Risk Survey

• Survey Date

  Date

• Eocene Representative

• Facility

• Address

• Facility Representative(s)

• NAICS Code(s)

• Description of Operations

• Background

• Summary

• Limitations

• Evaluation System: Exceeds Expectations (+), Meets Expectations (+/-), Below Expectations (-)

Policies & Procedures

• Documented effective policies & procedures

  +

  +/-

  -

  N/A

• EHS incentive program

  +

  +/-

  -

  N/A

• Formal disciplinary program

  +

  +/-

  -

  N/A

• Visitor controls

  +

  +/-

  -

  N/A

• Contractor controls

  +

  +/-

  -

  N/A

Training

• Formal initial training program

  +

  +/-

  -

  N/A

• Formal refresher training program

  +

  +/-

  -

  N/A

• Training records organization

  +

  +/-

  -

  N/A

Incident Management

• Documented incident management system

  +

  +/-

  -

  N/A

• Incident (injury/illness, equipment/property damage, environmental release) reporting

  +

  +/-

  -

  N/A

• Close call/near miss reporting

  +

  +/-

  -

  N/A

• Root cause analysis investigation

  +

  +/-

  -

  N/A

• Corrective action management procedure

  +

  +/-

  -

  N/A

• Return-to-work program

  +

  +/-

  -

  N/A

Recordkeeping

• OSHA 300/300A for previous five (5) years

  +

  +/-

  -

  N/A

• Workers compensation EMR data for five (5) years

  +

  +/-

  -

  N/A

Compliance

• Regulatory inspections in previous three (3) years

  +

  +/-

  -

  N/A

• Notice of violation/citation in previous three (3) years

  +

  +/-

  -

  N/A

• General Comments

• Evaluation System: Exceeds Expectations (+), Meets Expectations (+/-), Below Expectations (-)
  
  Types of Environmental Violations (penalty ranges)
  - Minor: $363 - $2,177 per violation
  - Moderate: $544 - $7,981 per violation
  - Major: $1,995 - $18,139 per violation

• EPA Facility Registry Service (FRS) Listed

  Yes

  No

  N/A

• EPA FRS ID

• EPA ECHO report review

  +

  +/-

  -

  N/A

• Air Emissions

  +

  +/-

  -

  N/A

• Potential penalty

  Select

• Emergency Planning

  +

  +/-

  -

  N/A

• Potential penalty

  Select

• Spill Prevention

  +

  +/-

  -

  N/A

• Potential penalty

  Select

• Stormwater

  +

  +/-

  -

  N/A

• Potential penalty

  Select

• Toxic Release Inventory

  +

  +/-

  -

  N/A

• Potential penalty

  Select

• Waste Management

  +

  +/-

  -

  N/A

• EPA Handler ID

• Biennial Reporting

  +

  +/-

  -

  N/A

• Potential penalty

  Select

• General Comments

• Evaluation System: Exceeds Expectations (+), Meets Expectations (+/-), Below Expectations (-)
  
  Types of Safety & Health Violations (penalty ranges per violation)
  - Other-than-serious: Direct relationship to job safety and health but is not serious in nature ($0 - $16,131).
  - Serious: Workplace hazard that could cause an accident or illness that would most likely result in death or serious physical harm ($1,190 - $16,131).
  - Willful: Employer either knowingly failed to comply with a legal requirement (purposeful disregard) or acted with plain indifference to employee safety ($11,524 - $161,323).

• Abrasive Blasting

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Air Contaminants (Industrial Hygiene)

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Aisles & Passageways

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Asbestos

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Bloodborne Pathogens

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Chains, Cables, Ropes & Hooks

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Combustible Dust

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Compressed Air, Use of

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Compressed Gas Cylinders

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Confined Spaces

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Cranes, Hoists & Derricks

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Dockboards

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Electrical

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Emergency Action Planning

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Emergency Response/HAZWOPER

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Ergonomics

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Exits

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Eyewash/Drench Shower

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Facility Maintenance

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Fall Protection

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Fire Prevention

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Fire Protection

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Flammable Liquids

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Floors

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Hand & Power Tools

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Hazard Communication

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Hazardous Energy (Lockout/Tagout)Pop

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Housekeeping

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Ladders

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Machine Guarding

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Marking, Placards & Labels

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Medical Services & First Aid

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Mobile Elevated Work Platform

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Noise

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Personal Protective Equipment

  +

  +/-

  -

  N/A

• Head

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Eye/Face

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Respiratory

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Body

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Hand

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Foot

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Powered Industrial Trucks (Forklifts)

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Process Safety Management (PSM)

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Radiation, Ionizing

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Radiation, Non-Ionizing

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Security

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Stairways/Railings

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Storage

  +

  +/-

  -

  N/A

• Potential violation

  Select

• Welding, Cutting & Hotwork

  +

  +/-

  -

  N/A

• Potential violation

  Select

• General Comments

• Evaluation System: Exceeds Expectations (+), Meets Expectations (+/-), Below Expectations (-)

• Company-owned vehicles

  Yes

  No

  N/A

• Commercial motor vehicles

  Yes

  No

  N/A

• US DOT Number

  +

  +/-

  -

  N/A

• Current MCS-150

  +

  +/-

  -

  N/A

• Inspection performance

  +

  +/-

  -

  N/A

• Crash performance

  +

  +/-

  -

  N/A

• Electronic logging devices

  +

  +/-

  -

  N/A

• Proper markings

  +

  +/-

  -

  N/A

• GPS monitoring system

  +

  +/-

  -

  N/A

• Dash cameras

  +

  +/-

  -

  N/A

• Type

  Select

• Vehicle inspections

  +

  +/-

  -

  N/A

• Vehicle maintenance

  +

  +/-

  -

  N/A

• Annual driver MVR review process

  +

  +/-

  -

  N/A

• General Comments