Title Page
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Site conducted
File Name:
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File Name:
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Conducted on:
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NO RESPONSE NECESSARY OR PLEASE RESPOND TO FACILITIES MANAGEMENT - SAFETY AND HEALTH LOSS CONTROL OFFICER BY
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Location:
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Prepared by:
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Facilities Management Personnel and Department Site Personnel:
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Score: XX/XX - XX%
1.0 Employee OSHA (publication 3165) and U.S. Department of Labor Postings: 29 CFR 1903.2 and Pima County Medical Clinics
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1.1 Are the OSHA (publication 3165) and US Department of Labor Postings posted and available for the employees to read?
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1.2 COMPENSATION CONTACTS AND MEDICAL CLINICS (Best Management Practices); Is the Pima County Workers Compensation Contacts and Medical Clinics information posted?
2.0 OSHA GENERAL DUTY CLAUSE: OSHA ACT 5(a)(1)
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2.1 Does the employer furnish employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to employees?
3.0 BEST MANAGEMENT PRACTICES
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3.1 Does the location follow Best Management Practices?
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3.2 Does the location follow Best Management Practices?
4.0 OTHER VIOLATIONS (OSHA Act of 1970 - General Duty Clause and ARS 23-403)
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4.1 Do all other conditions at the location provide a safe workplace free from potential hazards to employees?
5.0. ADMINISTRATIVE QUESTIONS
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5.1. SITE SAFETY AND HEALTH POLICY (OSHA Recommended Practice); Has the site established a written Safety and Health policy and is it conspicuously posted?
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5.2. ROUTINE SAFETY INSPECTIONS OF WORK AREA; Does the site perform routine Safety inspections of the work area and are the inspections documented using some form of checklist??
6.0 COVID-19 WORKER SAFETY & HEALTH
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6.1 Use and distribution of masks; Does the main office entrance have a supply of masks available for employees and the public as necessary?
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6.2 Purchase, storage, and use of hygiene supplies; Does the location have adequate hygiene supplies and are they properly stored?
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6.3 Facilities guidance [policies] and signage; Does the location have guidance policies and signage posted [break rooms, elevators, entry ways, bathrooms, etc.]?
10.0 Automated External Defibrillator (AED)
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10.1 MONTHLY AED INSPECTIONS (PC Admin. Procedure 30-18, ARS 36-2262); Is the location performing the monthly AED inspection?
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10.2 AED PADS: EXPIRATION DATE (PC Admin. Procedure 30-18, ARS 36-2262); Are the AED pads still within their expiration date?
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10.3 AED BATTERY: EXPIRATION DATE (PC Admin. Procedure 30-18, ARS 36-2262); Is the AED battery still within its expiration date?
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10.4 AED KIT CONTENTS (PC Admin. Procedure 30-18, ARS 36-2262); Does the AED kit contain a pocket mask with one-way valve, examination gloves, razor, and absorbent hand towel?
20.0 CONFINED SPACES
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20.1 CONFINED SPACES INVENTORY (29 CFR 1910.146 (c)(1)); Have confined spaces been identified and documented in a confined space inventory?
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20.2 CONFINED SPACE "DANGER" SIGNS (29 CFR 1910.146(c)(2)); Are danger signs posted (or other equally effective means of communication) to inform employees about the existence, location, and dangers of the confined space?
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20.4 OTHER "OBSERVED" CONDITIONS (29 CFR 1910.146); Are all other "OBSERVED" conditions free from Confined Space hazards?
30.0 ELECTRICAL
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30.1 EXTENSION CORDS/ELECTRICAL STRIPS - MANUFACTURER'S GUIDELINES (29 CFR 1910.303(b)(2)); Are extension cords and electrical strips used in accordance with manufacturer's guidelines?
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30.2 EXTENSION CORDS/ELECTRICAL STRIPS - DAISY CHAINING (29 CFR 1910.303(b)(2)); Are electrical cords and electrical power strips free from daisy chaining?
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30.3 EXTENSION CORDS NOT USED AS PERMANENT WIRING (29 CFR 1910.305(g)(1)(iv)(A)); Are extension cords used only for immediate use and not as permanent wiring?
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30.4 ELECTRICAL CORD DAMAGE AND DEFECTS (29 CFR 1910.334(a)(2)(ii)); Are all portable cord and plug connected equipment and extension cords free from damage and defects such as damage to the outer jackets (insulation) or missing grounding pins?
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30.5 ELECTRICAL CORD STRAIN RELIEF POINTS (29 CFR 1910.305(g)(2)(iii)); Are all strain relief points free from exposed electrical wires?
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30.6 ELECTRICAL WIRE EXPOSED ENDS - CAPPED OR REMOVED (29 CFR 1910.303(c)(3)(i)); Are electrical wires which have exposed ends capped (or do they need to be removed)?
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30.7 UNUSED OPENINGS IN ELECTRICAL OUTLETS, BOXES, CABINETS (29 CFR 1910.305(b)(1)(i)); Are unused openings in electrical outlets, boxes, equipment casings, cabinets closed to prevent exposure and accidental entry?
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30.8 STORAGE 36 INCHES FROM ELECTRICAL PANELS (29 CFR 1910.303(g)(1)(ii)); Is storage maintained 36 inches from electrical panels?
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30.9 COVERS ON ELECTRICAL BOXES, JUNCTION BOXES AND OUTLET FIXTURES (29 CFR 1910.305(b)(2)(i)); Do electrical pull boxes, junction boxes, and fittings have covers?
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30.10 GFCI OUTLETS INSTALLED WITHIN 6 FT OF OUTSIDE EDGE OF A SINK (NFPA 70E 210.8(A)); Are electrical outlets installed within 1.8m (6 ft.) of the outside edge of a sink (laundry, utility, and wet bar sinks) GFCI protected?
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30.11 GFCI RECEPTACLES ON KITCHEN COUNTERTOP SURFACES (NFPA 70E 210.8(A)(9)); Are receptacles installed to serve the countertop surfaces in kitchens GFCI protected?
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30.12 GFCI PROTECTION OUTDOORS FOR CORD AND PLUG CONNECTED EQUIPMENT (NFPA 70E 110.4(C)(2)); Is GFCI protection provided when an employee is outdoors and operating or using cord and plug connected equipment supplied by 125-volt, 15, 20 or 30 amp circuits?
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30.13 WATERPROOF RECEPTACLES FOR OUTDOOR AND DAMP LOCATIONS (29 CFR 1910.305(j)(2)(v)); Are waterproof receptacles installed in outdoor locations or in other damp locations?
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30.14 ELECTRICAL PANELS LABELED WITH VOLTAGE, CURRENT AND PROTECTIVE CLOTHING REQUIREMENTS (29 CFR 1910.303(e)(1)(ii), NFPA 70E); Are labels providing voltage, current, wattage or other ratings [and protective clothing ]requirements posted on outside of electrical panels?
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30.15 LAMP FIXTURES OR GUARDS (29 CFR 1910.305(a)(2)(ix)); Are all lamps used for general illumination protected from accidental contact or breakage by a suitable fixture or guard?
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30.16 LOCKOUT TAGOUT (LOTO) PERFORMANCE REQUIREMENTS (29 CFR 1910.147(a)(1)(i)); Does the location follow minimum LOTO performance requirements for the control of hazardous energy such as the unexpected energization or startup of the machines or equipment, or the release of stored energy?
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30.17 ELECTRICAL DRINKING FOUNTAINS (NFPA 70 2020 - 422.5 (A)(1)); Are all electric drinking fountains protected with ground fault circuit interrupter (GFCI) protection?
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30.18 OTHER "OBSERVED" ELECTRICAL CONDITIONS; Are all other "OBSERVED" conditions free from Electrical hazards?
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30.19 OTHER "OBSERVED" ELECTRICAL CONDITIONS; Are all other "OBSERVED" conditions free from Electrical hazards?
50.0 EYEWASH STATIONS
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50.1 ACCESS TO EYEWASH STATIONS - SHOWERS (ANSI Z358.1 2014: 29 CFR 1910.151); Are eyewash stations - showers [where the eyes or body of any person may be exposed to injurious corrosive materials] unblocked and placed within 10 seconds or 55 feet of the hazard?
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50.2 EYEWASH STATION - SHOWERS TESTING (ANSI Z358.1 2014); Are eyewash stations - showers flow tested on a weekly basis and mechanically tested annually?
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50.3 EYEWASH STATION - TEPID WATER (ANSI Z358.1 2014); Does the eyewash station deliver tepid (between 60 and 100 degrees F) water for 15 minutes?
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50.4 PORTABLE EYEWASH STATION SOLUTION EXPIRATION DATE (ANSI Z358.1 2014); Are the eyewash solutions for portable eyewash stations being inspected for expiration dates?
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50.5 OTHER "OBSERVED" EYEWASH CONDITIONS (ANSI Z358.1 2014); Are all other "OBSERVED" conditions free from Eyewash Station hazards?
70.0 FIRE EXTINGUISHERS
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70.1 FIRE EXTINGUISHER MOUNTING - LOCATION - IDENTIFICATION (29 CFR 1910.157(c)(1)); Are portable fire extinguishers properly mounted, located and identified so they are readily accessible to employees?
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70.2 FIRE EXTINGUISHER MONTHLY INSPECTIONS (29 CFR 1910.157(e)(2)); Do all of the fire extinguishers receive a monthly inspection?
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70.3 FIRE EXTINGUISHER ANNUAL INSPECTIONS (29 CFR 1910.157(e)(3)); Do fire extinguishers receive an annual inspection?
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70.4 OTHER "OBSERVED" FIRE EXTINGUISHER CONDITIONS; Are all other "OBSERVED" conditions free from Fire Extinguisher hazards?
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70.5 OTHER "OBSERVED" FIRE EXTINGUISHER CONDITIONS; Are all other "OBSERVED" conditions free from Fire Extinguisher hazards?
80.0 FIRE SAFETY
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80.1 STORAGE CLEARANCE OF 24 INCHES FOR NON-SPRINKLED BUILDING (International Fire Code 2012:315.3.1); Is storage maintained 24 inches below the ceiling in non-sprinkled buildings?
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80.2 STORAGE CLEARANCE OF 18 INCHES FOR SPRINKLED BUILDING (International Fire Code 2012:312.3.1); Is storage maintained 18" from sprinkler heads in buildings which have fire sprinkler systems?
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80.3 FLAMMABLE CABINETS - FLAMMABLES AND COMBUSTIBLES STORED IN FLAMMABLE CABINETS (29 CFR 1910.106(d)(3)(ii)); Are flammables and combustibles properly stored in flammable cabinets?
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80.4 "ONLY" FLAMMABLES AND COMBUSTIBLES STORED IN FLAMMABLE CABINETS (29 CFR 1910.106(d)(3)(ii))
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80.5 SPRING CLOSING LID AND SPOUT ON FLAMMABLE CONTAINERS (UP TO 5 GAL) (29 CFR 1910.106(a)(29)); Are flammable containers approved containers, of not more than 5 gallons capacity, having a spring-closing lid and spout cover and so designed that it will safely relieve internal pressure when subjected to fire exposure?
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80.6 FIRE RISER SAFETY (FM Global); Are all fire protection control valves in the "OPEN" and "LOCKED" position?
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80.7 MANUALLY ACTUATED ALARM-INITIATING DEVICES (NFPA 72 [2019] 17.15.9.4); Are Manual fire alarm boxes located within 5 ft (1.5m) of each exit doorway on each floor?
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80.8 OTHER "OBSERVED" FIRE SAFETY CONDITIONS; Are all other "OBSERVED" conditions free from Fire Safety hazards?
130.0 HAZARD COMMUNICATION
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130.1 LIST OF HAZARDOUS CHEMICALS AND SAFETY DATA SHEETS (SDS) (29 CFR 1910.1200(e)); Is there a list of hazardous chemicals known to be present and are the appropriate safety data sheets available to employees?
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130.2 PROPER CHEMICAL CONTAINER LABELING (29 CFR 1910.1200(f)); Are chemical containers labeled properly?
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130.3 SAFETY DATA SHEET RETRIEVAL (BEST MANAGEMENT PRACTICE); Can employee(s) find an SDS for a given product in a reasonable amount of time (<= 3 minutes) to use in case of emergency? Note: Hard Copy, computer, cell phone may be used to find information.
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130.4 OTHER "OBSERVED" HAZARD COMMUNICATION CONDITIONS (29 CFR 1910.1200); Are all other "OBSERVED" conditions free from Hazard Communication hazards?
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130.5 OTHER "OBSERVED" HAZARD COMMUNICATION CONDITIONS (29 CFR 1910.1200); Are all other "OBSERVED" conditions free from Hazard Communication hazards?
150.0 LADDER SAFETY
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150.1 ALL MANUFACTURER/WARNING LABELS LEGIBLE (Best Management Practice); Are manufacturer warning / information labels (weight capacity, Category, etc.) legible?
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150.2 DEFECTIVE LADDERS (29 CFR 1910.23(b)(10)); Is any ladder with structural or other defects immediately tagged "Dangerous: Do Not Use" or with similar language and removed from service until repaired or replaced?
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150.3 LADDERS STORED PROPERLY AND SECURED (BEST MANAGEMENT PRACTICE); Are observed ladders not in use stored properly and secured?
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150.4 OBSERVED FIXED LADDERS COMPLY WITH OSHA GUIDELINES (29 CFR 1910.23(d)(1)); Do "OBSERVED" fixed ladders comply with OSHA guidelines?
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150.5 OBSERVED MOBILE LADDERS COMPLY WITH OSHA GUIDELINES (29 CFR 1910.23(e)); Do "OBSERVED" mobile ladder stands and mobile ladder stand platforms comply with OSHA guidelines?
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150.6 OTHER "OBSERVED" LADDER CONDITIONS (29 CFR 1910.23); Are all other "OBSERVED" conditions free from any other Ladder hazards?
165.0 MATERIAL HANDLING AND STORAGE
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165.1 STORAGE ISLES AND PASSAGEWAYS KEPT CLEAR AND IN GOOD REPAIR (29 CFR 1910.176(a)); Where mechanical handling equipment is used, are all isles and passageways kept clear and in good repair with no obstruction that could create a hazard?
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165.2 MATERIAL SECURELY STORED (29 CFR 1910.176(b)); Is all storage material securely stored in tiers that are stacked, blocked, interlocked and limited in height so they are stable and secure against sliding or collapse?
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165.3 STORAGE AREAS KEPT HAZARD FREE FROM TRIPPING - FIRE - EXPLOSION - PESTS (29 CFR 1910.176(c)); Are storage areas kept free from accumulation of materials that constitute hazards from tripping, fire, explosion, or pest harborage?
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165.4 MANUFACTURE'S RACK WEIGHT/CAPACITY POSTING (ANSI MH16.1-2012: ANI MH26.c-2007); Do storage racks have the manufacture's rack weight limit/capacity clearly posted?
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165.5 OTHER "OBSERVED" MATERIAL HANDLING AND STORAGE CONDITIONS (29 CFR 1910.176); Are all other OBSERVED conditions free from Material Handling and Storage hazards?
170.0 OVERHEAD CRANES, HOISTS (DEVICE) AND GANTRY HOISTS / LIFTS
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170.1 LOAD RATINGS POSTED ON CRANES, HOISTS (DEVICE) AND GANTRY HOISTS / LIFTS (29 CFR 1910.179(b)(5)); Is the rated load of the hoist/crane plainly marked on each side of the crane [where visible] and is the marking clearly legible from the ground or floor?
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170.2 PERIODIC INSPECTIONS FOR CRANE/HOIST/LIFT IDLE OVER 6 MONTHS (29 CFR 1910.179(j)(4)(ii)); Does a crane/hoist/lift which has been idle for a period of over 6 months receive a complete inspection conforming with requirements of paragraphs (j) (2) and (3) of this section and (m)(2) of this section before placing in service?
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170.3 OTHER "OBSERVED" HOIST/CRANE/LIFT CONDITIONS (29 CFR 1910.179); Are all other "OBSERVED" conditions free from Hoist/Crane hazards?
210.0 WALKING WORKING SURFACES: GENERAL REQUIREMENTS - GUARDRAIL SYSTEMS - SAFETY NET SYSTEMS - COVERS FOR HOLES - SIDEWALK SAFETY - FIXED LADDERS
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210.1 GENERAL REQUIREMENTS - PLACES OF EMPLOYMENT (29 CFR 1910.22(a)(1)); Are places of employment kept clean and orderly and in sanitary condition?
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210.2 GENERAL REQUIREMENTS - WORKROOM FLOORS (29 CFR 1910.22(a)(2)); Are the floors of every work room maintained in a clean and, so far as possible a dry condition?
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210.3 GENERAL REQUIREMENTS - ACCESS AND EGRESS (29 CFR 1910.22(c)); Does the employer provide, and ensure each employee uses a safe means of access and egress to and from walking-working surfaces?
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210.4 GENERAL REQUIREMENTS - STORAGE AREAS [HOUSEKEEPING] (29 CFR 1910.176(c)); Are storage areas kept free from accumulation of materials that constitute hazards from tripping, fire, explosion, or pest harborage? (Vegetation control will be exercised when necessary)
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210.5 STANDARD RAILING - UNPROTECTED SIDE OR EDGE (29 CFR 1910.28(b)(1)(i) (A),(B),(C)); Are walking-working surfaces with and unprotected side or edge that is 4 feet or more above a lower level protected from falling by one or more of the following: Guardrail Systems, Safety Net Systems or Personal Fall Protection Systems (See section 60.0)?
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210.6 GUARDRAIL SYSTEMS REQUIREMENTS (29 CFR 1910.29(b)); Do all guardrail systems meet requirements set forth in 1910.29(b)?
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210.7 COVERS FOR HOLES (29 CFR 1910.29(e)); Do all covers for each hole on a walking-working surface meet requirement in 1910.29(e)?
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210.8 SIDEWALK SAFETY - SIDEWALK ELEVATION CHANGE (ADA 4.3.6); Are observed elevation changes on sidewalks 1/4" or less?
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210.9 FIXED LADDER - SELF CLOSING GATE REQUIREMENTS (29 CFR 1910.29 (b)(13)(i)); Does the fixed ladder have a self-closing gate that slides or swings away from the hole, and is equipped with a top rail and mid-rail or equivalent intermediate member that meets the requirements in paragraph (b) of this section? (NOTE: No longer may have chains guarding the opening).
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210.10 OTHER - WALKING WORKING SURFACES: GENERAL REQUIREMENTS - GUARDRAIL SYSTEMS - SAFETY NET SYSTEMS - COVERS FOR HOLES - SIDEWALK SAFETY - FIXED LADDERS CONDITIONS
410.0 PUBLIC SPACES: POOLS / POOL FIXTURES
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410.1 POOL WATER FREE OF SCUM, FLOATIND DEBRIS, SEDIMENT, DIRT, SLIME AND ALGAE (PC Code of Ordinances 8.32.080.D); Is the observed pool water is kept free of scum and floating debris? Are the bottom and sides observed to be free of sediment, dirt, slime and algae?<br>
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410.2 SIGNAGE TO INSTRUCT PATRONS TO OBEY SAFETY REGULATIONS (PC Code of Ordinances 8.32.090); Are persons instructed before entering the pool, by means of suitable, clearly lettered signs properly located, to observe all safety regulations?
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410.3 FIRST AID KIT PROVIDED, MAINTAINED AND AVAILABLE (PC Code of Ordinances 8.32.130 / OSHA 29 CFR 1910.151 (App A)); Are First Aid Kits fully supplied with unexpired components?Is a first aid kit provided, maintained and readily available for emergency use at public pools?
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410.4 POOL EQUIPPED WITH MINIMUM OF ONE MAIN DRAIN COVERED BY GRATING (PC Code of Ordinances 8.32.160.G); Is the pool equipped with at least one main drain located in the deepest portion? Are the drains covered by grating, which are not readily removable by bathers and which have safe openings at least four times the area of the drain pipe?
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410.5 POOL EXITS MARKED AND FREE FROM OBSTRUCTION (Best Management Practices); Are pool exit points clearly marked ("EXIT" or "NOT AN EXIT") and free from obstructions?
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410.6 POOL SURFACES MAINTAINED PROPERLY (Best Management Practices); Are pool surfaces (walls, decking, tile, drain grate covers, impact material etc.) maintained properly?
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410.7 LIFEGUARD STANDS /PLATFORMS, HANDRAILS AND LADDERS PROPERLY MAINTAINED AND SECURED (Best Management Practices); Are lifeguard stands/platforms, handrails and ladders maintained properly and secured?
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410.8 ALL OTHER POOL FIXTURES PROPERLY MAINTAINED (Best Management Practices); Are other pool fixtures (diving boards, water slides, special water features etc.) maintained properly?
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410.9 SPLASH PADS PROPERLY MAINTAINED (Best Management Practices); Are splash pads and fixtures (special water features) maintained properly?
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410.10 PPE MAINTAINED AND STORED PROPERLY (29 CFR 1910.132(a)); Is the PPE maintained and stored in a sanitary and reliable condition to prevent damage and/or contamination?
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410.11 OTHER "OBSERVED" CONDITIONS (Best Management Practices); Are other "OBSERVED" conditions free from Public Spaces "Pool Area" safety hazards?
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420.0 PUBLIC SPACES: CONCESSION AREAS (3rd PARTY ISSUES)
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420.1 Other "OBSERVED" CONDITIONS (THIRD PARTY ISSUES: CONCESSION AREAS); Are other "OBSERVED" conditions free from Public Spaces "concession area" safety hazards?
COMMENTS
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COMMENTS
SIGNATURES
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Participating Employee(s):
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Participating Facilities Management LCO: