• INTERNAL AUDIT SIGN SHEET

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1.0 HSE STAFF

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

  • Full time or Part time?

  • Is HSE Management their primary responsibility?

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

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

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

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

  • Does the company establish annual HSE goals?

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

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

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

2.0 HSE Manual

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

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

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

  • Is it current? Last date updated?

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

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

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

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

  • Are employees provided a company specific HSE Handbook?

3.0 HSE Work Procedures

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

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

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

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

  • Is training conducted?

  • Is the training documented?

4.0 Personal Protective Equipment (PPE)

  • Does the company have a written PPE Program?

  • Does the program reference applicable ANSI standards?

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

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

  • Does the program include criteria for PPE inspections?

  • Is PPE training current and documented?

Hearing Conservation:

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

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

  • Is a Hearing Conservation Program developed?

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

  • Does the company provide hearing protection for workers?

Fall Protection:

  • Does the company have a written Fall Protection program?

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

  • Is Competent Person level training conducted?

  • Is user training conducted? How?

  • Does the company use Fall Rescue equipment? Identify.

  • How are employees trained on rescue equipment?

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

  • Does e program include equipment inspection guidelines?

Respiratory Protection:

  • Does the company have a written Respiratory Protection Program?

  • Is a program administrator identified?

  • Are medical evaluations conducted?

  • Is FIT testing conducted?

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

  • Are equipment inspections conducted?

  • Are equipment inspections documented?

Access to Medical Records:

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

  • Does the company have a written plan?

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

  • How?

  • Do employees have access to their medical records?

  • Is initial and annual refresher training conducted and documented?

Hazard Communication:

  • Does the company have a written program?

  • Are MSDS available on site for employees?

  • Is a current chemical inventory list developed and maintained?

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

Hazwoper

  • Does the company have a written HAZWOPER program?

  • Is training conducted and documented?

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

  • Does the company keep manifests on file?

  • Does the program include Emergency Contact information?

  • Is training conducted and documented?

Industrial Hygiene:

  • Does the company perform IH monitoring on employees?

  • For which substances?

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

Lock Out / Tag Out

  • Is there a written program?

  • A process inspection conducted at least annually?

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

  • Is training conducted and documented?

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