Title Page

  • Facility Name

  • Date of Audit

  • Audit Completed By

  • Facility Attendees

  • Location
  • Signature



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

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

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

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

  • OSHA Compliance checklist completed annually?

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

Respiratory Protection

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

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

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

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


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

  • 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)

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

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

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

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

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

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

Exposure Control (BBP)

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

  • 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)

  • 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)

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

  • 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)

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

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

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

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

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

  • 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

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

  • 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)

  • 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)

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

  • Comments, Suggestions, or Other Concerns:


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

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

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


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

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

  • Are container labeling elements included?

  • Is there instruction over SDS format and content?

  • Is explanation given on how to access SDS?


  • Are SDS's updated when available?

  • Is HAzCom program updated as needed?

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

  • Are EE's trained on labeling system?

  • Are all container labels compliant?

  • Comments, Suggestions, or Other Concerns:

Walking, Working Surfaces

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

  • 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)

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

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

  • 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)

  • 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)

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

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

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


Program Management

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

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

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

Program Implementation

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

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

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

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

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

Workplace Violence

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

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

  • Management commitment and employee participation General Duty Clause

  • Worksite analysis General Duty Clause

  • Hazard prevention and control General Duty Clause

  • Safety and health training General Duty Clause

  • Recordkeeping and program evaluation General Duty Clause

Active Shooter Preparation

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

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

  • Comments, Suggestions, or Other Concerns:


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

  • Does the facility follow the current guidance on Masking?

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

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

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

Fleet Safety Management

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

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

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

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

  • Comments, Suggestions, or Other Concerns:

  • Subject to change with Fleet Management Policy

Physical Hazards

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