Safety Assessment 2022

• Facility Name

• Date of Audit

  Date

• Audit Completed By

• Facility Attendees

• Location
  Address

• Signature

  Sign

Basic

• Is PPE readily available for employees who are required to wear it? 1910.132(a), (c), and (e)

  Yes

  No

  N/A

• Are all employee's trained on the proper use and care of PPE? 1910.132(f)(1)

  Yes

  No

  N/A

• Are all work-related patient hospitalizations, amputations, or loss of an eye reported to OSHA within twenty-four (24) hours? 1904.39(a)(2)

  Yes

  No

  N/A

• Are all work-related fatalities reported to OSHA within eight (8) hours? 1904.39(a)(1)

  Yes

  No

  N/A

• OSHA Compliance checklist completed annually?

  Yes

  No

  N/A

• Does the facility participate in W.I.S.E. program? (note current level)

  Yes

  No

  N/A

Respiratory Protection

• Does facility have a written Respiratory Protection program? 1910.134(a)(2)

  Yes

  No

  N/A

• Are employees trained over Respiratory Protection? (Initial and annual) 1910.134 (k)(1)(i)-(vii), (2), (3) & (5)(i) - (iii)

  Yes

  No

  N/A

• Do employees receive respiratory fit testing? (Initial and annual to all occupationally exposed employees) 1910.134(c)(1)(iii)

  Yes

  No

  N/A

• Are medication rooms, closets, and carts locked to prevent unauthorized access? 1910.1030(e)(2)(ii)©

  Yes

  No

  N/A

Facilities

• Has facility developed LOTO written program? 1910.147(a)(1)(i)

  Yes

  No

  N/A

• Are all "Affected" and "Authorized" employees trained over LOTO? 1910.147(a)(3)(ii), (4)(I)(D), (7)(i)(A) - (C), (ii)(A) - (C)(iv) & (8)

  Yes

  No

  N/A

• Are annual LOTO periodic inspections performed? 1910.147(c)(6)(i)

  Yes

  No

  N/A

• Have employees potentially exposed to Asbestos been trained over Asbestos Awareness? (Initial and annual) 1910.1001(j)(7)(i)-(iii)A-H

  Yes

  No

  N/A

• Area is free from recognizable Electrical hazards? (GFCI protection, flexible cord requirements, breaker box) 1910.303(b)(1)

  Yes

  No

  N/A

• Are all pressurized cylinders secured while in the upright position? 1910.253(b)(2)(ii)

  Yes

  No

  N/A

• Are all working at heights operations (above 4 feet) protected by fall protection? 1910.28(b)(1)(i)

  Yes

  No

  N/A

• Are fire extinguishers current? (Inspected monthly, Serviced annually) 1910.157(e)(2)

  Yes

  No

  N/A

• Does the facility have a site specific Exposure Control Plan (ECP) for Blood/Bodily Fluid Exposures? 1910.1030(c)(1)(i)

  Yes

  No

  N/A

• Is Exposure Control Plan reviewed annually or whenever new tasks/procedures affect occupational exposure? Note: This review must reflect changes in technology and document annual consideration and implementation of safer medical devices. 1910.1030(c)(1)(iv)

  Yes

  No

  N/A

• Are engineering and work practice controls shall be used to eliminate or minimize employee exposure? Where occupational exposure remains after institution of these controls, personal protective equipment shall also be used. 1910.1030(d)(2)(i)

  Yes

  No

  N/A

• Have all employees with occupational exposure been offered the Hepatitis B vaccination or signed a declination statement? 1910.1030(f)(1)(i)

  Yes

  No

  N/A

• Are all needle sticks or sharps and bodily fluid exposure injuries recorded on a separate log as a 'PRIVACY CASE'? 1910.1030(h)(5)(i)

  Yes

  No

  N/A

• Are all employees given Blood Borne Pathogen training? (Initial and annual) 1910.1030(g)(2)(i)

  Yes

  No

  N/A

• Have all employees with occupational exposure to BBFE been provided live training with the ability to ask questions annually? 1910.1030(g)(2)(iv)

  Yes

  No

  N/A

• Are sharps containers available where needed within the facility? 1910.1030(d)(4)(iii)(A)(2)(i)

  Yes

  No

  N/A

• Are refrigerators designated for biological specimens marked with biohazard waste symbols? 1910.1030(g)(1)(i)(A)

  Yes

  No

  N/A

• Are biohazard waste containers or blood borne pathogens spill kits available for the disposal of blood/bodily fluid contaminated waste? Best Practice

  Yes

  No

  N/A

• Are biohazard wastes or material containing blood or other potentially infectious materials are placed is red bags or biohazard labeled waste bags and disposed of properly? Best Practice

  Yes

  No

  N/A

• Are soiled linens are collected immediately and sorted efficiently to minimize exposure to blood/bodily fluid exposures? 1910.1030(d)(3)(vi)

  Yes

  No

  N/A

• Do employees wear gloves when hand contact with blood, mucous membranes, OPIM, or non-intact skin is anticipated, and when performing vascular access procedures, or when handling contaminated items or surfaces? 1910.1030(d)(3)(ix)

  Yes

  No

  N/A

• Employees wash hands and any other skin with soap and water or flush mucous membranes with water as soon as feasible after contact with blood or other potentially infectious materials (OPIM)? 1910.1030(d)(2)(vi)

  Yes

  No

  N/A

• Employees are provided readily accessible hand washing facilities near BBP operations? 1910.1030(d)(2)(iii)

  Yes

  No

  N/A

• Comments, Suggestions, or Other Concerns:

• Facility has developed a written Hazard Communication Program? 1910.1200(a)(2)

  Yes

  No

  N/A

• Do employees understand content and availability of SDS's? 1910.1200(h)(1)

  Yes

  No

  N/A

• Are SDS's accessible to employees? 1910.1200(h)(1)

  Yes

  No

  N/A

Training

• Are EE's trained on the hazardous chemicals within their workplace?

  Yes

  No

  N/A

• Is instruction provided on how to recognize exposure of hazardous chemicals?

  Yes

  No

  N/A

• Are container labeling elements included?

  Yes

  No

  N/A

• Is there instruction over SDS format and content?

  Yes

  No

  N/A

• Is explanation given on how to access SDS?

  Yes

  No

  N/A

Management

• Are SDS's updated when available?

  Yes

  No

  N/A

• Is HAzCom program updated as needed?

  Yes

  No

  N/A

• Is explanation provided on how to obtain copy of HazCom program?

  Yes

  No

  N/A

• Are EE's trained on labeling system?

  Yes

  No

  N/A

• Are all container labels compliant?

  Yes

  No

  N/A

• Comments, Suggestions, or Other Concerns:

• Public restroom floors are clean and dry (or otherwise marked), free of slip or trip hazards. 1910.22(a)(1)

  Yes

  No

  N/A

• Are wet floor signs used properly? (i.e. only left out when floor is wet; mopping half an area at a time to allow safe passage) 1910.145(c)(2)

  Yes

  No

  N/A

• Are exits free from obstruction? Access to exits must remain clear of obstructions at all times. 1910.36(b)(4)

  Yes

  No

  N/A

• Are walk off mats placed and maintained at facility entrances to prevent slick floors? Are they without wrinkles/waves? 1910.22(a)(1)

  Yes

  No

  N/A

• Are sidewalks/parking lots free from trip and fall hazards? (i.e. heaving sidewalk sections, landscaping drop-offs, potholes, ice, etc.) 1910.22(a)(1)

  Yes

  No

  N/A

• Are ladders in good repair & available for all tasks where they are needed? (i.e. 8 foot ladder for 10 foot light fixture access) 1910.25(d)(1)(x) and 1910.26(c)(2)(vi)

  Yes

  No

  N/A

• Electrical wires are properly connected, grounded and not overpopulating outlets causing a trip hazard. 1910.22(a)

  Yes

  No

  N/A

• Use no-skid waxes and surfaces coated with grit to create non-slip surfaces in slippery areas such as toilet and shower areas? Best Practice

  Yes

  No

  N/A

• Has facility implemented waterproof footgear to decrease slip/fall hazards? Best Practice

  Yes

  No

  N/A

• Does facility have adequate lighting in stairway(s) areas? Best Practice

  Yes

  No

  N/A

Program Management

• Is there a system for hazard identification and analysis? General Duty Clause, Section 50.9.5

  Yes

  No

  N/A

• Who has responsibility and authority for compliance with the system? General Duty Clause, Section 50.9.6

  Yes

  No

  N/A

• Have employees provided input into the development of lifting, transferring or repositioning procedures? General Duty Clause, Section 50.9.7

  Yes

  No

  N/A

Program Implementation

• How is patient mobility determined? General Duty Clause, Section 50.9.10

  Yes

  No

  N/A

• What is the decision logic for using lift, transfer, or repositioning devices? General Duty Clause, Section 50.9.11

  Yes

  No

  N/A

• Are there appropriate polices and procedures for manual lifting, transfering, or repositioning devices at the establishment? General Duty Clause, Section 50.9.12

  Yes

  No

  N/A

Employee Training

• Have employees been trained in the recognition of hazards associated with manual resident lifting, transferring, or repositioning? General Duty Clause, Section 50.9.15

  Yes

  No

  N/A

• Can employees demonstrate competency in performing lifting, transfering, or repositioning using the assistive devices? General Duty Clause, Section 50.9.16

  Yes

  No

  N/A

• Does facility have a written Workplace Violence program? General Duty Clause

  Yes

  No

  N/A

• Does the Workplace Violence Program include the following key elements?

  Yes

  No

  N/A

• Management commitment and employee participation General Duty Clause

  Yes

  No

  N/A

• Worksite analysis General Duty Clause

  Yes

  No

  N/A

• Hazard prevention and control General Duty Clause

  Yes

  No

  N/A

• Safety and health training General Duty Clause

  Yes

  No

  N/A

• Recordkeeping and program evaluation General Duty Clause

  Yes

  No

  N/A

Active Shooter Preparation

• Does the facility have a policy that covers 'Active Shooter'

  Yes

  No

  N/A

• Does the facility perform 'Active Shooter' Drills? (specify tabletop, full scale, etc.)

  Yes

  No

  N/A

• Comments, Suggestions, or Other Concerns:

• Does the facility have a specific and up-to-date COVID-19 Plan, that follows most recent guidance?

  Yes

  No

  N/A

• Does the facility follow the current guidance on Masking?

  Yes

  No

  N/A

• Does the facility follow the current guidance on Screening (visitor and employee)

  Yes

  No

  N/A

• Proper signage related to COVID-19 posted? (bathrooms, entrances, etc.)

  Yes

  No

  N/A

• Are there an adequate number of sanitizing stations throughout the facility?

  Yes

  No

  N/A

• Have Motor Vehicle Reports (MVRs) been used within the last year to determine driver qualification at this facility? Best Practice

  Yes

  No

  N/A

• Are driver qualification files maintained for all company drivers at this location? Best Practice

  Yes

  No

  N/A

• Do drivers who operate passenger vehicles have valid CDL licenses with the proper state endorsement? Best Practice

  Yes

  No

  N/A

• Have all drivers been trained on the wheelchair securement device(s), where applicable? Best Practice

  Yes

  No

  N/A

• Comments, Suggestions, or Other Concerns:

• Subject to change with Fleet Management Policy

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation

• Major Hazard - 5 points

  Hazard - 1 point

  Minor Hazard - 0.5 points

  Observation