VPP Pre-Audit Federal OSHA

• Site-Based Participation Evaluation Report VPP

• Business/Facility

• Location
  Address

• Conducted on

  Date

• Personnel

Documentation

Pictures & Attachments

• Add media

  Media

Executive Summary

• I. Purpose and Scope of Review
  
  An onsite review was conducted on dates and location listed below. The purpose of the evaluation was to determine the site's eligibility or continued eligibility for site-based participation in the Occupational Safety and Health Administration's (OSHA) Voluntary Protection Program (VPP). The VPP evaluation team consisted of:

• Enter Evaluator Name(s) & Tittle(s)

II. Methods of Data Collection The information for this report was obtained from the site's VPP Application, documentation reviewed onsite, interviews with employees and management personnel, annual evaluation reports, and physical observations of the facility.

III. Employees at the Worksite

• The number of employees working on site:

• The number of contractors working on site performing maintenance, capital projects, guard services, janitorial services:

• Formal interviews conducted with site employees:

• Formal interviews conducted with contract employees:

IV. The Worksite

• The site is properly classified under North American Industrial Classification System (NAICS) code:

• Housekeeping at the facility was considered by the VPP Evaluation Team to be:

• Select Poor Good Excellent

  • Poor
  • Good
  • Excellent

V. Worksite Hazards

• The hazards at the site include, but are not limited to:

• Does the site use highly hazardous chemicals in sufficient quantity to place the site under the Process Safety Management (PSM) Standard?

  YES

  Not Applicable

VI. Injury and Illness Rates

• The three-year Total Case Incident Rate (TCIR) and Days Away/Transferred Case Incidence (DART) rate for the years:

• The three-year Total Case Incident Rate (TCIR):

• The three-year Days Away/Restricted Work Activity Case Incidence Rate (DART):

• The three-year Total Case Incident Rate (TCIR) is below 2012 Bureau of Labor Statistics (BLS) industry average for Bushiness NAICS code by (%):

• The three-year DART rate is below 2012 Bureau of Labor Statistics (BLS) industry average for Business NAICS code by (%):

VII. OSHA Activity

• Has there been any OSHA inspection activity or fatalities at this site within the past 5 years?

  YES

  Not Applicable

• If Yes. Please Explain:

• The site relationship with its localOSHA Area and Regional offices is:

  Select Poor Good Excellent

  • Poor
  • Good
  • Excellent

VIII. Elements of the VPP Review/Program Changes

• The VPP Evaluation Team has examined each of the required elements of the site's safety and health management programs.

• Select have been met have not been met

  • have been met
  • have not been met

• Bullet summary information of VPP Elements.
  I. Management Leadership and Employee Involvement
  II. Worksite Analysis
  III. Hazard Prevention and Control
  IV. Safety and Health Training

• Does the site utilize an incentive program which meets the requirements of revised Memorandum #5: "Further Improvements to the Voluntary Protection Program (VPP)" dated 8/14/14?

  Yes

  No

  N/A

• Whistleblower Activity(ies): Briefly document the site's policy on anti-retaliation/discrimination. Indicate whether the site has had or not had any whistleblower activity(ies) within the past 3 years.

• Has the site had any whistleblower activity(ies) within past 3 years?

  YES

  Not Applicable

• If so, include a brief description and findings/outcome.

IX. Areas of Excellence

• All elements of the site's safety and health management programs met the high quality expected of VPP participants or describe the program requirements that were considered and area of excellence.

• The site's safety and health management programs met the high quality expected of VPP participant.

  Yes

  No

  N/A

• Describe the program requirements that were considered an area of excellence.

X. Recommendation for Participation

• The VPP team

  does recommend the site be approved for participation in the OSHA Star VPP Program.

  does not recommend the site be approved for participation in the OSHA VPP Star Program.

XI. Goals (if applicable

Section I: Management Leadership & Employee Involvement

A. Written Safety & Health Management System

• A1. Are all the elements (such as Management Leadership and Employee Involvement, Worksite Analysis, Hazard Prevention and Control, and Safety and Health Training) and sub-elements of a basic safety and health management system part of a signed, written document? (For Federal Agencies, include 29CFR 1960.) If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A2. Have all VPP elements and sub-elements been in place at least 1 year? If not, please identify those elements that have not been in place for at least 1 year.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A3. Is the written safety and health management system at least minimally effective to address the scope and complexity of worksite hazards? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A4. Have any VPP documentation requirements been waived (as per FRN, VOL. 74, NO. 6, 01/09/09 page 936, IV, A.4.) If so, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

B. Management Commitment & Leadership

• B1.Does management overall demonstrate at least minimally effective, visible leadership with respect to the safety and health management system (as per FRN, VOL. 74, NO. 6, 01/09/09 page 936, IV, A.5. a-h)?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• B2. How has the site communicated established policies and results oriented goals and objectives for employee safety to employees?

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• B3. Do employees understand the goals and objectives for the safety and health management system?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• B4. Are the safety and health management system goals and objectives meaningful and attainable? Provide examples supporting the meaningfulness and attainability (or lack there of if answer is no) of the goal(s). (Attainability can either be unrealistic/realistic goals or poor/good implementation to achieve them.)

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• B5. How does the site measure its progress towards the safety and health management system goals and objectives? Provide examples.

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

C. Planning

• C1. How does the site integrate planning for safety and health with its overall management planning process (for example, budget development, resource allocation, or training)?

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• C2. Is safety and health effectively integrated into the site's overall management planning process? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• C3. For site-based construction sites, is safety included in the planning phase of each project?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

D. Authority and Line Accountability

• D1. Does top management accept ultimate responsibility for safety and health? (Top management acknowledges ultimate responsibility even if some safety and health functions are delegated to others.) If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D2. How is the assignment of authority and responsibility documented and communicated (for example, organization charts, job descriptions, etc.)?

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D3. Do the individuals assigned responsibility for safety and health have the authority to ensure that hazards are corrected or necessary changes to the safety and health management system are made? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D4. How are managers, supervisors, and employees held accountable for meeting their responsibilities for workplace safety and health? (Are annual performance evaluations for managers and supervisors required?)

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D5. Are adequate resources (equipment, budget, or experts) dedicated to ensuring workplace safety and health? Provide examples.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D6. Is access to experts (for example, Certified Industrial Hygienists, Certified Safety Professionals, Occupational Nurses, or Engineers), reasonable available, based upon the nature, conditions, complexity, and hazards of the site? If so, under what arrangements and how often are they use?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

E. Contract Employees

• E1. Does the site utilize contractors? Please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E2. Were there contractors/sub-contractors onsite at the time of the evaluation?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E3. When selecting onsite contractors/sub-contractors, how does the site evaluate the contractor's safety and health management system ad performance (including Rates)?

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E4. Are contractors and subcontractors required to maintain an effective safety and health management system and to comply with all applicable OSHA and company safety and health rules and regulations? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E5. Does the site's contractor program cover the prompt correction and control of hazards in the event that the contractor/subcontractor fails to cover or control such hazards? Provide examples.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E6. How does the site document and communicate oversight, coordination, and enforcement of safety and health expectations to contractors?

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E7. Have the contract provisions specifying penalties for safety and health issues been enforced, when appropriate? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E8. How does the site monitor the quality of safety and health protection of its contract employees?

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E9. Do contract provisions for contractors require the periodic review and analysis of injury and illness? Provide examples.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E10. Based on your answers to the above items, is the contract oversight minimally effective for the nature of the site? (Inadequate oversight is indicated by significant hazards created by the contractor, employees exposed to hazards, or a lack of host audits.) If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

F. Employee Involvement

• F1. How were employees selected to be interviewed by the VPP team?

  Random

  Pre-Selected

  Other - See Comments

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F2. How many employees were interviewed formally? How many were interviewed informally?

  10% Employees and Contractors

  greater than 10%

  less than 10%

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F3. Do the employees support the site's participation in the VPP?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F4. Do employees feel free to participate in the health and safety management system without fear of discrimination or reparisal? If so, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F5. Are employees meaningfully involved in the problem identification and resolution, or evaluation of the safety and health management system (beyond hazard reporting). (As per FRN page 936 IV, A.6.) For site based construction sites, does the company encourage strong labor-management communication in the form of supervisor and employee participation in toolbox safety meetings and training, safety audits, incident investigations, etc.?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F6. Are employees knowledgeable about the site's safety and health management system? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F7. Are employees knowledgeable about the VPP? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F8. Are the employees knowledgeable about OSHA rights and responsibilities? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F9. How were the employees informed of the safety and health management system, VPP and OSHA rights and responsibilities? Please explain.

  Training

  Postings

  Other - See Comments

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F10. Did management verify employee's comprehension of the site's safety and health management system, VPP and OSHA rights and responsibilities?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F11. Do employees have access to results of self-inspection, accident investigation, appropriate medical records, and personal sampling data upon request? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

G. Safety and Health Management System Evaluation

• G1. Briefly describe the system in place for conducting an annual evaluation.

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G2. Does the annual evaluation cover the aspects of the safety and health management system, including the elements described in the Federal Register? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G3. Does the annual evaluation include written recommendations in a narrative format? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G4. Is the annual evaluation an effective tool for assessing the success of the site's safety and health management system? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G5. What evidence demonstrates that the site responded adequately to the recommendations made in the annual evaluation?

  Compliant - See Comments

  Non-Compliant

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G6. Is the annual evaluation conducted by competent site, corporate or other trained personnel experienced in performing evaluation?

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

Section II: Worksite Analysis

A. Baseline Hazard Analysis

• A1. Has the site been at least minimally effective at identifying and document the common safety and health hazards associated with the site (such as those found in OSHA regulations, building standards, etc., and for which existing controls are well known)? If not, please explain.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A2. What methods are used in the baseline hazard analysis to identify health hazards? (Please include examples of instances when initial screening and full-shift sampling are used. See FRN page 937, B.2.b)

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A3.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A4.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A5.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A6.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A7.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A8.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A9.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

B. Hazard Analysis of Significant Changes

• B1.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• B2.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

C. Hazard Analysis of Routine Activities

• C1.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• C2.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• C3.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• C4.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• C5.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

D. Routine Inspections

• D1.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D2.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D3.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D4.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D5.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D6.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• D7.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

E. Worksite Analysis

• E1.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E2.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E3.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• E4.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

F. Hazard Tracking

• F1.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F2.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F3.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• F4.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

G. Accident/Incident Investigations

• G1.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G2.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G3.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G4.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G5.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• G6.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

H. Trend Analysis

• H1.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• H2.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• H3.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• H4.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• H5.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• H6.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

Section III. Hazard Prevention and Control

A. Hazard Prevention and Control

• A1.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A2.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A3.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A4.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A5.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A6.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A7.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A8.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A9.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

Emergency Procedures

• A10.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A111.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A12.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A13.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

Preventative/Predictive Maintenance

• A14.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A15.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A16.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

Personal Protective Equipment (PPE)

• A17.

  Yes

  No

  N/A

• How Assessed

  Select Interview Observation Doc Review

  • Interview
  • Observation
  • Doc Review

• Comments:

• A18.

  Yes

  No

  N/A

• Comments:

• A19.

  Yes

  No

  N/A

• Comments:

• A20.

  Yes

  No

  N/A

• Comments:

Process Safety Management (PSM)

• A21.

  Yes

  No

  N/A

• Comments:

• A22.

  Yes

  No

  N/A

• Comments:

• A23.

  Yes

  No

  N/A

• Comments:

• A24.

  Yes

  No

  N/A

• Comments:

• A25.

  Yes

  No

  N/A

• Comments:

B. Occupational Health Care Program

• B1.

  Yes

  No

  N/A

• Comments:

• B2.

  Yes

  No

  N/A

• Comments:

• B3.

  Yes

  No

  N/A

• Comments:

C. Recorkeeping

• C1.

  Yes

  No

  N/A

• Comments:

• C2.

  Yes

  No

  N/A

• Comments:

• C3.

  Yes

  No

  N/A

• Comments:

• C4.

  Yes

  No

  N/A

• Comments:

• C5.

  Yes

  No

  N/A

• Comments:

Disciplinary System

Section IV: Safety and Health Training

A. Safety and Health Training

• A1.

  Yes

  No

  N/A

• Comments:

• A2.

  Yes

  No

  N/A

• Comments:

• A3.

  Yes

  No

  N/A

• Comments:

• A4.

  Yes

  No

  N/A

• Comments:

• A5.

  Yes

  No

  N/A

• Comments:

• A6.

  Yes

  No

  N/A

• Comments:

• A7.

  Yes

  No

  N/A

• Comments:

• A8.

  Yes

  No

  N/A

• Comments:

• A9.

  Yes

  No

  N/A

• Comments:

• A10.

  Yes

  No

  N/A

• Comments:

• A11.

  Yes

  No

  N/A

• Comments: