MMA - Safety Program Policy and Procedure Audit w/Logic

• Client:

• Prepared by:

• Conducted on:

  Date

Hazard Communication (Right to Know)

• Written Plan

  Yes

  No

  N/A

• Please provide for accurate audit results

• Annual Training Documentation

  Yes

  No

  N/A

• New Employee Training Documentation

  Yes

  No

  N/A

• List of Definitions

  Yes

  No

  N/A

• Training Outline

  Yes

  No

  N/A

• MSDS’s Available for Employee Review

  Yes

  No

  N/A

• Chemical Inventory List

  Yes

  No

  N/A

• Secondary Container Labeling

  Yes

  No

  N/A

• Yes

  No

  N/A

• Notes

AWAIR

• Written Plan

  Yes

  No

  N/A

• Annual Training Documentation

  Yes

  No

  N/A

• New Employee Orientation Documentation

  Yes

  No

  N/A

• New Employee Orientation Outline Available

  Yes

  No

  N/A

• Safety Committee Organized and Periodic Safety Committee Meeting Held

  Yes

  No

  N/A

• Employee Request for Corrective Action Forms Available

  Yes

  No

  N/A

• Management, Supervisor & Employee Responsibilities

  Yes

  No

  N/A

• In-house Inspection Forms Available & Documented Periodically

  Yes

  No

  N/A

• Disciplinary Policy Outlined & Enforced

  Yes

  No

  N/A

• Safety Goals Set & Reviewed

  Yes

  No

  N/A

• Yes

  No

  N/A

• Is an AWAIR Program required?

  Yes

  No

  N/A

• Please provide for accurate audit results

• Skip section if N/A

• Notes

Injury Log OSHA 300

• Recordable Injuries Logged are Current

  Yes

  No

  N/A

• Injury Reports Available & Reviewed by Safety Committee

  Yes

  No

  N/A

• 300A Log Posted (Feb. 1st – April 30th Annually)

  Yes

  No

  N/A

• Columns Totaled

  Yes

  No

  N/A

• Corrective Action Taken if Applicable

  Yes

  No

  N/A

• NOTES:

Lockout Tagout

• Written Plan

  Yes

  No

  N/A

• Annual Training for Authorized Employees

  Yes

  No

  N/A

• Annual Awareness Training for Affected & Other Employees

  Yes

  No

  N/A

• Annual Program Audit Checklist

  Yes

  No

  N/A

• Equipment Specific Energy Isolation Checklists

  Yes

  No

  N/A

• Equipment Sufficient to Isolate all Operating Energy Sources

  Yes

  No

  N/A

• Authorized Employees Equipped with Their Own Lock & Tag

  Yes

  No

  N/A

• One Key per Lock

  Yes

  No

  N/A

• Equipment Sign-out Sheet (Non-mandatory)

  Yes

  No

  N/A

• Procedure for Device Removal by Supervisor or Another Authorized Employee

  Yes

  No

  N/A

• Compliance with Plan Enforced

  Yes

  No

  N/A

• Please provide for accurate audit results

• Notes

PPE

• Written Plan

  Yes

  No

  N/A

• Please provide for accurate audit results

• Annual Training Documented

  Yes

  No

  N/A

• Job Hazard Analysis

  Yes

  No

  N/A

• Enforced

  Yes

  No

  N/A

• Required Areas Posted

  Yes

  No

  N/A

• Employees Fit Tested

  Yes

  No

  N/A

• Supplied for Employees by Employer if Required

  Yes

  No

  N/A

• Yes

  No

  N/A

• Notes

Respiratory Protection

• Written Plan

  Yes

  No

  N/A

• Please provide for accurate audit results

• Annual Training Documented

  Yes

  No

  N/A

• Medical Evaluations Documented & Updated

  Yes

  No

  N/A

• Annual Fit Testing Documented

  Yes

  No

  N/A

• Air Quality Monitoring Documented for Respirable Hazards

  Yes

  No

  N/A

• Filter Changing Frequency Documented

  Yes

  No

  N/A

• Policy for Non-mandatory Use of Respirators

  Yes

  No

  N/A

• Proper Storage

  Yes

  No

  N/A

• Yes

  No

  N/A

• Notes

Blood Borne Pathogens

• Exposure Control Plan

  Yes

  No

  N/A

• Annual Employee Awareness Training Documented

  Yes

  No

  N/A

• Annual Safety Committee/ERT Training Documented

  Yes

  No

  N/A

• Safety Committee/ERT Vaccination or Declination Forms Updated

  Yes

  No

  N/A

• Notes

Hearing Conservation

• Written Plan

  Yes

  No

  N/A

• Please provide for accurate audit results

• Annual Employee Training Documented

  Yes

  No

  N/A

• Affected Areas Posted

  Yes

  No

  N/A

• Noise Map Developed (Dosimeter Testing)

  Yes

  No

  N/A

• Variety of Hearing Protection Available for Employees

  Yes

  No

  N/A

• Proper Use Enforced

  Yes

  No

  N/A

• Annual Audiological Testing Conducted for Affected Employees

  Yes

  No

  N/A

• Notes

Confined Space Entry

• Written Plan

  Yes

  No

  N/A

• Please provide for accurate audit results

• Annual Training Documented

  Yes

  No

  N/A

• List of Authorized Employees

  Yes

  No

  N/A

• List of Permit Required Confined Spaces

  Yes

  No

  N/A

• Space Specific Hazards

  Yes

  No

  N/A

• Physical

  Yes

  No

  N/A

• Mechanical

  Yes

  No

  N/A

• Atmospheric

  Yes

  No

  N/A

• Safe Entry Procedures

  Yes

  No

  N/A

• Hazard Control Procedures

  Yes

  No

  N/A

• Air Monitoring Requirements

  Yes

  No

  N/A

• Oxygen

  Yes

  No

  N/A

• Flammables

  Yes

  No

  N/A

• Toxics

  Yes

  No

  N/A

• List of Confined Space Entry Equipment

  Yes

  No

  N/A

• Calibration Requirements of Air Quality Monitor

  Yes

  No

  N/A

• On-Site/Off-site Rescue Team Acquired

  Yes

  No

  N/A

• If On-site, CPR/First Aid Certification of at least One Team Member

  Yes

  No

  N/A

• If Off-site, Documentation of Availability, Competence, & Knowledge of On-site Confined Spaces

  Yes

  No

  N/A

• Permits Retained for 3 Years

  Yes

  No

  N/A

• Confined Spaces Posted & Entry Restricted

  Yes

  No

  N/A

• Hot Work Permit Available – if Applicable

  Yes

  No

  N/A

• Responsibilities of Authorized Attendant & Entrant Defined

  Yes

  No

  N/A

• Policy for Cancellation of a Permit

  Yes

  No

  N/A

• Safe Entry Procedures into Non-permit Required Confined Spaces

  Yes

  No

  N/A

• Yes

  No

  N/A

• Notes

Emergency Response/Contingency Plan

• Written Plan

  Yes

  No

  N/A

• Emergency Response Team (ERT) Assigned Titles & Job Duties

• Evacuation Maps Developed & Posted

  Yes

  No

  N/A

• Emergency Contact List Developed & Posted

  Yes

  No

  N/A

• Plan Sent to Appropriate Agencies (Cover Letters Available)

  Yes

  No

  N/A

• Chemical/Waste Inventory in Plan

  Yes

  No

  N/A

• Periodic ERT Trainings Held and ERT Meetings Documented & Minutes Recorded

  Yes

  No

  N/A

• Spill Kits On-site & Contents Listed in the Plan (Including an Explanation of how to use PPE)

  Yes

  No

  N/A

• ERT has Written Authority to Act

  Yes

  No

  N/A

• Incident Reports Available in Plan & Completed as Necessary

  Yes

  No

  N/A

• Yes

  No

  N/A

• Please provide for accurate audit results

• Notes

Fire Prevention Plan

• Written Plan

  Yes

  No

  N/A

• List of all major fire hazards

  Yes

  No

  N/A

• Proper handling and storage procedures for hazardous materials

  Yes

  No

  N/A

• List of potential ignition sources and their control

  Yes

  No

  N/A

• List of the type of fire protection equipment necessary to control each major hazard

  Yes

  No

  N/A

• Procedures to control accumulations of flammable and combustible waste materials

  Yes

  No

  N/A

• Procedures for regular maintenance of safeguards installed on heat-producing equipment to prevent the accidental ignition of combustible materials

  Yes

  No

  N/A

• Name or job title of employees responsible for maintaining equipment to prevent or control sources of ignition or fires

  Yes

  No

  N/A

• Name or job title of employees responsible for the control of fuel source hazards

  Yes

  No

  N/A

• Please provide for accurate audit results

• Notes

Emergency Action Plan

• Written Plan

  Yes

  No

  N/A

• Procedures for reporting a fire or other emergency

  Yes

  No

  N/A

• Procedures for emergency evacuation, including type of evacuation and exit route assignments

  Yes

  No

  N/A

• Procedures to be followed by employees who remain to operate critical plant operations before they evacuate

  Yes

  No

  N/A

• Procedures to account for all employees after evacuation

  Yes

  No

  N/A

• Procedures to be followed by employees performing rescue or medical duties

  Yes

  No

  N/A

• List of every employee who may be contacted by employees in need of more information about the plan, or an explanation of their duties under the plan

  Yes

  No

  N/A

• Please provide for accurate audit results

• Notes

Industrial Lift Trucks

• Written Plan

  Yes

  No

  N/A

• Please provide for accurate audit results

• Authorized Employee Training Documented

  Yes

  No

  N/A

• Classroom Training

  Yes

  No

  N/A

• Written Testing

  Yes

  No

  N/A

• Practical Driving Evaluation

  Yes

  No

  N/A

• License Available On Person

  Yes

  No

  N/A

• Per Shift Inspections Documented

  Yes

  No

  N/A

• Proper Use of Seatbelts

  Yes

  No

  N/A

• Periodic Retraining

  Yes

  No

  N/A

• Every 3 Years and After Unsafe Driving is Observed

  Yes

  No

  N/A

• Policy for Removing Forklift from Operation if Unsafe

  Yes

  No

  N/A

• ID Plates Legible

  Yes

  No

  N/A

• Recharge Stations Equipped with Appropriate PPE – if Applicable

  Yes

  No

  N/A

• Notes

Notes