RAK Louisville

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Information

• Do you have an OSHA Manual?

  Yes

  No

  N/A

• Is OSHA Manual up to date?

  Yes

  No

  N/A

• Yes

  No

  N/A

Ergonomic Plan

• Customized ergonomic plan for office?

  Yes

  No

  N/A

• Plan accessible to all Employees? Posted?

  Yes

  No

  N/A

• Employees able to identify signs and symptoms of MDS's?

  Yes

  No

  N/A

• Employees know how to report signs and symptoms? Understand importance of reporting?

  Yes

  No

  N/A

• Employees trained in proper transfer techniques with patients?

  Yes

  No

  N/A

• Employees provided medical access, beyond first aid?

  Yes

  No

  N/A

• Employees provided work restriction protection for action trigger jobs?

  Yes

  No

  N/A

• Management and employee participation encouraged?

  Yes

  No

  N/A

• Training upon hire and every 3 years?

  Yes

  No

  N/A

• Report records kept for 3 years/HCP opinions kept for length of employment + 3 years?

  Yes

  No

  N/A

• Program evaluation performed to ensure risks are minimized and controlled?

  Yes

  No

  N/A

• Are employee work areas adequately lighted?

  Yes

  No

  N/A

• Is there adequate ventilation in employee work areas?

  Yes

  No

  N/A

Written Exposure Control Plan

• Does the employer have a written exposure control plan?

  Yes

  No

  N/A

• Exposure plan current?

  Yes

  No

  N/A

• Plan reviewed and updated at least annually?

  Yes

  No

  N/A

• Universal and standard precautions observed?

  Yes

  No

  N/A

• Engineering controls/work practice controls/ PPE?

  Yes

  No

  N/A

• Methods of compliance? (SOP) Schedules for implementing?

  Yes

  No

  N/A

• Exposure determination worksheets?

  Yes

  No

  N/A

• Management of exposure incidents? Immediate reporting of exposures and referrals?

  Yes

  No

  N/A

• Recordkeeping: Medical records, training, and incidents?

  Yes

  No

  N/A

• Plan accessible to all employees?

  Yes

  No

  N/A

Training

• All employees provided training?

  Yes

  No

  N/A

• Training provided prior to performing duties during normal business hours?

  Yes

  No

  N/A

• Disease control training updated annually for Hep B and C, HIV, TB and Anthrax?

  Yes

  No

  N/A

• Exposure control and Universal Precautions updated annually?

  Yes

  No

  N/A

• Provided training at an appropriate level of comprehension and interactive?

  Yes

  No

  N/A

• Training records kept for a minimum of 3 years?

  Yes

  No

  N/A

Confidential Medical Files (Kept term of employment + 30 years)

• Medical Reports?

  Yes

  No

  N/A

• Vaccination History?

  Yes

  No

  N/A

• Informed Consent(s)?

  Yes

  No

  N/A

• Informed Refusal(s)/Condition of Employment?

  Yes

  No

  N/A

• Exposure determination?

  Yes

  No

  N/A

• Incident reports?

  Yes

  No

  N/A

• Post Exposure follow up?

  Yes

  No

  N/A

• Written opinion(s)?

  Yes

  No

  N/A

Personal Protective Equipment

• PPE Provided to all employees? (gloves, masks, apparel - all in appropriate sizes)

  Yes

  No

  N/A

• PPE designed with knee length, long sleeves, and crewneck to protect legs, arms, and neck?

  Yes

  No

  N/A

• Gloves worn and changed after each patient?

  Yes

  No

  N/A

• Masks worn and changed after providing care to potentially infectious/contagious patient?

  Yes

  No

  N/A

• Protective eyewear/shields worn and disinfected after each patient?

  Yes

  No

  N/A

• Lab coats and/or gowns worn and changed when visibly soiled or when leaving treatment areas?

  Yes

  No

  N/A

• Employees prohibited from home laundering gowns?

  Yes

  No

  N/A

• Synthetic gloves provided to those who have latex sensitivity?

  Yes

  No

  N/A

• All employees offered Hepatitis vaccination free of charge and within 10 days of task assignment? Vaccine offered only after risks and benefits have been explained?

  Yes

  No

  N/A

• If vaccination declined, employee sign a vaccine declination form? Aware that they can accept at a later date?

  Yes

  No

  N/A

• Hand hygiene policies been reviewed?

  Yes

  No

  N/A

Laundry

• Soiled laundry placed in marked bags or containers?

  Yes

  No

  N/A

• Employees DO NOT TAKE contaminated laundry home?

  Yes

  No

  N/A

• Employees minimize handling and wear appropriate PPE when handling?

  Yes

  No

  N/A

Posters and Signs Appropriately Displayed

• Safety and Health protection on the job? (Employee rights OSHA 2203 Language poster (OSHA 3165))?

  Yes

  No

  N/A

• Notice of Workers Compensation?

  Yes

  No

  N/A

• Emergency Evacuation Plan?

  Yes

  No

  N/A

• Form 200, if 11 employee or more

  Yes

  No

  N/A

• Emergency telephone numbers/qualified first aid providers?

  Yes

  No

  N/A

• Illuminated Exit and "Not An Exit" signs posted?

  Yes

  No

  N/A

• Biohazard Symbol

  Yes

  No

  N/A

• Eyewash station location?

  Yes

  No

  N/A

• Housekeeping schedule posted?

  Yes

  No

  N/A

Sharps

• Engineering sharps injury protection (self sheathing needles)?

  Yes

  No

  N/A

• Have Employees been allowed to evaluate engineered sharp protection devices? Documented?

  Yes

  No

  N/A

• If needles are recapped, do employees use self-sheathing device or 1 handed scoop technique?

  Yes

  No

  N/A

• Exposed individuals/source patient tested as soon as feasible for HIV, HBV, and HCV?

  Yes

  No

  N/A

• Containers readily accessible in the area of use? Containerized immediately after use?

  Yes

  No

  N/A

• Containers have a closeable lid, and are puncture resistant, labeled, and leak proof?

  Yes

  No

  N/A

• Containers prohibit two handed removal, not allowed to be overfilled?

  Yes

  No

  N/A

• Employees prohibited from using two handed recapping?

  Yes

  No

  N/A

• Contaminated needles and sharps prohibited from being bent?

  Yes

  No

  N/A

• Filled containers transported by licensed recycler?

  Yes

  No

  N/A

• Work Place Controls employed to reduce risks when handling sharps?

  Yes

  No

  N/A

Waste/Waste Segregation

• Regulated medical waste in closeable, leak proof biohazard labeled containers/pick up by licensed recycler?

  Yes

  No

  N/A

• Biohazard waste identified with biohazard symbol?

  Yes

  No

  N/A

• Have employees been trained on the office biohazard waste plan?

  Yes

  No

  N/A

• Infectious waste hauled by certified waste hauler? Manifest records kept on file for 7 years?

  Yes

  No

  N/A

• Does business owner have EPA# for small generator? (800-618-6942)

  Yes

  No

  N/A

• Spent hazardous waste (cannot go down drain) picked up by licensed recycler?

  Yes

  No

  N/A

• Expired pharmaceuticals containerized and disposed of properly?

  Yes

  No

  N/A

• Office treating their own waste? EPA # for treating on site? Records kept?

  Yes

  No

  N/A

• Instruments sterilized or disinfected according to CDC and/or state requirements?

  Yes

  No

  N/A

• Is biological monitoring performed weekly to ensure each autoclave or other mechanical sterilizers are functioning properly?

  Yes

  No

  N/A

• Are appropriate disinfectants used for disinfecting surfaces?

  Yes

  No

  N/A

• Employees received annual training on bloodborne pathogens and how to comply with the facility's plans to reduce the risk of infection? Documentation of those trainings?

  Yes

  No

  N/A

• Does the training include methods of transmission of bloodborne pathogens and the symptoms of HIV and Heptitis?

  Yes

  No

  N/A

• Is medical waste found in solid waste containers?

  Yes

  No

  N/A

• Is solid waste found in RMW container and/or sharps container?

  Yes

  No

  N/A

Hazard Communication

• Written program customized and reviewed/updated annually? Done when new products are introduced?

  Yes

  No

  N/A

• Have employees been trained on your Hazard Communication plan?

  Yes

  No

  N/A

• Do employees know where SDS information is located and understand how to read a SDS?

  Yes

  No

  N/A

• Does program include description of how to read the label and use SDS sheets?

  Yes

  No

  N/A

• SDS sheets on file with inventory control list? Paper? Electronic?

  Yes

  No

  N/A

• Keeping Master List for 30 years - including those that are no longer used?

  Yes

  No

  N/A

• Request letters to Manufacturers for missing SDS's on file?

  Yes

  No

  N/A

• All products labeled at the point of use have original labels?

  Yes

  No

  N/A

• All transferred products re-labeled with product name, chemical ID, and appropriate hazard?

  Yes

  No

  N/A

• Are labels on secondary containers readable?

  Yes

  No

  N/A

• All employees have read, reviewed, and signed off on each SDS?

  Yes

  No

  N/A

• Is there a Master List of Hazardous Chemicals set up and maintained?

  Yes

  No

  N/A

• Are chemicals stored properly?

  Yes

  No

  N/A

• Have chemical containers been inspected for leaks?

  Yes

  No

  N/A

• Employees understand emergency spill procedures? Spill kit maintained?

  Yes

  No

  N/A

• All employees know how to use eyewash station?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

Medical Emergencies, Safety, and First Aid

• Is at least one person on each shift trained in first aid and CPR?

  Yes

  No

  N/A

• Do all staff members know how to immediately report occupational exposure to blood or other OPIM?

  Yes

  No

  N/A

• Does the employer or designated manager fill out an exposure incident form?

  Yes

  No

  N/A

• Does the incident report contain: Date, time and route of exposure, circumstances, and severity of exposure?

  Yes

  No

  N/A

• All employees trained in Occupational Injury and Illness Prevention? Records maintained?

  Yes

  No

  N/A

• Qualified safety controller identified?

  Yes

  No

  N/A

• Safety Committee established? Members identified?

  Yes

  No

  N/A

• Monthly meetings held? Meeting minutes?

  Yes

  No

  N/A

• Accident file established and maintained?

  Yes

  No

  N/A

• Periodic inspection of facility (first aid, fire, electrical, and evacuation)?

  Yes

  No

  N/A

• First Aid training provided?

  Yes

  No

  N/A

• First Aid supplies keot stocked and replenished periodically?

  Yes

  No

  N/A

• Eyewash station within 25 feet or 15 seconds without obstruction (door, furniture, etc)?

  Yes

  No

  N/A

• Eyewash station has proper signage? Sign designate location?

  Yes

  No

  N/A

• Eyewash station functioning properly? (Monthly Bump Test)

  Yes

  No

  N/A

• Have employees been trained on how to use the eyewash station?

  Yes

  No

  N/A

• Does eyewash station deliver cold water to avoid thermal injury to the eyes?

  Yes

  No

  N/A

• Emergency facilities within 15 minutes or qualified person available?

  Yes

  No

  N/A

• Proper lifting procedures? (SEE ERGONOMIC PLAN)

  Yes

  No

  N/A

• Are there any trip and fall hazards?

  Yes

  No

  N/A

• Food and drink held or consumed in areas where they could be contaminated?

  Yes

  No

  N/A

Electrical

• Multiple plug adapters prohibited?

  Yes

  No

  N/A

• All electrical devices with a three prong plug grounded?

  Yes

  No

  N/A

• All electrical outlets within 6 feet of sink or water on a grounded fault interpreter (GFI) circuit?

  Yes

  No

  N/A

• Electrical cords in good condition?

  Yes

  No

  N/A

• Circuit breakers properly marked?

  Yes

  No

  N/A

• Do employees know where circuit breakers are and how to cut power?

  Yes

  No

  N/A

Fire

• Employees aware of fire hazards of materials?

  Yes

  No

  N/A

• Fire alarm on premises?

  Yes

  No

  N/A

• Fire extinguishers inspected, recharged, and accessible 3 feet from floor?

  Yes

  No

  N/A

• Emergency escape procedures/evacuation plan?

  Yes

  No

  N/A

• Floor plan with method of egress? Periodic mock fire drills?

  Yes

  No

  N/A

• Exit signs/Not An Exit sign (where applicable): front, side, rear

  Yes

  No

  N/A

• Are all exit signs properly marked?

  Yes

  No

  N/A

• Are exit paths clear of obstructions, both inside and out?

  Yes

  No

  N/A

• Maximum occupancy?

  Yes

  No

  N/A

• All exit doors unlocked so emergency egress does not require a key?

  Yes

  No

  N/A

• Have you reviewed emergency escape procedures and route assignments, such as floor plans, workplace maps, and safe refuge area?

  Yes

  No

  N/A

• Are employees aware of fire and emergency plan(s)?

  Yes

  No

  N/A

• Fire extinguishers mounted at eye level?

  Yes

  No

  N/A

General Housekeeping, Storage, and Walking Surfaces

• Instrument processing center(s) kept in clean, uncluttered, and sanitary condition?

  Yes

  No

  N/A

• Imaging center(s) kept in clean, uncluttered, and sanitary condition?

  Yes

  No

  N/A

• Treatment rooms kept in clean, uncluttered, and sanitary condition?

  Yes

  No

  N/A

• Laser/surgical suites kept in clean, uncluttered, and sanitary condition?

  Yes

  No

  N/A

• Storage rooms kept in clean, uncluttered, and sanitary condition?

  Yes

  No

  N/A

• Walkways kept in clean, uncluttered, and sanitary condition?

  Yes

  No

  N/A

• Staff lounge kept in clean, uncluttered, and sanitary condition?

  Yes

  No

  N/A

• Business Office/Private offices kept in clean, uncluttered, and sanitary condition?

  Yes

  No

  N/A

• Food and drinks consumed outside of exposure area?

  Yes

  No

  N/A

• Walking and working surfaces are dry?

  Yes

  No

  N/A

• Waling and working surfaces are slip resistant?

  Yes

  No

  N/A

• Articles stored on shelves stored so they can't fall on employees?

  Yes

  No

  N/A

• Areas under sinks and trash areas clean and orderly?

  Yes

  No

  N/A

Monitoring

• Nitrous Oxide use?

  Yes

  No

  N/A

• Air Quality control?

  Yes

  No

  N/A

• Is all equipment given regularly scheduled, routine maintenance to ensure it is functioning properly? Records of maintenance completed?

  Yes

  No

  N/A

• Repair records of all equipment maintained in office?

  Yes

  No

  N/A

Gasses

• Equipment in good and safe condition with guards and shields?

  Yes

  No

  N/A

• Are safety shields in place to protect against projectile debris?

  Yes

  No

  N/A

• Nitrous Oxide/Oxygen stored in a manner to prevent tipping? Chained?

  Yes

  No

  N/A

• Are empty and unused compress cylinders capped and properly labeled?

  Yes

  No

  N/A

Laser Safety

Administrative

• Lasers are classified appropriately (2, 3R, 3B, 4)

  Yes

  No

  N/A

• Standard operating procedures available?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Alignment procedures are available?

  Yes

  No

  N/A

• Viewing cards are used for alignment?

  Yes

  No

  N/A

• Laser users attended appropriate training?

  Yes

  No

  N/A

• Lasers are included in inventory?

  Yes

  No

  N/A

• Yes

  No

  N/A

Labeling and Posting

• Certification Label Present?

  Yes

  No

  N/A

• Class designation and appropriate warning label present?

  Yes

  No

  N/A

• Radiation output information on label?

  Yes

  No

  N/A

• Aperture label present?

  Yes

  No

  N/A

• Appropriate label/sign at entrance to laser area?

  Yes

  No

  N/A

• Warning posted for invisible radiation?

  Yes

  No

  N/A

Control Measures

• Protective housing present and in good condition?

  Yes

  No

  N/A

• Beam attenuator present?

  Yes

  No

  N/A

• Laser table below eye level?

  Yes

  No

  N/A

• Beam is enclosed as much as possible?

  Yes

  No

  N/A

• Beam not directed towards door or window?

  Yes

  No

  N/A

• Beams are terminated with fire resistant beam stops?

  Yes

  No

  N/A

• Surfaces minimize specular reflections?

  Yes

  No

  N/A

• Controls are located so that the operator is not exposed to beam hazards?

  Yes

  No

  N/A

Personal Protective Equipment

• Eye protection is appropriate for wavelength?

  Yes

  No

  N/A

• Eye protection has adequate OD?

  Yes

  No

  N/A

• Warning/indicator lights can be seen through protective filters?

  Yes

  No

  N/A

Class 3B and 4 Lasers

• Interlocks on protective housing?

  Yes

  No

  N/A

• Service access panel present?

  Yes

  No

  N/A

• Limited access to spectators?

  Yes

  No

  N/A

• Nominal hazard zone determined?

  Yes

  No

  N/A

• Operators do not wear watches and reflective jewelry while laser is operating?<br>

  Yes

  No

  N/A

• Viewing portals present where MPE is exceeded?

  Yes

  No

  N/A

Class 4 Lasers

• Failsafe interlocks at entry to controlled area?

  Yes

  No

  N/A

• Area restricted to authorized personnel?

  Yes

  No

  N/A

• Laser may be fired remotely?

  Yes

  No

  N/A

• Laser may be fired remotely?

  Yes

  No

  N/A

• If present, curtains are fire-resistant?

  Yes

  No

  N/A

• Area designed to allow rapid emergency egress?

  Yes

  No

  N/A

• Pulsed- interlocks designed to prevent firing of the laser by dumping the stored energy into a dummy load?

  Yes

  No

  N/A

• CW- interlocks designed to turn off power supply or interrupt the beam by means of shutters?

  Yes

  No

  N/A

• Operators know not to wear ties around the laser?

  Yes

  No

  N/A

Non Beam Hazards

• High voltage equipment appropriately grounded?

  Yes

  No

  N/A

• High voltage equipment located away from wet surfaces or water sources?

  Yes

  No

  N/A

• High voltage warning label in place?

  Yes

  No

  N/A

• Compressed gases secured?

  Yes

  No

  N/A