Safety Audit - To be transferred

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Accident investigation

• Does the safety Coordinator have the current OSHA 300 and 300A logs

  Yes

  No

  N/A

• Is there an accident investigation completed on all injuries?

  Yes

  No

  N/A

• Has the safety coordinator, supervisor & employee signed all accident investigations?

  Yes

  No

  N/A

• Any information missing on the accident investigation form?

  Yes

  No

  N/A

Safety Coordinator Performance

• Are monthly safety inspection conducted and documented accordingly?

  Yes

  No

  N/A

• Are Safety inspections being conducted with the Director Of Warehousing at least quarterly?

  Yes

  No

  N/A

• Is the fleet garage being inspected quarterly with the fleet manager? If not is a review of the findings conducted with the fleet manager before you leave the shop?

  Yes

  No

  N/A

• Is a quarterly observation being completed on switcher operators so that all operators are observed at least once a year?

  Yes

  No

  N/A

• Is all the employee safety training being completed by the safety coordinator?

  Yes

  No

  N/A

• Are sign in sheets being used for all safety training?

  Yes

  No

  N/A

• Sign in sheets filled out correctly?

  Yes

  No

  N/A

• Safety training tests being graded, signed, etc..

  Yes

  No

  N/A

• Is current training material being utilized from the warehouse sites? (Perform a random file check for the past two years)

  Yes

  No

  N/A

• Is all safety training being completed for new hires prior to them working in the warehouse?

  Yes

  No

  N/A

• Has an annual training calendar been developed and shared with the leadership team at the division?

  Yes

  No

  N/A

• Is the safety coordinator attending the LEPC meetings on a monthly basis or whenever meetings are scheduled?

  Yes

  No

  N/A

• Does the safety coordinator have documented communication with the LEPC along with meeting minutes of the LEPC meetings?

  Yes

  No

  N/A

• Has the safety coordinator been certified as a class A, B or C operator for Underground storage tanks? Certifying class is dependent on the State of local government.

  Yes

  No

  N/A

• Is the safety coordinator a certified First Aid and CPR trainer?

  Yes

  No

  N/A

• Does the Safety Coordinator conduct all the first aid and CPR training for the warehouse?

  Yes

  No

  N/A

• Has the safety Coordinator been through GCAP's PSM training program and received certification?

  Yes

  No

  N/A

• Has the safety coordinator become Arc Flash certified through the 16 hour training course?

  Yes

  No

  N/A

• Has the safety coordinator set up fire extinguisher training for the maintenance, fleet maintenance, & ERT members?

  Yes

  No

  N/A

• Is the safety coordinator inspecting /documenting monthly fire extinguisher checks in the warehouse, administration area, & fleet?

  Yes

  No

  N/A

• Has the safety coordinator been trained on the Fire Suppression system by either the maintenance team or Fire protection contractor?

  Yes

  No

  N/A

• Are monthly inspections conducted on the fire suppression system by the safety coordinator? This includes turning all PIV's, Wall PIV's, street boxes and running the fire pump. This is conducted separate from the maintenance inspection?

  Yes

  No

  N/A

• Have all the eyewash/emergency showers been exercised and inspected monthly by the safety coordinator?

  Yes

  No

  N/A

• Are two fire drills conducted per year, per shift, & documented?

  Yes

  No

  N/A

• has an ammonia drill been conducted & documented annually?

  Yes

  No

  N/A

Lockout Tag Out (Lock Out Tag Out Policy)

• Has the safety coordinator conducted annual training for Authorized Personnel and affected employees? (Section 10.2)

  Yes

  No

  N/A

• Have equipment specific lock out procedures been developed for each piece of equipment? (Section 6.1)

  Yes

  No

  N/A

• Has the maintenance leadership conducted at least one documented observation on each authorized person on each piece of equipment?(Section 9.0 Periodic Inspections Observations)

  Yes

  No

  N/A

• Has the Safety Coordinator conducted at Least one documented observation on each authorized person on each piece of equipment?(Section 9.0 Periodic Inspections Observations)

  Yes

  No

  N/A

• Has the Safety Coordinator conducted a self audit on the observations that were completed by the maintenance leadership

  Yes

  No

  N/A

• Are designated locks used for locking out equipment (Policy 5.1)

  Yes

  No

  N/A

• Have locks been assigned to each authorized person (Policy 5.1)

  Yes

  No

  N/A

• Has a log been used to track who has been given locks and keys with the employee signature? (Section 5.1)

  Yes

  No

  N/A

• Are the locks used for locking out equipment the same color(i.e. Red)

  Yes

  No

  N/A

• Have all employees received the formal Lock out policy and signed an acknowledgement form?

  Yes

  No

  N/A

Fall Protection

• Have all employees received training on the fall protection policy

  Yes

  No

  N/A

• Have all employees that are authorized to use fall protection received annual training (Policy 5.0)

  Yes

  No

  N/A

• Is the Safety Coordinator completing the fall protection training

  Yes

  No

  N/A

• Have annual observations been completed and documented on each authorized employee (Policy 5.0 & 5.1)

  Yes

  No

  N/A

• Have individuals who have received the required fall protection training been assigned fall protection equipment. If not assigned equipment has a log in sheet been developed and used for sign out fall protection equipment.

  Yes

  No

  N/A

• Have the individuals using the fall protection completed an inspection of the equipment visually before each use (Policy 3.2)

  Yes

  No

  N/A

• Are quarterly inspections being conducted and documented on the required form for fall protection (Policy 3.2)

  Yes

  No

  N/A

• Have all employees received the written Fall Protection policy and signed an acknowledgement form?

  Yes

  No

  N/A

• Has an annual audit been completed, by the safety coordinator, on the inspection sheets to ensure they are being completed as required (Policy 3.2)

  Yes

  No

  N/A

• Verified

  Yes

  No

  N/A

Arc Flash

• Has an Arc Flash Study been completed (Policy 4.0)

  Yes

  No

  N/A

• Have all panels been labeled and identified (Policy)

  Yes

  No

  N/A

• Have boundaries been determined for each area which has been identified as an Arc Flash hazard

  Yes

  No

  N/A

• Have all employees received Arc Flash awareness training (Policy 7.0)

  Yes

  No

  N/A

• Have all employees received annual Arc Flash awareness training (Policy 7.0)

  Yes

  No

  N/A

• Have all employees received a copy of the Arc Flash policy and signed an acknowledgement form?

  Yes

  No

  N/A

• Have Authorized personnel received 16 hours of training and been certified (Policy 7.1.2)<br>

  Yes

  No

  N/A

• Has refresher training been completed every 3 years for authorized personnel

  Yes

  No

  N/A

• Has an annual documented observation been conducted on all authorized personnel?

  Yes

  No

  N/A

• Have Authorized personnel been equipped with Arc Flash rated uniforms (Policy 8.0)

  Yes

  No

  N/A

• Have authorized personnel been provided with the required PPE (Policy 8.0)

  Yes

  No

  N/A

Blood Borne Pathogens

• Have all employees received Blood Borne Pathogens training

  Yes

  No

  N/A

• Have all employees received annual training as required

  Yes

  No

  N/A

• Has a site specific Hazard exposure planned been developed and implemented

  Yes

  No

  N/A

• Site specific plan has been verified that has been developed and implemented

  Yes

  No

  N/A

• Has the site specific plan been reviewed annually and updated as needed

  Yes

  No

  N/A

• Have employees who have been exposed to or have jobs that could expose them to Blood Borne Pathogens been offered a Hepatitis "B" vaccination

  Yes

  No

  N/A

• Has a Hepatitis "B" vaccination request form been signed for those who have requested the vaccine

  Yes

  No

  N/A

• Have those employees that have been offered a Hepatitis vaccine program but declined signed a declination form

  Yes

  No

  N/A

• Have all employees received a copy of the Blood Borne pathogens policy and signed an acknowledgement?

  Yes

  No

  N/A

Confined Space Program

• Has a formal Confine Space Entry Evaluation and review been completed and documented using the evaluation form? (Policy 3.0)

  Yes

  No

  N/A

• Has the confined space entry evaluation form been completed by the designated individual and reviewed by the safety coordinator?(formal sign-off)

  Yes

  No

  N/A

• Have Confine Spaces been identified and labeled accordingly

  Yes

  No

  N/A

• Have permit required confine spaces been identified and labeled accordingly

  Yes

  No

  N/A

• Has annual training been given to authorized personnel (Policy 6.0)

  Yes

  No

  N/A

• Has a pre-entry checklist been completed prior to entering the permit confine space

  Yes

  No

  N/A

• If a permit confined space has been identified has the authorized personnel been given the required PPE to enter the space (Policy 7.0)

  Yes

  No

  N/A

• Has authorized personnel been trained on how to complete a permit and the requirements (Policy 6.0)

  Yes

  No

  N/A

• Has annual training been given to authorized personnel (Policy 6.0)

  Yes

  No

  N/A

Foot Protection Program

• Have new employees been trained on the foot protection policy and the requirements by the safety coordinator?

  Yes

  No

  N/A

• Have those areas requiring steel toe or composite toe boots been identified and employees trained to the requirement

  Yes

  No

  N/A

• Has an annual assessment of the workplace been conducted on foot protection requirements

  Yes

  No

  N/A

• Have all employees received a copy of the Foot protection Policy and signed an acknowledgement form?

  Yes

  No

  N/A

Hazard Communication/GHS Program

• Have all new employees received training on the Hazard Communication/SDS program before they begin working at Gordon Food Service

  Yes

  No

  N/A

• Have all employees received annual hazard communication training. Has this training been conducted by the safety coordinator?

  Yes

  No

  N/A

• Do all supervisor know how to get access to all Safety Data Sheets (SDS)

  Yes

  No

  N/A

• Is the 1-800 number posted throughout the warehouse for SDS access

  Yes

  No

  N/A

• Are all hazardous chemical containers properly Labeled to meet the SDS Standard (Policy 3.0)

  Yes

  No

  N/A

• Have all employees received a copy of the Hazard Communication/SDS policy and signed an acknowledgement form? (Policy 6.1)

  Yes

  No

  N/A

• Are all contractors made aware of any hazardous chemicals that they may come into contact with while working onsite. Is this documented and on file (Policy 7.0)

  Yes

  No

  N/A

• Are all pipes and piping systems properly labeled and legible to all employees in the area (Policy 8.0)

  Yes

  No

  N/A

Hearing Conservation Program

• Has a formal noise level map been completed, documented and reviewed annually? (Policy 3.1)<br>

  Yes

  No

  N/A

• Have the areas that exceed 85db been identified and posted within the warehouse?

  Yes

  No

  N/A

• Has a base line hearing test been given to employees within the first 6 months of the employee working in the high noise areas? (Policy 4.2 (a)

  Yes

  No

  N/A

• Has annual hearing test been completed on all employees exposed to noise levels exceeding 85db? (Policy 4.2 (b)

  Yes

  No

  N/A

• Have employees who have had a threshold shift in their hearing been given additional documented training on how to properly wear hearing protection, steps to reduce hearing loss, etc. (Policy 6.1 & 6.2)

  Yes

  No

  N/A

• Have all employees received training on hearing protection and been given the hearing conservation policy? (Policy 6.1)

  Yes

  No

  N/A

• Have all employees signed the acknowledge form? (Policy 6.1)

  Yes

  No

  N/A

Hot Work Permit Program

• Has the Hot Work Policy been review with all employees or at a minimum the authorized employees?

  Yes

  No

  N/A

• Has the safety coordinator completed the annual hot work training with the employees? (Policy 6.3)

  Yes

  No

  N/A

• Have employees that have been authorized to perform Hot Work been through the FM Global Hot work training module?

  Yes

  No

  N/A

• Has an area, such as the maintenance shop, been identified as a designated hot work area? Policy 2.1)<br>

  Yes

  No

  N/A

• If an area has been identified as the designated area are all combustibles at least 35 feet away from the hot work area when hot work is being performed?

  Yes

  No

  N/A

• Are welding curtains, blankets, etc used when welding or hot work is being performed? (Policy 2.1)

  Yes

  No

  N/A

• Has a signed been posted stating, "Designated Hot Work Area"? (Policy 2.1)

  Yes

  No

  N/A

• When Hot work is being performed outside the designated area are Hot work permits issued? (Policy 3.0)

  Yes

  No

  N/A

• Are hot work permits only issued by a member of the leadership team( supervisor, lead)? (Policy 3.1)

  Yes

  No

  N/A

• Are all hot work permits completely filled out and signed as required?

  Yes

  No

  N/A

• Has a fire watch been assigned to all hot work task and have they signed off on the work once it has been completed? (Policy 5.7)

  Yes

  No

  N/A

• Has the person performing the hot work signed off on the permit once the work has been completed and inspected? (Policy 3.3 (b)

  Yes

  No

  N/A

• Are all hot work permits kept on file for the current and past year? (Policy 3.3 (c)

  Yes

  No

  N/A

• Has a quarterly audit of all the permits been performed by the Safety coordinator to ensure they are filled our completely and correctly as stated in the policy? (Policy 6.3)

  Yes

  No

  N/A

• Have those authorized to performed hot work been given a copy of the policy and signed the acknowledgement form?

  Yes

  No

  N/A

Operations Safety Manual

• Has the Operations Safety Manual been reviewed with all the employees before they begin work at Gordon Food Service?

  Yes

  No

  N/A

• Has the employees signed the acknowledgement form stating they have received the operations manual?

  Yes

  No

  N/A

• Has the Operations Safety Manual been reviewed annually with all employees?<br>

  Yes

  No

  N/A

• Has the Safety Coordinator conducted the initial training and annual review of the operations safety manual with all the employees?

  Yes

  No

  N/A

Personal Protective Equipment Policy

• Has the personal protective equipment policy been reviewed with all employees by the Safety Coordinator?

  Yes

  No

  N/A

• Have employees been shown how to don/doff different types of PPE by the safety coordinator? Has the employee demonstrated this skill? (Policy 6.1)

  Yes

  No

  N/A

• Has a formal documented Hazard Survey been performed on all jobs within the warehouse by the safety coordinator? (Policy 2.0, 2.1, & 2.2)

  Yes

  No

  N/A

• Has every employee received a copy of the Personal Protective Equipment Policy and signed the acknowledgement form?

  Yes

  No

  N/A

• Has the PPE Hazard Assessment certification form been filled out and signed for each job function within the warehouse by the supervisor and safety coordinator? (Policy 2.0 & 2.2)

  Yes

  No

  N/A

Powered Industrial Vehicle (PIV)

• Has the safety coordinator reviewed the Powered Industrial Vehicle Policy with all PIV operators?

  Yes

  No

  N/A

• Has the Safety Coordinator conducted the initial PIV training for operators? Including classroom and performance.

  Yes

  No

  N/A

• Have operators completed equipment specific training which included classroom and performance based training.

  Yes

  No

  N/A

• Have annual observations been completed and documented for every operator for each piece of equipment they may operate?

  Yes

  No

  N/A

• Has the safety coordinator conducted operator observations on various employees?

  Yes

  No

  N/A

• Have operators completed pre-shift inspections on the equipment they are operating?

  Yes

  No

  N/A

• Are pre-shift inspection kept for the current and previous year for each piece of equipment? (Policy 11.0)<br>

  Yes

  No

  N/A

• Are Pre-shift inspection sheets audited at least quarterly by the Safety Coordinator to ensure they are being completed correctly?

  Yes

  No

  N/A

• Do all operators either have a valid driver license or passed a vision tested that was given by a medical professional? (Policy 8.0)

  Yes

  No

  N/A

• Are all operators in the quarterly random drug screening program (Policy 8.0 (g)

  Yes

  No

  N/A

• Is a list of current operators been maintained by the safety coordinator

  Yes

  No

  N/A

• Is a current list of operators sent to the drug screening company as required (verify list for the past two quarters)

  Yes

  No

  N/A

• Is the safety coordinator managing the random drug screening process for operators? This must include providing the list to the drug screening company, sending the list of individuals to be tested to the supervisors and following up to ensure all the testing has been completed.

  Yes

  No

  N/A

Yard Switchers Program

• Has the switcher packet (CDL or non-CDL) been completed for each operator, including part time operators?

  Yes

  No

  N/A

• Has the operators training manual been review with all operators?

  Yes

  No

  N/A

• Have all the switcher operators completed the operator training course?<br>

  Yes

  No

  N/A

• Has the training log been completed and signed by the trainer, safety coordinator and employee?

  Yes

  No

  N/A

• Has an observation been completed by the Safety Coordinator on each operator?

  Yes

  No

  N/A

• Have at least 2 observations been completed by the Supervisor/lead?

  Yes

  No

  N/A

• Has an annual observation been conducted?

  Yes

  No

  N/A

Respiratory Protection Program

• Has the Respiratory Protection Policy been reviewed with the employees who are subject to the policy?

  Yes

  No

  N/A

• Has an acknowledge form been signed by the employees stating they have received the policy?

  Yes

  No

  N/A

• Have the employees been through and passed a pulmonary function test?<br>

  Yes

  No

  N/A

• Has a fit test been given and passed by all the employees who fall under the Respiratory Protection Program? (Policy 3.3)

  Yes

  No

  N/A

• Are all SCBA's inspected annually by an outside agency as required?

  Yes

  No

  N/A

• Has all respirators been inspected on a monthly basis with documentation supporting the inspection? (Policy 3.4 (a)

  Yes

  No

  N/A

Emergency Response Team (ERT)

• Has an Emergency Response Team been set-up?

  Yes

  No

  N/A

• Does the safety coordinator set-up & attend quarterly ERT meeting's?

  Yes

  No

  N/A

• Does the safety coordinator assure medical supplies in the ERT response bag are adequate?

  Yes

  No

  N/A

• Are all ERT members and warehouse management certified in CPR/First Aid & AED?

  Yes

  No

  N/A

• Any members have expired certifications?

  Yes

  No

  N/A

• CPR rosters kept on file?

  Yes

  No

  N/A

Contractor Safety Program

• Have all contractors used at the warehouse and fleet gone through the Contractor safety program?

  Yes

  No

  N/A

• Has both appendix A & B been signed by all contractors before they start working?<br>

  Yes

  No

  N/A

• Have all the CQ forms( 1, 2, 3 & 4) been completed for each outside contractor?

  Yes

  No

  N/A

• Any information missing on the CQ forms?

  Yes

  No

  N/A

• Has the CQ 6 form been used to evaluate the contractor while he is on Gordon Food Service premises? This review should be conducted weekly by the maintenance supervisor and safety coordinator.

  Yes

  No

  N/A

• Is there an active list of contractors for the division?

  Yes

  No

  N/A

Fire Protection/Life Safety

• Are all fire protection risers chained in the open position?

  Yes

  No

  N/A

• Are all outside PIV's and wall PIV's locked in the open position?

  Yes

  No

  N/A

• Are all riser rooms either locked or have card access?

  Yes

  No

  N/A

• Are all emergency exits easily accessible and unblocked?

  Yes

  No

  N/A

• Have all emergency exit lights been tested monthly and are in good working order?

  Yes

  No

  N/A