Safety Risk Assessment - Blank

• Document No.

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Safety Associate

• Second Auditor/ If Applicable

• Primary/Department Contact

Personal Protective Equipment

• Are the employee(s) wearing the minimum required PPE indicated on the PPE Door tag?<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Do the employee(s) wear the respirator correctly? (e.g., tight‐fitting respirators' head straps correctly positioned, PAPR faceshield kept closed, etc.)<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Has the employee(s) properly stored their reusable respirator during breaks (i.e., placed the half‐mask respirator or the head gear of the PAPR into a clean bag and sealed)?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is a storage area for the PPE available within the zone, ie. Coat rack, hooks,?

  Yes

  No

  N/A

• Is all PPE available within the area or zone, ie. Hearing protection, respirators?

  Yes

  No

  N/A

• Is the employee(s) donning and doffing the indicated PPE correctly?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are employees wearing harnesses and lanyards for task requiring fall protection?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are employees wearing appropriate hearing and eye protection?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are contractors wearing hard hats, safety glasses and other appropriate PPE when required?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are laboratory employees wearing appropriate shoes, safety glasses, and laboratory coats?

  Safe

  At Risk

  Non-Compliant

  N/A

Equipment Safety

• Has all equipment undergoing cleaning, maintenance or servicing been properly locked out?<br><br><br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Are all electrical cords in good condition? Do all electrical cord plugs in the room have their grounding prongs intact?<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Are all machine guards and safety interlocks working correctly?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are employee(s) following LOTO guides if applicable for tasks being completed?

  Yes

  No

  N/A

• Are plug locks being used when necessary?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are all breakers and/or valves appropriately locked out?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are all LOTO tags filled out correctly?

  Safe

  At Risk

  Non-Compliant

  N/A

• Has all equipment been properly grounded or bonded?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is explosion proof equipment being used where required?

  Safe

  At Risk

  Non-Compliant

  N/A

• Has equipment been modified in any way that jeopardizes the safety of the process or operator?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are all required warning tags on equipment accounted for, visible, and identifiable?

  Safe

  At Risk

  Non-Compliant

  N/A

Ergonomics

• Are the following basic lifting techniques being followed? Back straight, knees bent, load close to body, lifts with legs, does not twist at the waist.<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Do employees scoop product from boxes or drums that are too heavy to make them lighter before handling them?<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Are employees using mechanical lift assist devices (drum dumpers, inverters, hoists, etc.) properly?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are employees using mechanical lift assist devices (drum dumpers, inverters, hoists, etc.) properly?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are employees referencing available ergonomic guides?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are rooms efficiently staged to diminish distances of material handling?

  Safe

  At Risk

  Non-Compliant

  N/A

Housekeeping & Walking/Working Surfaces

• Are materials that are staged/stored stable, neat and orderly?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are ladders and/or platforms in good repair, no noticeable damage?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are all egress and exit areas clear of obstruction? <br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Do batch staging areas have aisle ways so employees can search for jobs without climbing on top of drums?

  Safe

  At Risk

  Non-Compliant

  N/A

• Area all walking surfaces, platforms free of clutter and debris?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is accumulating dust being appropriately controlled through housekeeping measures?

  Yes

  No

  N/A

• Are pallets stored appropriately in the area or zone?

  Safe

  At Risk

  Non-Compliant

  N/A

• In Construction or Maintenance areas, is the work area, ladder, lift, etc., appropriately marked, attended, or barricaded?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are wet floor areas appropriately marked?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are employees wearing the appropriate footwear for the cleaning processes as specified in the SOP?

  Safe

  At Risk

  Non-Compliant

  N/A

Emergency Equipment & Evacuation

• Are emergency equipment and exits in the area free from obstructions and available for use?<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Do the employee(s) know their primary and secondary evacuation routes from their current location?<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Do the employees know where their designated outside evacuation assembly area is located?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are Emergency supplies and Maps in-date or need updated?

  Safe

  At Risk

  Non-Compliant

  N/A

• Does emergency equipment or emergency equipment storage require maintenance or replacement?

  Safe

  At Risk

  Non-Compliant

  N/A

• Has emergency equipment been appropriately PM'd?

  Safe

  At Risk

  Non-Compliant

  N/A

Flammable/Combustible Material Handling

• Flammable/combustible liquids are being stored in proper containers and in designated storage areas?<br>

  Safe

  At Risk

  Non-Compliant

  N/A

• Is bonding and grounding equipment being used properly? I the equipment in the room in good condition? (Such as no fraying or broken connections)

  Safe

  At Risk

  Non-Compliant

  N/A

• IS XP equipment being used with flammable liquids/solvents?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are equipment or containers appropriately grounded to grounding bars, exhaust drops, etc.?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are Earthrite systems working appropriately?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is LEL detection present and working appropriately?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are SSTVs present appropriately grounded and bonded?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are appropriate labels for flammable and combustible liquids present?

  Safe

  At Risk

  Non-Compliant

  N/A

Environmental Compliance

• Waste drums are closed, grounded (flammable only), properly labeled and in good condition/clean?

  Safe

  At Risk

  Non-Compliant

  N/A

• Low pH and acetone waste drums are located inside processing rooms, where applicable?

  Safe

  At Risk

  Non-Compliant

  N/A

• Sanitary drains are plugged during all acetone processing and/or washing?

  Safe

  At Risk

  Non-Compliant

  N/A

• Storm water drains are clean and clear of sediment or debris?

  Safe

  At Risk

  Non-Compliant

  N/A

• Metal stored outside is covered?

  Yes

  No

  N/A

• Containment dike drain valves are locked in a closed position?

  Safe

  At Risk

  Non-Compliant

  N/A

Laboratory

• Are chemicals stored in their appropriate location?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are chemicals appropriately capped?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are all nozzles appropriately turned to eliminate the chance of spills?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are Sashes at appropriate heights?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are Sashes at appropriate heights?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are Hoods pulling appropriate CFMs and not in alarm or Setup mode?

  Safe

  At Risk

  Non-Compliant

  N/A

• Have Hoods been tested appropriately?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are stir plates and other corded equipment appropriately stored?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are cords in good condition?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is glassware in good condition?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is glassware stored above eye level?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are aisle-ways free of clutter and debris?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is waste appropriately being dumped and dump stations maintained?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is waste appropriately labeled?

  Safe

  At Risk

  Non-Compliant

  N/A

• Is PPE being worn and worn correctly?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are spill kits appropriately stocked?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are electrical panels and emergency equipment unblocked and accessible?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are cylinders appropriately chained and stored?

  Safe

  At Risk

  Non-Compliant

  N/A

• Are spills appropriately cleaned up,or does evidence of spills exist?

  Safe

  At Risk

  Non-Compliant

  N/A

Potential IPO Risks

• Chemical Exposure<br>

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Employee Falls

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Electrical

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Power Tools

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Overhead tasks

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Driver Safety

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Burns / thermal exposure

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Ergonomics<br>

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Fire

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Gas / Vapor / Fume

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

• Weather impact

  Virtually No Risk

  Minor Risk

  Moderate Risk

  High Risk

  Severe Risk

• Analytical /Actions

  Select Process Change recommended Additional Training Required PPE Assessment Required Policy Amendment needed. No Action Needed

  • Process Change recommended
  • Additional Training Required
  • PPE Assessment Required
  • Policy Amendment needed.
  • No Action Needed

Documentation

• Photos

  Media

• Corrective Action Plan

Validation

• Safety Rep Signature

  Sign

• Second Auditor Signature

  Sign

Communication

• Forward to

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