Safety Competency Assessment - Facilities

Audit Title

• Employee

• Conducted on

  Date

• Assessed by

• Department/Location
  Address

Direct Observations

• Based on a direct observation of the employee, does the employee consistently perform hand hygiene prior to leaving a laboratory area?

  Yes

  No

  N/A

• Based on direct observation of the employee, does the employee wear appropriate personal protective equipment (PPE) when working with uncontrolled chemical, biological or physical hazards?

  Yes

  No

  N/A

• Situation and PPE used:

• OK?

• Based on direct observation of the employee, does the employee use appropriate engineering controls (e.g. enclosures, guards, lock outs) when operating electrical or pneumatic equipment or tools?

  Yes

  No

  N/A

• Equipment or tool use observed:

REview of Records

• Based on a review of records, has the employee participated in a fire drill in the past 12 months?

  Yes

  No

  N/A

Problem Solving and Knowledge Assessment

• Based on an assessment test, does the employee have adequate knowledge and understanding of biological hazards and biosafety work practices to safety perform his/her assigned duties in a laboratory area?

  Yes

  No

  N/A

Signatures

• Employee's signature

  Sign

• Assessor's signature

  Sign