Safety, Security & Risk Management Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select Region

  Select ServiceSource - Operations ServiceSource - Mark Center ServiceSource - Food Service ServiceSource - CRDS ServiceSource - Rehabilitation Virginia Central Fairfax Delaware Region North Carolina Region Florida Region

  • ServiceSource - Operations
  • ServiceSource - Mark Center
  • ServiceSource - Food Service
  • ServiceSource - CRDS
  • ServiceSource - Rehabilitation
  • Virginia Central Fairfax
  • Delaware Region
  • North Carolina Region
  • Florida Region

General Safety Programs Section

• Virtual Office Safety Program is in place and up-to-date?

  Yes

  No

  N/A

• Exposure Control Program is in place and up-to-date?

  Yes

  No

  N/A

• Hearing Conservation Program is in Place and up-to-date?

  Yes

  No

  N/A

• Respirator Protection Program is in place and up-to-date?

  Yes

  No

  N/A

• Lockout/Tagout Program is in place and up-to-date?

  Yes

  No

  N/A

• Personal Protection Program is in place and up-to-date?

  Yes

  No

  N/A

• Industrial Truck Safety processes and training are in place and up-to-date?

  Yes

  No

  N/A

• Automated Defibrillator Program is in place and up-to-date?

  Yes

  No

  N/A

• Emergency medical response plan and first aid kits up-to-date and effective?

  Yes

  No

  N/A

• Other required safety program or policy - is up-to-date?

  Yes

  No

  N/A

CARF Requirements Section

• Drills are up-to-date and cataloged?

  Yes

  No

  N/A

• Internal inspections are current and cataloged?

  Yes

  No

  N/A

• External inspections are current and cataloged?

  Yes

  No

  N/A

• Safety Committee Meetings, Reports and Activities are compliant with CARF Standards and are cataloged?

  Yes

  No

  N/A

• Accessibility Report is current, compliant and cataloged?

  Yes

  No

  N/A

• Transportation Safety Report is current, compliant and cataloged?

  Yes

  No

  N/A

Regional Plans, Programs and Reports Section

• Continuity of Operations Plan (COOP) - where applicable - is current and in place?

  Yes

  No

  N/A

• Regional and/or site specific Occupational Emergency Management (OEM) plans or Emergency Response Plans are in place and current?

  Yes

  No

  N/A

• Regional and/or facility specific Security Assessments are current?

  Yes

  No

  N/A

• Enterprise Risk Management Reports are current?

  Yes

  No

  N/A

Human Resource Section

• Fair Credit and Reporting Act (FCRA) disclosure on file?

  Yes

  No

  N/A

• New Hire Safety Orientation Acknowledgement Form signed and in file?

  Yes

  No

  N/A

• Signed Job Description in file?

  Yes

  No

  N/A

• Required employment law posters properly displayed and current? (DOL, workers' comp., FMLA, EEOC, NLRB, etc.).

  Yes

  No

  N/A

• Network User Agreement in file?

  Yes

  No

  N/A

• Have the following required training modules been completed by staff: <br> Bloodborne Pathogens Training, <br> Workplace Safety Orientation, <br> Workplace Ethics,<br> Workplace Diversity,<br> Emergency Disaster Preparedness,<br> Employe Sexual Harassment Awareness.

  Yes

  No

  N/A

HIPAA Compliance Section

• Clean desk program in place and compliant?

  Yes

  No

  N/A

• Computer screen lock/timers in place and compliant? (Maximum 20 min.).

  Yes

  No

  N/A

• Senstive information is kept secure and where only authorized personnel have access?

  Yes

  No

  N/A

• Auditor

  Sign