WorkWISE NH General Industry Preliminary Report

• Client:

• This report contains the preliminary findings of the recently conducted safety hazard survey at your company's facility or job site. It is intended to be used for the early correction of hazards, pending completion of the official report from the WorkWISE NH consultant. WorkWISE NH reserves the right to add to or alter the preliminary report according to their findings during the inspection. Any additions or alterations will be made on the official report from the WorkWISE NH consultant within 1 month of the date of inspection.

  

• Conducted:

  Date

• Prepared by: Brady Keene

• Location:
  Address

• Company Representative(s):

• Confidentiality and Stipulations

  

• Add signature

  Sign

• Would the company like a copy of the agreement sent to them by email?

  Yes

  No

General Information

• Would the consultants like to use the general information checklist?

  Yes

  No

Union

• Union or not union?

  Union

  Not Union

Company General Information

• Age of Company

• Company Description

• How many square feet is the facility?

Employees

• Number of employees on site

• Number of employees company wide

• Number of Temporary Workers

• General Notes

Opening Conference Chechlist

• Would the consultant like to use the digital version of the checklist?

  Yes

  No

OSHA 300 Logs

• Are they required?

  Yes

  No

• Are they present?

  Yes

  No

Foreign Workers

• Do you have any foreign workers who have a hard time or cannot read English?

  Yes

  No

• Do you have a OSHA poster that they can read in the language they are most comfortable reading?

  Yes

  No

Reward System

• Is there one in place?

  Yes

  No

• Description

Disciplinary Policy

• Is there one in place?

  Yes

  No

• Description

Safety Committee

• Is it a requirement?

  Yes

  No

• Does the safety committee meet?

  Yes

  No

• How often do they meet?

  Once a month

  Once a week

  Every other month

  Every other week

  Quarterly

• How people on the committee?

• How many regular employees?

• How many managers/supervisors?

• Does someone take meeting minutes or notes?

  Yes

  No

• Do you post the minutes?

• Is there one in place?

  Yes

  No

  N/A

• Description

Workplace Audits

• Is there an audit system in place?

  Yes

  No

• Are workers compensation carriers, private consultants or in house audits used?

  Workers Compensation Carrier

  Private Consultants

  In House Audits

  Safety Committee

Emergency Response

• Is there a written program?

  Yes

  No

• Do employees have a meeting spot during a fire or emergency?

  Yes

  No

• Does management have annual fire drills for all shifts?

  Yes

  No

Medical Emergencies

• Is medical assistance located within 5 minutes of the site?

  Yes

  No

• Are there employees that are dedicated first aid responders?

  Yes

  No

• Are the first aid certified or trained?

  Yes

  No

• Are these employees received Blood Borne Pathogen training?

  Yes

  No

Fire Extinguishers

• Are they inspected annually?

  Yes

  No

• Are they inspected monthly?

  Yes

  No

• In the event of a fire will employees be able to use the extinguishers?

  Yes

  No

• Are employees trained to use extinguishers?

  Yes

  No

Fork Trucks

• Does the site use fork trucks?

  Yes

  No

• Electric

  Yes

  No

  N/A

• How many?

• Do employees preform maintenance on the fork trucks batteries?

  Yes

  No

• Propane

  Yes

  No

• How many?

• Have CO emissions checks been done?

  Yes

  No

  N/A

• Diesel

  Yes

  No

• How many?

• Have CO emissions checks been done?

  Yes

  No

  N/A

• Are employees trained?

  Yes

  No

• Are daily inspection preformed?

  Yes

  No

• Have CO emissions checks been done?

  Yes

  No

Respirator Program

• Do employees use respirators; including paper dust masks?

  Yes

  No

• Are employees required to use these respirators, or are they using them voluntarily?

  Mandatory

  Voluntary

• Is there a respirator program?

  Yes

  No

• Have employees been medically evaluated?

  Yes

  No

• Have employees been fit-tested for their respirators?

  Yes

  No

• Have employees been medically evaluated?

  Yes

  No

Lockout/Tagout (LOTO)

• Is LOTO required?

  Yes

  No

• Is there a written program?

  Yes

  No

• Is the program reviewed annually?

  Yes

  No

• Have all employees been trained on the purpose and function of the energy control program - The knowledge and skills required for the safe application, usage, and removal of energy control devices (locks and tags)?

  Yes

  No

• Have authorized employees received additional training on the recognition of potential hazardous energy sources, the type a energy available in the workplace (electrical, hydraulic, mechanical,etc.), and the methods and means necessary for energy isolation and control(locks and procedures of locking out).

  Yes

  No

• Are there procedures for specific machines?

  Yes

  No

Hazard Communication

• Is there a written program?

  Yes

  No

• Have all employees been trained on the new GHS system?

  Safe

  At Risk

  N/A

• Have MSDS's been converted to SDS?

  Yes

  No

• Are chemicals at the worksite labeled?

  Yes

  No

(Permit Required) Confined Spaces

• Are there spaces on site?

  Yes

  No

• Locations

• What are the hazards?

• Are spaces marked or labeled by signs?

  Yes

  No

• Are permits in place for all spaces?

  Yes

  No

• Are the means to preform atmospheric monitoring present?

  Yes

  No

• Four gas meter?

  Yes

  No

• Is proper calibration completed?

  Yes

  No

NFPA 70E

• Do employees work go into/work on electrical panels, boxes, switches, or other electrical equipment? Including replacing breakers, fuses or similar.

  Yes

  No

• Has an arch flash study been completed?

  Yes

  No

• Is all required PPE available for use when entering an electrical panel or similar?

  Yes

  No

Capstone + Intern

• Client interested in potential intern?

  Yes

  No

• What a hazard inspection completed during the visit?

  Yes

  No

  N/A

Slips, Trips and Falls

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Guarding

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Electrical

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Cranes

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Flammable Liquids and Fire Protection

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

HAZCOM/Eye Wash

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Housekeeping/Emergency Egress/General Work Environment

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Confined Spaces

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Compressed Gas Cylinders + Welding

• Was there a hazard?

  Yes

  No - Mandatory
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

PPE

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Ladders

• Was there a hazard?

  Yes

  No
Hazard

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

Other

• Was there a hazard?

  Yes

  No
Hazard

• Description of Hazard

  Yes

  No

  N/A

• How many employees are exposed?

• Location

• Picture Of Hazard

  Media

• This report obtains the preliminary findings of the recently conducted inspection of your facility or job site. It is intended to be used for the early correction of hazards, pending completion of the official report from the WorkWISE NH consultant. WorkWISE NH reserves the right to add to or alter the preliminary report according to their findings during the inspection. Any additions or alterations will be made on the official report from the WorkWISE NH consultant within 1 month of the date of inspection.