PREVENT General Industry 6-28-18

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• AWAIR Safety Program<br>with 5 elements; updated annually with goals and objectives.

  Yes

  No

  N/A

• Add estimated OSHA fine:

Estimated OSHA fine:

• Estimated OSHA fine:

• Injury & Illness OSHA 300 Record Keeping<br>Log posted?<br>Log correct?<br>Posters?

  Safe

  At Risk

  N/A
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• Estimated OSHA fine:

• Safety Committee MN<br>Regular Meetings?<br>Documented Meetings?<br>Management & employee equally represented?

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Right To Know / GHS / SDS<br>Annual training?<br>SDS available to employees?<br>Labeling of Containers?<br>

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Bloodborne Pathogens<br>Training?<br>BBP clean up kits?

  Safe

  At Risk

  N/A
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• Estimated OSHA fine:

• Personal Protective Equipment - Proper Use

  Safe

  At Risk

  N/A
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• Estimated OSHA fine:

• Emergency Action Plan<br>Maps developed?<br>Drills?

  Safe

  At Risk

  N/A
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• Estimated OSHA fine:

• Lock Out Tag Out<br>Procedures?<br>Authorized training?<br>Procedures evaluated?

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Respiratory Protection (Voluntary & Required Use)<br>Medical evaluations?<br>Stored properly?<br>Appendix D if voluntary?<br>

  Safe

  At Risk

  N/A
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• Estimated OSHA fine:

• Powered Industrial Trucks<br>Classroom?<br>Test?<br>Behind the wheel, every 3 years?

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Fire Extinguishers<br>Training?<br>Monthly inspection?<br>Blocked?<br>Mounted properly?

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• First Aid & CPR<br>with no EMS Response within 4 minutes<br>Training every 2 years?<br>Eyewash station?<br>

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Permit Required Confined Space Entry<br>Signs?<br>Training?<br>Rescue plan?<br>

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Walking & Working Surfaces <br>Fall Protection 4 feet vs. 6 feet<br>Guard rails?<br>PFAS?<br>Restraint?<br><br>

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Ladders<br>4:1 angle<br>Storage?<br>

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Machine Guarding<br>AUTO<br>Interlocks?<br>Light curtains?<br>Two hand controls?

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Woodworking Machines<br>Guards in place?<br>Push Sticks?<br>Anti restart?<br>

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Power Tools<br>Cords?<br>Guards/Shields?<br>Proper Use?<br>PPE?

  Safe

  At Risk

  N/A
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• Estimated OSHA fine:

• Overhead Cranes<br>Documenting Inspections?<br>Safety latch?<br>Controls labeled?<br>

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• Safe electrical work practices?<br>Pin in place?<br>Free of nicks/cuts?<br>Daisy chaining?<br>Permanent/temporary wiring?

  Safe

  At Risk

  N/A
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• Estimated OSHA fine:

• Miscellaneous Hazards not discussed elsewhere:

  Safe

  At Risk

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

• To the Best of Your Knowledge All Other Hazards are Controlled?

  Yes

  No

  N/A
Add estimated OSHA fine:

• Estimated OSHA fine:

Total estimated OSHA fines:

• Total estimated OSHA fines:

Disclaimer

• These potential OSHA fines are based on a worst case scenario. OSHA provides credits in the areas of size of company up to 55%, good faith credit up to 30%, & history with OSHA up to 10%. We cannot estimate these credits to the actual dollar due to many variables. These estimated OSHA penalties can be used to help support return on investment & for prioritization purposes. Marsh and Mclennan Agency is not responsible for estimates that differ from incurred penalties occurring in an OSHA inspection.