SABRE EH&S

• INTERNAL AUDIT SIGN SHEET

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1.0 HSE STAFF

• Does the company have staff personnel dedicated to HSE Management?

  Yes

  No

  N/A

• Full time or Part time?

  Yes

  No

  N/A

• Is HSE Management their primary responsibility?

  Yes

  No

  N/A

• Identify responsibilities other than HSE management (if applicable).

  Yes

  No

  N/A

• What is the experience level of the designated HSE representative participating in this audit?

  Yes

  No

  N/A

• What is the designated HSE representatives' length of employment with the company?

  Yes

  No

  N/A

• Does the company have an HSE policy statement endorsed by senior management?

  Yes

  No

  N/A

• Does the company establish annual HSE goals?

  Yes

  No

  N/A

• Does the company have a process in place to measure goal achievement?

  Yes

  No

  N/A

• Do Management Performance Reviews include HSE Performance criteria and/or requirements?

  Yes

  No

  N/A

• Do company employees receive incentives or rewards for the company's HSE performance?

  Yes

  No

  N/A

2.0 HSE Manual

• Does the company have a process in place for determining which existing regulations apply to specific operations?

  Yes

  No

  N/A

• Does the company have documented operations HSE manual applicable to their work activities?

  Yes

  No

  N/A

• Does it include assignment of responsibilities for Management, Supervisors, Employees?

  Yes

  No

  N/A

• Is it current? Last date updated?

  Yes

  No

  N/A

• Is the HSE manual consistent with current regulatory requirements and applicable industry standards?

  Yes

  No

  N/A

• Does the HSE manual contain necessary components to cover all major work place hazardous activities?

  Yes

  No

  N/A

• Is the HSE manual communicated to all management personnel? How?

  Yes

  No

  N/A

• Is the HSE manual communicated to all employees? How?

  Yes

  No

  N/A

• Are employees provided a company specific HSE Handbook?

  Yes

  No

  N/A

3.0 HSE Work Procedures

• Are there documented safe work procedures for work activity exposures?

  Yes

  No

  N/A

• How, when and by whom are they communicated to employees?

  Yes

  No

  N/A

• Are they formally reviewed and updated? How often and by whom?

  Yes

  No

  N/A

• Are proper manual lifting techniques covered through safe work procedures?

  Yes

  No

  N/A

• Is training conducted?

  Yes

  No

  N/A

• Is the training documented?

  Yes

  No

  N/A

4.0 Personal Protective Equipment (PPE)

• Does the company have a written PPE Program?

  Yes

  No

  N/A

• Does the program reference applicable ANSI standards?

  Yes

  No

  N/A

• Does the company conduct and update a PPE Hazard Assessment annually?

  Yes

  No

  N/A

• Does the company maintain a current Certification of PPE Hazard Assessment?

  Yes

  No

  N/A

• Does the program include criteria for PPE inspections?

  Yes

  No

  N/A

• Is PPE training current and documented?

  Yes

  No

  N/A

Hearing Conservation:

• Has a Noise Survey been conducted of common work activities?

  Yes

  No

  N/A

• Do noise survey results indicate that company needs a hearing conservation program?

  Yes

  No

  N/A

• Is a Hearing Conservation Program developed?

  Yes

  No

  N/A

• Is training provided initially, annually and is it documented?

  Yes

  No

  N/A

• Does the company provide hearing protection for workers?

  Yes

  No

  N/A

Fall Protection:

• Does the company have a written Fall Protection program?

  Yes

  No

  N/A

• Are guidelines developed establishing requirements for using fall protection? What are they?

  Yes

  No

  N/A

• Is Competent Person level training conducted?

  Yes

  No

  N/A

• Is user training conducted? How?

  Yes

  No

  N/A

• Does the company use Fall Rescue equipment? Identify.

  Yes

  No

  N/A

• How are employees trained on rescue equipment?

  Yes

  No

  N/A

• Is training provided initially and with changes in exposure and is it documented?

  Yes

  No

  N/A

• Does e program include equipment inspection guidelines?

  Yes

  No

  N/A

Respiratory Protection:

• Does the company have a written Respiratory Protection Program?

  Yes

  No

  N/A

• Is a program administrator identified?

  Yes

  No

  N/A

• Are medical evaluations conducted?

  Yes

  No

  N/A

• Is FIT testing conducted?

  Yes

  No

  N/A

• Does the program include criteria for determining End of Service Life for respirator cartridges?

  Yes

  No

  N/A

• Are equipment inspections conducted?

  Yes

  No

  N/A

• Are equipment inspections documented?

  Yes

  No

  N/A

Access to Medical Records:

• Is initial and annual refresher training conducted and is it documented?

  Yes

  No

  N/A

• Does the company have a written plan?

  Yes

  No

  N/A

• Are employees made aware of their "Right to Access" their own medical records?

  Yes

  No

  N/A

• How?

  Yes

  No

  N/A

• Do employees have access to their medical records?

  Yes

  No

  N/A

• Is initial and annual refresher training conducted and documented?

  Yes

  No

  N/A

Hazard Communication:

• Does the company have a written program?

  Yes

  No

  N/A

• Are MSDS available on site for employees?

  Yes

  No

  N/A

• Is a current chemical inventory list developed and maintained?

  Yes

  No

  N/A

• Is initial and with changes in exposure training conducted and documented?

  Yes

  No

  N/A

Hazwoper

• Does the company have a written HAZWOPER program?

  Yes

  No

  N/A

• Is training conducted and documented?

  Yes

  No

  N/A

• What type of training is applicable? 20 hour, 40 hour, Spill Response or Storage.

  Yes

  No

  N/A

• Does the company keep manifests on file?

  Yes

  No

  N/A

• Does the program include Emergency Contact information?

  Yes

  No

  N/A

• Is training conducted and documented?

  Yes

  No

  N/A

Industrial Hygiene:

• Does the company perform IH monitoring on employees?

  Yes

  No

  N/A

• For which substances?

  Yes

  No

  N/A

• Does the company conduct fitness for work exams for Audiograms, pre-employment, re- employment, respiratory and visual?

  Yes

  No

  N/A

Lock Out / Tag Out

• Is there a written program?

  Yes

  No

  N/A

• A process inspection conducted at least annually?

  Yes

  No

  N/A

• If applicable, are written equipment procedures developed? How?

  Yes

  No

  N/A

• Is training conducted and documented?

  Yes

  No

  N/A