Information
Safety and Health Assessment Program Evaluation (SHAPE)
Company Name
Type of Visit
Status
-
- Complete
- Cancelled
- Rescheduled
- Follow-Up
Retro Group
-
- MBA-GRIP
- Individual
- Smart Dream Team
- Smart A Team
- Smart Advantage
- Smart Healthcare
- PITB
- PITB Platinum
- WSHL
-
Safety Review Visit Conducted by:
Follow Up Scheduled:
-
Follow up scheduled (if Applicable):
General Information
Number of Employees:
Contact Name
WISHA POSTER
-
1.) WISHA Poster
-
Notes:
Accident Prevention Plan
-
2.) Is there an effective and practical ACCIDENT PREVENTION PLAN Present?
-
Notes:
SAFETY Committee/Meetings
-
3.) Is there an established Safety Committee?
-
4.) Is there established weekly safety meeting?
-
Notes:
Weekly Inspections (construction)
-
5.) Is the company completing weekly "Walk around Inspections"? (construction)
-
Notes
OSHA 300 LOG
-
6.) Does company keep an OSHA 300 LOG
-
Notes:
PERSONAL PROTECTIVE EQUIPMENT
-
7.) Has a hazard assessment been conducted?
-
8.) Is there an effective written PPE Program?
-
8a.) Are the employees trained?
-
Notes:
LOCK OUT/ TAG OUT
-
9.) Is there a written LO/TO Program
-
9a.) Are the employees trained?
-
Notes:
First-Aid and CPR
-
10.) Are First-Aid kits available on every job?
-
11.) Are employees FIRST AID/CPR Trained?
-
Notes
Hazard Communication Program
-
12.) Is there a written HAZCOM Program?
-
12a.) Are employees trained?
-
12b.) Is training documented?
-
13.) Is there an MSDS
-
13a.) Do employees have reasonable access?
-
Notes
Hearing Conservation
-
14.) Is there a written hearing conservation plan?
-
14a.) Are employees trained?
-
Notes:
Permit Required Confined Space Program
-
15.) Has the employer evaluated the workplace to determine if confined spaces are present?
-
16.) Is there a Written Confined Space Program?
-
16a.) Are employees trained?
-
Notes:
Respiratory Protection
-
17.) Has the employer conducted a Hazard Assessment
-
18.) Is there a written Respirator Protection Program?
-
18a.) Are employees trained in the RPP?
-
Notes
Fall Protection
-
19.) Has employer conducted a hazard assessment
-
20.) Is there a Written Fall Protection Plan?
-
20a.) Are employees trained?
-
Notes:
Hot Work
-
21.) Does company have a Hot Work program established?
-
21a.) Are employees trained?
-
Notes:
MISC TOPICS
-
22.) Does company conduct new hire orientation?
-
23.) Does company have an employee discipline program?
