Van Hessen Gut Room Assessment

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

GENERAL INSPECTION

• 1.1 All Electrical boxes free of holes/bends/rust, no rubbish on/below/leaning on it? Electrocution signs?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 1.3 Floor clean or under cleaning schedule (EE assign to clean)

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 1.4 Gut Room free or clutter, hoses hung, knifes in place, floors clear of spare parts, etc

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 1.5 Stands, platforms in good condition

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

RECORDKEEPING & INJURY INVESTIGATION DOCUMENTATION

• 2.1 Injuries filed on-site?

  Yes

  No

  N/A

• 2.2 PIV training completed and documented for all PIV authorized employees?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 2.3 OSHA 300A form posted between Feb 1 and April 30?

  Yes

  No

  N/A

• 2.4 Discuss Root Cause Analysis process

• 2.5 Discuss Action Taken and Risk Measures initiative

• 2.6 Submitting all Monthly Training on time?

  Yes

  No

  N/A

LOCAL SAFETY COMMITTE TEAM ACTIVITES

• 3.1 Safety Committee structure reflects required management and hourly team member participation?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 3.2 Meetings held at least once per month and documented using the designated Safety Committee Team Report Form?

  Yes

  No

  N/A

• 3.3 Local Safety Committee Team conducting discussions of accident investigations/Near Misses?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 3.5 Local Safety Committee, turning feedback in on time and conducting documented monthly topic training?

  Yes

  No

  N/A

EMERGENCY PLAN

• 4.1 Review Local Emergency Plan for accuracy

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 4.2 Do we have Emergency Route Maps in the Room? How many and take Picture

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 4.3 Are we training employees on the local EP?

  Yes

  No

  N/A

• 4.4 Exit Door signs on all exit doors?

  Yes

  No

  N/A

• 4.5 Non exit signs on non-exit doors?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 4.6 Exit Doors free of obstruction? Pic if not

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

FIRE PROTECTION

• 5.1 Do we have Fire extinguishers in the Gut Room?

  Yes

  No

  N/A

• 5.2 How many Fire extinguishers do we have and where? Pics

• 5.3 Are these tagged, and non-expired?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 5.4 Are fire extinguishers hung?

  Yes

  No

  N/A

• 5.5 Fire extinguisher free of rust, bracket in good condition? If not pic

  Yes

  No

  N/A

SDS

• 6.1 Do we have ALL SDS on site?

  Yes

  No

  N/A

• 6.2 Do employees know where these are? Pic

  Yes

  No

  N/A

• 6.3 Are SDS readily available?

  Yes

  No

  N/A

• Sorting Method?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

PPE

• 7.1 Assess PPE with Manager

• 7.2 What to change?

• 7.3 Is it readily available to employees?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

MACHINERY

• 8.1 All Safety Guards in place and firmly secured? Pic

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 8.2 Are EEs using gloves around the machines where they should not?

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 8.3 E-Stops – Where are they? Are they labeled? Pic

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

• 8.4 Signage – pinch points, electrical hazard, etc.? Pic

  Fully-Compliant

  Partially Compliant

  Non-Compliant

  N/A

FIRST AID AND BBP KITS

• 9.1 Where are the First Aid and BBP kits?

• 9.2 Available to employees?

  Yes

  No

  N/A

• 9.3 Well stocked?

  Yes

  No

  N/A

• 9.4 Do we have a documented schedule to check supplies? Pic

  Yes

  No

  N/A

• 9.5 Anyone trained on First Aid/CPR/AED?

  Yes

  No

  N/A

• 9.6 Slaughterhouse has an emergency/first aid/nurse on site?

  Yes

  No

  N/A

EYE WASH / SHOWER STATION

• 10.1 Where is it and how many? Pic

• 10.2 Is it in working condition and up to ANSI code?

  Yes

  No

  N/A

NEW HIRE ORIENTATION & TRAINING

• 11.1 Do we conduct New Hire Orientation before starting EEs on the job task?

  Yes

  No

  N/A

• 11.2 Is the content up to current VH Standard?

  Yes

  No

  N/A

• 11.3 Is documentation being submitted on time?

  Yes

  No

  N/A

• Safety Trainings, JHAs, Pre-Employment physical, etc

  Yes

  No

  N/A

JHAs (Job Hazard Analysis)

• 12.1 Manager has access to ALL JHAs for the operation

  Yes

  No

  N/A

• 12.2 Are these up to date?

  Yes

  No

  N/A

• 12.3 Are we presenting JHAs to employees BEFORE new tasks?

  Yes

  No

  N/A

• 12.4 Are these forms submitted to Safety Department?

  Yes

  No

  N/A

PIV (Powered Industrial Vehicles)

• 13.1 PIV authorized employees have documented training?

  Yes

  No

  N/A

• 13.2 ALL PIV training submitted to Safety Department?

  Yes

  No

  N/A

• 13.3 PIV Training up to VH Standard?

  Yes

  No

  N/A

LOTO

• 14.1 ALL authorized personnel that has the Authorized LOTO training completed documented and submitted to Safety Department?

  Yes

  No

  N/A

• 14.2 All locks, keys, and tags in good working condition and authorized for the particular use of the equipment?

  Yes

  No

  N/A

• 14.3 Single key locks identifiable to authorized employee using it, or tagged?

  Yes

  No

  N/A

• 14.4 Do we have a LOTO station where all locks and tags are stored?

  Yes

  No

  N/A

BLADE DISPOSAL

• 15.1 Do we have a written procedure?

  Yes

  No

  N/A

• 15.2 Are we utilizing a special container?

  Yes

  No

  N/A

• 15.3 How do we dispose of blades?

  Yes

  No

  N/A

ERGONOMICS

• 16.1 Knifers shuffling gut sets (not picking up)

  Yes

  No

  N/A

• 16.2 All Gut Room - Proper Lifting techniques being utilized?

  Yes

  No

  N/A

• 16.3 Salting – see ergonomics used to pull and stack casings. If applicable, bags of salt handling ergonomics

  Yes

  No

  N/A

• 16.4 Are stands being utilized efficiently?

  Yes

  No

  N/A

• 16.5 Any kind of rotating schedule for any position? Why?

• 16.6 Miscellaneous Ergonomic observation/recommendation

• Name/Signature of Gut Room Manager

  Sign

• Date

  Date