extinguishers selected and provided for the types of materials in areas where they are to be used?

  Yes

  No

  N/A

• Class A: Ordinary combustible material fires?

  Yes

  No

  N/A

• Class B: Flammable liquid, gas or grease fires?

  Yes

  No

  N/A

• Class C: Energized-electrical equipment fires?

  Yes

  No

  N/A

• If a Halon 1301 fire extinguisher is used, can employees evacuate within the specified time for that extinguisher?

  Yes

  No

  N/A

• Are appropriate fire extinguishers mounted within 75 feet of outside areas containing flammable liquids, and within 10 feet of any inside storage area for such materials?

  Yes

  No

  N/A

• Is the transfer/withdrawal of flammable or combustible liquids performed by trained personnel?

  Yes

  No

  N/A

• Are fire extinguishers mounted so that employees do not have to travel more than 75 feet for a class "A" fire or 50 feet for a class "B" fire?

  Yes

  No

  N/A

• Are employees trained in the use of fire extinguishers?

  Yes

  No

  N/A

• Are extinguishers free from obstructions or blockage?

  Yes

  No

  N/A

• Are all extinguishers serviced, maintained and tagged at intervals not to exceed one year?

  Yes

  No

  N/A

• Are all extinguishers fully charged and in their designated places?

  Yes

  No

  N/A

• Is a record maintained of required monthly checks of extinguishers?

  Yes

  No

  N/A

• Are "NO SMOKING" signs posted where appropriate in areas where flammable or combustible materials are used or stored?

  Yes

  No

  N/A

• Are "NO SMOKING" rules enforced in areas involving storage and use of flammable materials?

  Yes

  No

  N/A

Fire Protection

• Do you have a fire prevention plan?

  Yes

  No

  N/A

• Does your plan describe the type of fire protection equipment and/or systems?

  Yes

  No

  N/A

• Have you established practices and procedures to control potential fire hazards and ignition sources?

  Yes

  No

  N/A

• Are employees aware of the fire hazards of the material and processes to which they are exposed?

  Yes

  No

  N/A

• Are sprinkler heads protected by metal guards, when exposed to physical damage?

  Yes

  No

  N/A

• Is proper clearance maintained below sprinkler heads?

  Yes

  No

  N/A

• Are portable fire extinguishers provided in adequate number and type?

  Yes

  No

  N/A

• Are fire extinguishers mounted in readily accessible locations?

  Yes

  No

  N/A

• Are fire extinguishers recharged regularly and noted on the inspection tag?

  Yes

  No

  N/A

• Are employees periodically instructed in the use of extinguishers and fire protection procedures?

  Yes

  No

  N/A

Hazardous Chemical Exposures

• Are employees trained in the safe handling practices of hazardous chemicals such as acids, caustics, and the like?

  Yes

  No

  N/A

• Are employees aware of the potential hazards involving various chemicals stored or used in the workplace - such as acids, bases, caustics, epoxies, and phenols?

  Yes

  No

  N/A

• Is employee exposure to chemicals kept within acceptable levels?

  Yes

  No

  N/A

• Are eye wash fountains and safety showers provided in areas where corrosive chemicals are handled?

  Yes

  No

  N/A

• Are all containers, such as vats and storage tanks labeled as to their contents - I.e. "CAUSTICS"?

  Yes

  No

  N/A

• Are all employees required to use personal protective clothing and equipment when handling chemicals (I.e. gloves, eye protection, and respirators)?

  Yes

  No

  N/A

• Have standard operating procedures been established and are they being followed when cleaning up chemical spills?

  Yes

  No

  N/A

• Is personal protective equipment provided, used and maintained whenever necessary?

  Yes

  No

  N/A

• Have control procedures been instituted for hazardous materials, where appropriate, such as, respirators, ventilation systems, handling practices, and the like?

  Yes

  No

  N/A

• Do employees complain about dizziness, headaches, nausea, irritation, or other factors of discomfort when they use solvents or other chemicals?

  Yes

  No

  N/A

• Is there a dermatitis problem - do employees complain about skin dryness, irritation, or sensitization?

  Yes

  No

  N/A

Hazardous Substances Communication

• Is there a list of hazardous substances used in your workplace?

  Yes

  No

  N/A

• Is there a written hazard communication program dealing with Material Safety Data Sheets (MSDS) labeling, and employee training?

  Yes

  No

  N/A

• Who is responsible for MSDSs, container labeling, employee training?

  Yes

  No

  N/A

• Is each container for a hazardous substance (I.e. vats, bottles, storage tanks) labeled with product identity and a hazard warning (communication of the specific health hazards and physical hazards)?

  Yes

  No

  N/A

• Is there a Material Safety Data Sheet readily available for each hazardous substance used?

  Yes

  No

  N/A

• Is there an employee training program for hazardous substances?

  Yes

  No

  N/A

• Note: if yes, does this program include:

• An explanation of what an MSDS is and how to use and obtain one?

  Yes

  No

  N/A

• MSDS contents for each hazardous substance or class of substances?

  Yes

  No

  N/A

• Explanation of "Right to Know"?

  Yes

  No

  N/A

• Identification of where employees can see the employer's written hazard communication program and where hazardous substances are present in their work area?

  Yes

  No

  N/A

• The physical and health hazards of substances in e work area, how to detect their presence, and specified protective measures to be used?

  Yes

  No

  N/A

• Details of the hazard communication program, including how to use the labeling system and MSDSs?

  Yes

  No

  N/A

• How employees will be informed of hazards of non-routine tasks, and hazards of unlabeled pipes?

  Yes

  No

  N/A

Electrical

• Are portable electrical tools and equipment grounded or of the double insulated type?

  Yes

  No

  N/A

• Are electrical appliances grounded?

  Yes

  No

  N/A

• Do extension cords being used have a grounding conductor?

  Yes

  No

  N/A

• Are multiple plug adapters prohibited?

  Yes

  No

  N/A

• Are exposed wiring and cords with frayed or deteriorated insulation repaired or replaced promptly?

  Yes

  No

  N/A

• Are flexible cords and cables free of splices or taps?

  Yes

  No

  N/A

• Are clamps or other securing means provided on flexible cords or cables at plugs, receptacles, tools, and equipment and is the cord jacket securely held in place?

  Yes

  No

  N/A

• Are all cord, cable and raceway connections intact and secure?

  Yes

  No

  N/A

• In wet or damp locations, are electrical tools and equipment appropriate for the use or location or otherwise protected?

  Yes

  No

  N/A

• Is the location of electrical power lines and cables (overhead, underground, underfloor, other side of walls) determined before digging, drilling or similar work is begun?

  Yes

  No

  N/A

• Are all disconnecting switches and circuit breakers labeled to indicate their use or equipment served?

  Yes

  No

  N/A

• Are disconnecting means always opened before fuses are replaced?

  Yes

  No

  N/A

• Are all energized parts of electrical circuits and equipment guarded against accidental contact by approved cabinets or enclosures?

  Yes

  No

  N/A

• Are all unused openings (including conduit knockouts) in electrical enclosures and fittings closed with appropriate covers, plugs or plates?

  Yes

  No

  N/A

• Are electrical enclosures such as switches, receptacles, junction boxes, etc., provided with tight-fitting covers or plates?

  Yes

  No

  N/A

Noise

• Has the client advised you that the area within our service requires a "Hearing Conversation Program"?

  Yes

  No

  N/A

• Note: if yes, please answer the following questions.

• Are there areas in the workplace where continuous noise levels exceed 85 dBA? (To determine maximum allowable levels for intermittent or impact noise, see Title 8, Section 5097)

  Yes

  No

  N/A

• Are noise levels being measured using a sound level meter or an octave band analyzer and records being kept?

  Yes

  No

  N/A

• Have you tried isolating noisy machinery from the rest of your operation?

  Yes

  No

  N/A

• Have engineering controls been used to reduce excessive noise levels?

  Yes

  No

  N/A

• Where engineering controls are determined not feasible, are administrative controls (I.e. worker rotation) being used to minimize individual employee exposure to noise?

  Yes

  No

  N/A

• Is there an ongoing preventative health program to educate employees in safe levels of noise and exposure, effects of noise on their health, and use of personal protection?

  Yes

  No

  N/A

• Is the training repeated annually for employees exposed to continuous noise above 85 dBA?

  Yes

  No

  N/A

• Have work areas where noise levels make voice communication between employees difficult been identified and posted?

  Yes

  No

  N/A

• Is approved hearing protective equipment (noise attenuating devices) available to every employee working in areas where continuous noise levels exceed 85 dBA?

  Yes

  No

  N/A

• If you use ear protectors, are employees properly fitted and instructed in their use and care?

  Yes

  No

  N/A

• Are employees exposed to continuous noise above 85 dBA given periodic audio metric testing to ensure that you have an effective hearing protection system?

  Yes

  No

  N/A

Material Handling

• Do our duties require handling freight, boxes, mail, etc.?

  Yes

  No

  N/A

• Note: if yes, please answer the following questions.

• Is there safe clearance for equipment through aisles and doorways?

  Yes

  No

  N/A

• Are aisle ways designated, permanently marked, and kept clear to allow unhindered passage?

  Yes

  No

  N/A

• Are motorized vehicles and mechanized equipment inspected daily or prior to use?

  Yes

  No

  N/A

• Are vehicles shut off and brakes set prior to loading or unloading?

  Yes

  No

  N/A

• Are dock boards (bridge plates) used when loading or unloading operations are taking place between vehicles and docks?

  Yes

  No

  N/A

• Are trucks and trailers secured from movement during loading and unloading operations?

  Yes

  No

  N/A

• Are dock plates and loading ramps constructed and maintained with sufficient strength to support imposed loading?

  Yes

  No

  N/A

• Are hand trucks maintained in safe operating condition?

  Yes

  No

  N/A

• Are chutes equipped with sideboards of sufficient height to prevent the materials being handled from falling off?

  Yes

  No

  N/A

• Are chutes and gravity roller sections firmly placed or secured to prevent displacement?

  Yes

  No

  N/A

• At the delivery end of rollers or chutes, are provisions made to brake the movement of the handled materials?

  Yes

  No

  N/A

• Are pallets usually inspected before being loaded or moved?

  Yes

  No

  N/A

Transporting Employees & Materials

• Do employees who operate vehicles on public thoroughfares have valid operator's licenses and completed the Securitas Safe Driving Program?

  Yes

  No

  N/A

• When seven or more employees are regularly transported in a van, bus or truck, is the operator's license appropriate for the class of vehicle being driven?

  Yes

  No

  N/A

• Is each van, bus or truck used regularly to transport employees, equipped with an adequate number of seats?

  Yes

  No

  N/A

• When employees are transported by truck, are provisions provided to prevent their falling from the vehicle?

  Yes

  No

  N/A

• Are vehicles used to transport employees, equipped with lamps, brakes, horns, mirrors, windshields and turn signals in good repair?

  Yes

  No

  N/A

• Are employee transport vehicles equipped at all times with at least two reflective type flares?

  Yes

  No

  N/A

• Is a full charged fire extinguisher, in good condition, with at least 4 B:C rating maintained in each employee transport vehicle?

  Yes

  No

  N/A

Emergency Action Plan

• Have emergency escape procedures and routes been developed and communicated to all employees?

  Yes

  No

  N/A

• Do employees, who remain to operate critical plant operations before they evacuate, know the proper procedures?

  Yes

  No

  N/A

• Is the employee alarm system that provides a warning for emergency action recognizable and perceptible above ambient conditions?

  Yes

  No

  N/A

• Are alarm systems properly maintained and tested regularly?

  Yes

  No

  N/A

• Is the emergency action plan reviewed and revised periodically?

  Yes

  No

  N/A

• Note: Do employees know their responsibilities:

• For reporting emergencies?

  Yes

  No

  N/A

• During an emergency?

  Yes

  No

  N/A

• For conducting rescue and medical duties?

  Yes

  No

  N/A

Infection Control (Bloodborne Pathogens)

• Are employees potentially exposed to infectious agents in body fluids?

  Yes

  No

  N/A

• Note: if yes, please answer the following questions.

• Have occasions of potential occupational exposure been identified and documented?

  Yes

  No

  N/A

• Has a training and information program been provided for employees exposed to or potentially exposed to blood and/or body fluids?

  Yes

  No

  N/A

• Have infection control procedures been instituted where appropriate, such as ventilation, universal precautions, workplace practices, and personal protective equipment?

  Yes

  No

  N/A

• Are employees aware of specific workplace practices to follow when appropriate (hand washing, handling sharp instruments, handling of laundry, disposal of contaminated materials, reusable equipment)?

  Yes

  No

  N/A

• Is personal protective equipment provided to employees, and in all appropriate locations?

  Yes

  No

  N/A

• Is the necessary equipment (I.e. mouthpieces, resuscitation bags, and other ventilation devices) provided for administering mouth-to-mouth resuscitation on potentially infected patients?

  Yes

  No

  N/A

• Are facilities/equipment to comply with workplaces practices available, such as hand-washing sinks, biohazard tags and labels, needle containers, detergents/disinfectants to clean up spills?

  Yes

  No

  N/A

• Are all equipment, environmental and working surfaces cleaned and disinfected after contact with blood or potentially infectious materials?

  Yes

  No

  N/A

• Is infectious waste placed in closable, leak proof containers, bags or puncture-resistant holders with proper labels?

  Yes

  No

  N/A

• Has medical surveillance including HBV evaluation, antibody testing and vaccination been made available to potentially exposed employees?

  Yes

  No

  N/A

• Training on universal precautions?

  Yes

  No

  N/A

• Training on personal protective equipment?

  Yes

  No

  N/A

• Training on workplace practices, which should include blood drawing, room cleaning, laundry handling, clean up of blood spills?

  Yes

  No

  N/A

• Training on needlestick exposure/management?

  Yes

  No

  N/A

• Hepatitis B vaccinations?

  Yes

  No

  N/A

Ergonomics

• Can the work be performed without eye strain or glare to the employees?

  Yes

  No

  N/A

• Does the task require prolonged raising of the arms?

  Yes

  No

  N/A

• Do the neck and shoulders have to be stooped to view the task?

  Yes

  No

  N/A

• Are there pressure points on any parts of the body (wrists, forearms, back of thighs)?

  Yes

  No

  N/A

• Can the work be done using the larger muscles of the body?

  Yes

  No

  N/A

• Can the work be done without twisting or overly bending the lower back?

  Yes

  No

  N/A

• Are there sufficient rest breaks, in addition to the regular rest breaks, to relieve stress from repetitive-motion tasks?

  Yes

  No

  N/A

• Are tools, instruments and machinery shaped, positioned and handled so that tasks can be performed comfortably?

  Yes

  No

  N/A

• Are all pieces of furniture adjusted, positioned and arranged to minimize strain on all parts of the body?

  Yes

  No

  N/A