CS Entry and rescue rope history, usage, inspection log - App D
CS Atmospheric monitoring device calibration log - App C
Related Permits Verified (hot work, Line break permits)
Contractor Safety Program
Annual Program Review
Pre-Project review and safety briefing form - App B
Contractor Sign-in log - App F
Contractor Safety Orientation acknowledgement documentation - App E
Audits (weekly) - App D
Audits (Self) - App C
Plant ISNetworld usage/evaluation process (comparing Contractor Sign in log)
Review all ISN Exempt Contractor files (current) - Contractor safety data and general information - App A
Electrical Safety Related Work Practices
Annual Program Review
Arc Flash Analysis (most current)
Quarterly Infra-red scans performed
Infra red scan current and corrective action of identified hot spots (No critical or serious)
Electrical MCC inspections (PMs completed/Documented) - App H
Hot glove - 6 month verification process
Electrical Test Meter Monthly Inspections - App D
Electrical Small Hand Tool Monthly Inspection - App E
S/O cord requisition permit form - App B
Task specific procedures - App A
Energized Electrical Written Permit - App C
Ergonomics Program
Annual Program Review
Ergo Team (PIT Crew or Power Team) identified and functioning (look at meeting minutes and assigned actions)
EJMS assessments - Team involvement and evaluation steady progress
Action Tracking Log - Ergonomic project list current
Solution Matrix identified and tracking
Mechanism to capture quick fixes completed by plant team
Verification of employee involvement on ergo initiatives (EJMS, MOC's, Line meetings)
Trending completed identifying problem departments and/or jobs for CTD illnesses
Plant has identified and implemented job rotations to prevent CTDs
Industrial Athlete Program used and documented (New Hire/LOA Stretching process)
Follow up process for ramp in (break in pain) - New Hire/LOA
PDA (physical demad assessments) completed for all positions
PDA (physical demand assessments) used when assigning Restricted duty
Knife sharpening program (New hires/dull knife complaints)
Fall Prevention and Protection Program
Annual Program Review
Master list identifying all equipment (Harness, Lanyard, Ladders)
Manufacturer info for ladders, harnesses, and lanyards
Documented monthly inspections completed on each full body harness and lanyard inspection form - App A
Monthly Ladder Inspection Form - App B
Ladder Out of Service process - App C
Hazard anlaysis completed for each task identified (including rescue procedures) - App G and H
Anchor Points Identified on Map
Fire Prevention Program
Annual Program Review completed
Oily Rag Program - App A
SOP for Aerosol exchange process
Fire Extinguisher location maps
Fire Extinguisher monthly/annual Inspection - App B
Documented process (SOP) of fire extinguisher recharges/exchanges
Fire Prevention Valve Inspection form (Weekly/Monthly) documentation - App C
Fire Prevention Equipment Inspection form (monthly) - App D/Third Party Sprinkler Inspection Reports (at least annually) including reviewing any noted recommendations
Property Loss Prevention Survey (all recommendations responded)
Fire Protection Impairment Program
Annual Program Review completed
Process for Impairments outage incidents (Site specific - including Steam, CO2 and/or Water)
Fire Protection Impairment Tag completed last 12 months
Alternate Protective Measures Notification
Incident reports for fire incidents (summary documenting events)
Hot Work Permit Program
Annual Program Review completed (App D)
Hot work classification map - identifying Type 1, Type 2 & designated areas
Hot Work permits completed appropriately (including Contractors)
(Monthly) Welder inspection PMs - App C
Hazard Communication Program
Annual Program Review completed (App C)
Hazardous chemical inventory list - App B
Chemical Specific Procedures developed (chemical usage (mixing, handling), exposure)
SDS on file - Site Hawk system is functional
Required personnel trained on use of Site Hawk
Process to ensure proper chemical receiving SOP (tanks, totes, drums) & verify acknowledgements)
Chemical approval process in place (new or tiral chemicals) - Using Site Hawk
PMs for eyewash and shower (documented monthly)
Industrial Hygiene
Annual Program Review completed
Master log of IH Sampling Areas Identified (CO2, H2S, Acetic Acid, Chlorine, Heat, CO, etc)
Quarterly sampling of environmental stressors being completed and documentation (unless otherwise specified per the environmental stressor)
Sampling records retained permanently
Results of sampling posted on employee communication boards (min 15 days) App E and F
Air Sampling equipment being calibrated (per manufactures recommendations) - maintained for 1 rolling year
Heat Stress Program/Hot Weather Process
Heat stress monitoring being conducted in outlined areas (and any others as requested)
Analysis to drive engineering controls
Engineering controls documented (if any high reads are found)
Hot environment protocol
Hydrogen Sulfide Safety Program
Notices posted that require monitoring (as identified on the log)
Monitoring being conducted (minimum weekly) in areas identified on log
Incident Investigation Form - App B
Carbon Dioxide Monitoring Program
Notices posted (as identified on the log )
Monitoring being conducted at least quarterly - in areas identified on log
Analysis to drive engineering controls
Engineering controls documented (if any high reads are found)
Radiation Program
Notices posted (as identified on the log)
Monitoring being conducted at least quarterly - in areas identified on the log
Process in place to register equipment with specific state requirements (Department of Health)
Designated RSO
Hearing Conservation Program
Annual Program Review completed
Current area sound survey within 2 years (and any new equipment tested when implemented)
Dosimetry study completed (high noise areas - every 2 years) (3rd Party)
Documenting engineering controls
Respiratory Protection Program
Annual Program Review completed
Master list of all employee issued respirators (Including an identification system on each respirator)
Tracking sheet of monthly Respirator cleaning and inspections (by unique identifier)
Master list of all respirator users and fit tests dates and fit factor (annually)
Manufacturer info for equipment
Cartridge change out or Single Use Policy documentation - App A
Voluntary Use Form (if any) - App B and C
Lock out/Tag out Program
Annual Program Review - App F
Equipment specific procedures written and in place - App B
Equipment specific procedures reviewed and re-certified within last 12 months
Lock removal authorization form - App D (any within the last year and completed properly)
Alternate Procedure Form - App C
List of all authorized employees - by department and lock number
Are lockout devises singularly identified by shape, size and color?
Yellow out of service lock/Tag process?
Using correct Line Break permit (including completing all fields)/completed properly (all closed loop systems) on file for 1 year- App I
Contractors utilizing line break permits (issued by JBS) - App I
Personal Protective Equipment Program
Annual Program Review completed
Annual PPE Hazard Assessment been completed/verified (last 12 months) - App B
Hazard assessment certification forms completed (last 12 months) - App B
PPE check sheet developed per unique job (based off PPE haz assessment)
PPE checks completed and documented as required
Process to ensure employees trained properly for Job Transfer or Bids
Manufacturer information for all PPE
JSA (Job Safety Assessments) been completed for all unique jobs
Knife Handling Program
Annual Program Review completed
Process for transporting knives (straight, whizard, air knives, etc)
SOP identifying process for storage of blades (new/used)
Powered Industrial Truck Program
Annual Program Review completed
Pre-shift inspections and a tracking process to ensure all trucks receive the needed inspections/repairs - App C-H
SOPs for fueling/battery changing/charging - App A
Site Specific Safety Repairs (safety measures taken when repairing PIT) - App B (if inhouse)
SOP outlining process for new vehicle brought on-site/training
Documentation of Dock plates rated and certifications
List of Authorized Operators - App P
Incident Policy in use - App K
Suspension-Revocation Form - App L
Manufacturer info for all PIT used onsite
Railcar, Tanker and Hopper Safety Program
Annual Program Review completed
Site Specific SOPs developed for rail cars, tankers/hoppers
Coordination with railroad
Controls are implemented (e.g. blue light (blue flag), derailer, radios, etc
Fall protection systems in place
Pedestrian warning system in place
Vertical Reciprocating Conveyor Program/Freight Lift/Pedestrian Elevator
All VRC identified
Review Monthly PMs
Visitor Safety Program
Process in place to capture Visitors to the facility (maintain for 1 year)
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.
You should independently determine whether the template is suitable for your circumstances.
