PREVENT General Industry

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Ensure that the workplace is safe in accordance with the PREVENT General Industry Guide:

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

  Yes

  No

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Personal Protective Equipment - Proper Use

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• 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

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Chains & Slings<br>Inspected?<br>Rated?<br>

  Safe

  At Risk

  N/A

• Miscellaneous Hazards not discussed elsewhere:

  Safe

  At Risk

  N/A

• Additional Hazards: combustible dust, hot work permit program, servicing rims & wheels, mechanical power presses, lab safety, process safety management, stainless steel welding, and air quality.

  Safe

  At Risk

  N/A

• Safe Electrical Work Practices? Pin in Place? Free of nicks/cuts? Daisy chaining? Permanent/temporary wiring?

  Yes

  No

  N/A

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

  Yes

  No

  N/A