Title Page
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Client:
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Prepared by:
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Conducted on:
Safety Program Audit
Hazard Communication (Right to Know)
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Written Plan
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Annual Training Documentation
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New Employee Training Documentation
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Training Outline
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SDS’s Available for Employee Review
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Chemical Inventory List
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Secondary Container Labeling
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Notes
AWAIR
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Written Plan
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Annual Training Documentation
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New Employee Orientation Documentation
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New Employee Orientation Outline Available
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Safety Committee Organized and Periodic Safety Committee Meeting Held
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Employee Request for Corrective Action Forms Available
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Management, Supervisor & Employee Responsibilities
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In-house Inspection Forms Available & Documented Periodically
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Disciplinary Policy Outlined & Enforced
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Safety Goals Set & Reviewed
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Notes
Injury Log OSHA 300
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Recordable Injuries Logged are Current
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Injury Reports Available & Reviewed by Safety Committee
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300A Log Posted (Feb. 1st – April 30th Annually)
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Columns Totaled
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Corrective Action Taken if Applicable
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Notes
Lockout Tagout
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Written Plan
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Annual Training for Authorized Employees
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Annual Awareness Training for Affected & Other Employees
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Annual Program Audit Checklist
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Equipment Specific Energy Isolation Checklists
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Equipment Sufficient to Isolate all Operating Energy Sources
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Authorized Employees Equipped with Their Own Lock & Tag
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One Key per Lock
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Equipment Sign-out Sheet (Non-mandatory)
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Procedure for Device Removal by Supervisor or Another Authorized Employee
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Compliance with Plan Enforced
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Notes
PPE
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Written Plan
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Annual Training Documented
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Job Hazard Analysis
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Plan Enforced
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Required Areas Posted
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Employees Fit Tested
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Supplied for Employees by Employer if Required
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Notes
Respiratory Protection
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Written Plan
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Annual Training Documented
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Medical Evaluations Documented & Updated
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Annual Fit Testing Documented
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Air Quality Monitoring Documented for Respirable Hazards
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Filter Changing Frequency Documented
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Policy for Non-mandatory Use of Respirators
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Proper Storage
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Notes
Blood Borne Pathogens
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Exposure Control Plan
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Annual Employee Awareness Training Documented
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Annual Safety Committee/ERT Training Documented
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Safety Committee/ERT Vaccination or Declination Forms Updated
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Notes
Hearing Conservation
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Written Plan
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Annual Employee Training Documented
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Affected Areas Posted
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Noise Map Developed (Dosimeter Testing)
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Variety of Hearing Protection Available for Employees
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Proper Use Enforced
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Annual Audiological Testing Conducted for Affected Employees
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Notes
Confined Space Entry
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Written Plan
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Annual Training Documented
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List of Authorized Employees
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List of Permit Required Confined Spaces
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List of Space Specific Hazards
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Physical
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Mechanical
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Atmospheric
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Safe Entry Procedures
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Hazard Control Procedures
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Air Monitoring Requirements
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Oxygen
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Flammables
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Toxics
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List of Confined Space Entry Equipment
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Calibration Requirements of Air Quality Monitor
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On-Site/Off-Site Rescue Team Acquired
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If On-site, CPR/First Aid Certification of at least One Team Member
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If Off-site, Documentation of Availability, Competence, & Knowledge of On-site Confined Spaces
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Permits Retained for 3 Years
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Confined Spaces Posted & Entry Restricted
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Hot Work Permit Available – if Applicable
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Responsibilities of Authorized Attendant & Entrant Defined
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Policy for Cancellation of a Permit
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Safe Entry Procedures into Non-permit Required Confined Spaces
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Notes
Emergency Response/Contingency Plan
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Written Plan
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Emergency Response Team (ERT) Assigned Titles & Job Duties
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Evacuation Maps Developed & Posted
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Emergency Contact List Developed & Posted
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Plan Sent to Appropriate Agencies (Cover Letters Available)
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Chemical/Waste Inventory in Plan
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Periodic ERT Trainings Held and ERT Meetings Documented & Minutes Recorded
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Spill Kits On-site & Contents Listed in the Plan (Including an Explanation of how to use PPE)
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ERT has Written Authority to Act
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Incident Reports Available in Plan & Completed as Necessary
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Notes
Fire Prevention Plan
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Written Plan
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List of all major fire hazards
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Proper handling and storage procedures for hazardous materials
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List of potential ignition sources and their control
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List of the type of fire protection equipment necessary to control each major hazard
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Procedures to control accumulations of flammable and combustible waste materials
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Procedures for regular maintenance of safeguards installed on heat-producing equipment to prevent the accidental ignition of combustible materials
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Name or job title of employees responsible for maintaining equipment to prevent or control sources of ignition or fires
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Name or job title of employees responsible for the control of fuel source hazards
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Notes
Emergency Action Plan
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Written Plan
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Procedures for reporting a fire or other emergency
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Procedures for emergency evacuation, including type of evacuation and exit route assignments
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Procedures to be followed by employees who remain to operate critical plant operations before they evacuate
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Procedures to account for all employees after evacuation
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Procedures to be followed by employees performing rescue or medical duties
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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
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Notes
Industrial Lift Trucks
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Written Plan
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Authorized Employee Training Documented
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Classroom Training
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Written Testing
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Practical Driving Evaluation
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License Available On Person
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Per Shift Inspections Documented
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Proper Use of Seatbelts
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Periodic Retraining
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Every 3 Years and After Unsafe Driving is Observed
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Classroom Training
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Written Testing
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Practical Driving Evaluation
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License Available On Person
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Policy for Removing Forklift from Operation if Unsafe
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ID Plates Legible
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Recharge Stations Equipped with Appropriate PPE – if Applicable
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Notes
