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Page 1 of 27
MODEL INJURY AND
ILLNESS PREVENTION
PROGRAM FOR
HIGH HAZARD
EMPLOYERS
Cal/OSHA Publications Unit Rev. April 2018
ABOUT THIS MODEL PROGRAM
Every California employer must establish, implement and maintain a written Injury and
Illness Prevention (IIP) Program and a copy must be maintained at each workplace or
at a central worksite if the employer has non-fixed worksites. The requirements for
establishing, implementing and maintaining an effective written injury and illness
prevention program are contained in Title 8 of the California Code of Regulations,
Section 3203 (T8 CCR 3203) and consist of the following eight elements:
• Responsibility
• Compliance
• Communication
• Hazard Assessment
• Accident/Exposure Investigation
• Hazard Correction
• Training and Instruction
• Recordkeeping
This model program has been prepared for use by employers in industries, which have
been determined by Cal/OSHA to be high hazard. You are not required to use this
program. This model program was written for a broad spectrum of employers and it
may not match your establishment's exact needs. However, it does provide the
essential framework required for an Injury and Illness Prevention Program.
Proper use of this model program requires the IIP Program administrator of your
establishment to carefully review the requirements for each of the eight IIP Program
elements found in this model program, fill in the appropriate blank spaces and check
those items that are applicable to your workplace. The recordkeeping section requires
that the IIP Program administrator select and implement the category appropriate for
your establishment. Sample forms for hazard assessment and correction,
accident/exposure investigation, and worker training and instruction are provided with
this model program.
This model program must be maintained by the employer in order to be effective.
Page 2 of 27
INJURY AND ILLNESS PREVENTION PROGRAM
RESPONSIBILITY
The Injury and Illness Prevention Program (IIP Program) administrator,
Program Administrator
has the authority and responsibility for implementing the provisions of this program for
.
Establishment Name
All managers and supervisors are responsible for implementing and maintaining the IIP Program in their
work areas and for answering worker questions about the IIP Program. A copy of this IIP Program is
available from each manager and supervisor.
COMPLIANCE
Management is responsible for ensuring that all safety and health policies and procedures are clearly
communicated and understood by all employees. Managers and supervisors are expected to enforce the rules
fairly and uniformly.
All employees are responsible for using safe work practices, for following all directives, policies and
procedures, and for assisting in maintaining a safe work environment.
Our system of ensuring that all workers comply with the rules and maintain a safe work environment include:
1. Informing workers of the provisions of our IIP Program;
2. Evaluating the safety performance of all workers;
3. Recognizing employees who perform safe and healthful work practices;
4. Providing training to workers whose safety performance is deficient;
5. Disciplining workers for failure to comply with safe and healthful work practices; and
6. The following practices:
COMMUNICATION
We recognize that open, two-way communication between management and staff on health and safety
issues is essential to an injury-free, productive workplace. The following system of communication is
designed to facilitate a continuous flow of safety and health information between management and
staff in a form that is readily understandable and consists of one or more of the following checked
items:
□
New worker orientation including a discussion of safety and health policies and procedures.
□
Review of our IIP Program.
□
Workplace safety and health training programs.
Page 3 of 27
□
Regularly scheduled safety meetings.
□
Effective communication of safety and health concerns between workers and supervisors,
including translation where appropriate.
□
Posted or distributed safety information.
□
A system for workers to anonymously inform management about workplace hazards.
□
Our establishment has less than ten employees and communicates with and instructs
employees orally about general safe work practices and with respect to hazards unique to each
employee's job assignment.
□
A labor/management safety and health committee that meets regularly, prepares written records of
the safety and health committees meetings, reviews results of the periodic scheduled inspections,
reviews investigations of accidents and exposures and makes suggestions to management for the
prevention of future incidents, reviews investigations of alleged hazardous conditions, and submits
recommendations to assist in the evaluation of employee safety suggestion.
□
Other:
HAZARD ASSESSMENT
Periodic inspections to identify and evaluate workplace hazards shall be performed by the
following competent observer(s) in the following areas of our workplace:
Competent Observer Area
Periodic inspections are performed according to the following schedule:
1. ;
Frequency (Daily, weekly, monthly, etc.)
2. When we initially established our IIP Program;
3. When new substances, processes, procedures or equipment which present
potential new hazards are introduced into our workplace;
4. When new, previously unidentified hazards are recognized;
5. When occupational injuries and illnesses occur;
6. When we hire and/or reassign permanent or intermittent workers to processes,
operations, or tasks for which a hazard evaluation has not been previously
Page 4 of 27
conducted; and
7. Whenever workplace conditions warrant an inspection.
Periodic inspections consist of identification and evaluation of workplace hazards utilizing applicable
sections of the attached Hazard Assessment Checklist and any other effective methods to identify and
evaluate workplace hazards.
ACCIDENT/EXPOSURE INVESTIGATIONS
Procedures for investigating workplace accidents and hazardous substance exposures include:
1. Visiting the accident scene as soon as possible;
2. Interviewing injured workers and witnesses;
3. Examining the workplace for factors associated with the accident/exposure;
4. Determining the cause of the accident/exposure;
5. Taking corrective action to prevent the accident/exposure from reoccurring; and
6. Recording the findings and corrective actions taken.
HAZARD CORRECTION
Unsafe or unhealthy work conditions, practices or procedures shall be corrected in a timely
manner based on the severity of the hazards. Hazards shall be corrected according to the
following procedures:
1. When observed or discovered;
2. When an imminent hazard exists which cannot be immediately abated without
endangering employee(s) and/or property, we will remove all exposed workers from the
area except those necessary to correct the existing condition. Workers necessary to
correct the hazardous condition shall be provided with the necessary protection; and
3. All such actions taken and dates they are completed shall be documented on the
appropriate forms.
TRAINING AND INSTRUCTION
All workers, including managers and supervisors, shall have training and instruction on general and
job-specific safety and health practices. Training and instruction shall be provided as follows:
1. When the IIP Program is first established;
2. To all new workers, except for construction workers who are provided training through a
Cal/OSHA approved construction industry occupational safety and health training program;
3. To all workers given new job assignments for which training has not previously provided;
4. Whenever new substances, processes, procedures or equipment are introduced to the
workplace and represent a new hazard;
5. Whenever the employer is made aware of a new or previously unrecognized hazard;
6. To supervisors to familiarize them with the safety and health hazards to which workers under
Page 5 of 27
their immediate direction and control may be exposed; and
7. To all workers with respect to hazards specific to each employee's job assignment.
Workplace safety and health practices for all industries include, but are not limited to, the
following:
1. Explanation of the employer's IIP Program, emergency action plan and fire prevention plan, and
measures for reporting any unsafe conditions, work practices, injuries and when additional
instruction is needed.
2. Use of appropriate clothing, including gloves, footwear, and personal protective
equipment.
3. Information about chemical hazards to which employees could be exposed and other
hazard communication program information.
4. Availability of toilet, hand-washing and drinking water facilities.
5. Provisions for medical services and first aid including emergency procedures.
In addition, we provide specific instructions to all workers regarding hazards unique to their job
assignment, to the extent that such information was not already covered in other training.
RECORDKEEPING
We have checked one of the following categories as our recordkeeping policy.
□
Category 1. Our establishment is on a designated high hazard industry list. We have taken
the following steps to implement and maintain our IIP Program:
1.
Records of hazard assessment inspections, including the person(s) or persons
conducting the inspection, the unsafe conditions and work practices that have been
identified and the action taken to correct the identified unsafe conditions and work
practices, are recorded on a hazard assessment and correction form; and
2.
Documentation of safety and health training for each worker, including the worker's
name or other identifier, training dates, type(s) of training, and training providers are
recorded on a worker training and instruction form. We also include the records
relating to worker training provided by a construction industry occupational safety
and health program approved by Cal/OSHA.
Inspection records and training documentation will be maintained according to the
following checked schedule:
□
For one year, except for training records of employees who have worked for less
than one year that are provided to the worker upon termination of employment; or
□
Since we have less than ten workers, including managers and supervisors, we
maintain inspection records only until the hazard is corrected and only maintain
a log of instructions to workers with respect to worker job assignments when
they are first hired or assigned new duties.
□
Category 2. We are a local governmental entity (any county, city, or district, and any
public or quasi-public corporation or public agency therein) and we are not required to
keep written records of the steps taken to implement and maintain our IIP Program.
Page 6 of 27
LIST OF TRAINING SUBJECTS
We train our workers about the following checked training subjects:
□
The employer's Code of Safe Practices.
□
Confined spaces.
□
Safe practices for operating any agricultural equipment.
□
Good housekeeping, fire prevention, safe practices for operating any construction equipment.
□
Safe procedures for cleaning, repairing, servicing and adjusting equipment and machinery.
□
Safe access to working areas.
□
Protection from falls.
□
Electrical hazards, including working around high voltage lines.
□
Crane operations.
□
Trenching and excavation work.
□
Proper use of powered tools.
□
Guarding of belts and pulleys, gears and sprockets, and conveyor nip points.
□
Machine, machine parts, and prime movers guarding.
□
Lock-out/tag-out procedures.
□
Materials handling.
□
Chainsaw and other power tool operation.
□
Tree falling/bucking procedures and precautions, including procedures for recognizing and working
with hazard trees, snags, lodged trees, and unsafe weather conditions.
□
Yarding operations, including skidding, running lines, unstable logs, rigging and
communication.
□
Landing and loading areas, including release of rigging, landing layout, moving vehicles and
equipment, and log truck locating, loading and wrapping.
□
Fall protection from elevated locations.
□
Use of elevated platforms, including condors and scissor lifts.
□
Safe use of explosives.
□
Driver safety.
□
Slips, falls, and back injuries.
□
Ergonomic hazards, including proper lifting techniques and working on ladders or in a
stooped posture for prolonged periods at one time.
□
Personal protective equipment.
□
Respiratory Equipment.
□
Hazardous chemical exposures.
□
Hazard communication.
□
Physical hazards, such as heat/cold stress, noise, and ionizing and non-ionizing radiation.
□
Laboratory safety.
□
Bloodborne pathogens and other biological hazards.
□
Other job-specific hazards, such as _______________________________________________
Page 7 of 27
HAZARD ASSESSMENT CHECKLIST
GENERAL WORK ENVIRONMENT
□
Are all worksites clean and orderly?
□
Are work surfaces kept dry or appropriate means taken
to assure the surfaces are slip-resistant?
□
Are all spilled materials or liquids cleaned up
immediately?
□
Is combustible scrap, debris and waste stored safely
and removed from the worksite promptly?
□
Is accumulated combustible dust routinely removed
from elevated surfaces, including the overhead
structure of buildings?
□
Is combustible dust cleaned up with a vacuum system
to prevent the dust going into suspension?
□
Is metallic or conductive dust prevented from entering
or accumulation on or around electrical enclosures or
equipment?
□
Are covered metal waste cans used for oily and paint-
soaked waste?
□
Are all oil and gas fired devices equipped with flame
failure controls that will prevent flow of fuel if pilots or
main burners are not working?
□
Are paint spray booths, dip tanks and the like cleaned
regularly?
□
Are the minimum number of toilets and washing
facilities provided?
□
Are all toilets and washing facilities clean and sanitary?
□
Are all work areas adequately illuminated?
□
Are pits and floor openings covered or otherwise
guarded?
PERSONAL PROTECTIVE EQUIPMENT & CLOTHING
□
Are protective goggles or face shields provided and
worn where there is any danger of flying particles or
corrosive materials?
□
Are approved safety glasses required to be worn at all
times in areas where there is a risk of eye injuries
such as punctures, abrasions, contusions or burns?
□
Are employees who need corrective lenses (glasses or
contacts lenses) in working environments with
harmful exposures, required to wear only approved
safety glasses, protective goggles, or use other
medically approved precautionary procedures?
□
Are protective gloves, aprons, shields, or other means
provided against cuts, corrosive liquids and
chemicals?
□
Are hard hats provided and worn where danger of
falling objects exists?
□
Are hard hats inspected periodically for damage to the
shell and suspension system?
□
Is appropriate foot protection required where there is
the risk of foot injuries from hot, corrosive, poisonous
substances, falling objects, crushing or penetrating
actions?
□
Are approved respirators provided for regular or
emergency use where needed?
□
Is all protective equipment maintained in a sanitary
condition and ready for use?
□
Do you have eye wash facilities and a quick drench
shower within the work area where employees are
exposed to injurious corrosive materials?
□
Where special equipment is needed for electrical
workers, is it available?
□
When lunches are eaten on the premises, are they
eaten in areas where there is no exposure to toxic
materials or other health hazards?
□
Is protection against the effects of occupational noise
exposure provided when sound levels exceed those
of the Cal/OSHA noise standard?
WALKWAYS
□
Are aisles and passageways kept clear?
□
Are aisles and walkways marked as appropriate?
□
Are wet surfaces covered with non-slip materials?
□
Are holes in the floor, sidewalk or other walking
surface repaired properly, covered or otherwise made
safe?
□
Is there safe clearance for walking in aisles where
motorized or mechanical handling equipment is
operating?
□
Are spilled materials cleaned up immediately?
□
Are materials or equipment stored in such a way that
sharp projectiles will not interfere with the walkway?
□
Are changes of direction or elevations readily
identifiable?
□
Are aisles or walkways that pass near moving or
operating machinery, welding operations or similar
operations arranged so employees will not be
subjected to potential hazards?
□
Is adequate headroom provided for the entire length
of any aisle or walkway?
□
Are standard guardrails provided wherever aisle or
walkway surfaces are elevated more than 30 inches
above any adjacent floor or the ground?
□
Are bridges provided over conveyors and similar
hazards?
FLOOR & WALL OPENINGS
□
Are floor openings guarded by a cover, guardrail, or
equivalent on all sides (except at entrance to stairways or
ladders)?
□
Are toeboards installed around the edges of a permanent
floor opening (where persons may pass below the opening)?
□
Are skylight screens of such construction and mounting that
they will withstand a load of at least 200 pounds?
□
Is the glass in windows, doors, glass walls that are subject to
human impact, of sufficient thickness and type for the
condition of use?
□
Are grates or similar type covers over floor openings such as
floor drains, of such design that foot traffic or rolling
equipment will not be affected by the grate spacing?
□
Are unused portions of service pits and pits not actually in
use either covered or protected by guardrails or equivalent?
□
Are manhole covers, trench covers and similar covers, plus
their supports, designed to carry a truck rear axle load of at
least 20,000 pounds when located in roadways and subject
to vehicle traffic?
□
Are floor or wall openings in fire resistive construction
provided with doors or covers compatible with the fire rating
of the structure and provided with self-closing feature when
appropriate?
STAIRS & STAIRWAYS
□
Are standard stair rails or handrails on all stairways having
four or more risers?
□
Are all stairways at least 22 inches wide?
□
Do stairs have at least a 6'6" overhead clearance?
□
Do stairs angle no more than 50 and no less than 30
degrees?
□
Are stairs of hollow-pan type treads and landings filled to
noising level with solid material?
□
Are step risers on stairs uniform from top to bottom, with no
riser spacing greater than 7-1/2 inches?
□
Are steps on stairs and stairways designed or provided with
a surface that renders them slip resistant?
□
Are stairway handrails located between 30 and 34 inches
above the leading edge of stair treads?
□
Do stairway handrails have a least 1-1/2 inches of clearance
between the handrails and the wall or surface they are
mounted on?
□
Are stairway handrails capable of withstanding a load of 200
pounds, applied in any direction?
□
Where stairs or stairways exit directly into any area where
vehicles may be operated, are adequate barriers and
warnings provided to prevent employees stepping into the
path of traffic?
□
Do stairway landings have a dimension measured in the
direction of travel, at least equal to width of the stairway?
□
Is the vertical distance between stairway landings limited to
12 feet or less?
ELEVATED SURFACES
□
Are signs posted, when appropriate, showing the elevated
surface load capacity?
□
Are surfaces elevated more than 30 inches above the floor
or ground provided with standard guardrails?
□
Are all elevated surfaces (beneath which people or
machinery could be exposed to falling objects) provided with
standard 4-inch toeboards?
□
Is a permanent means of access and egress provided to
elevated storage and work surfaces?
□
Is required headroom provided where necessary?
□
Is material on elevated surfaces piled, stacked or racked in a
manner to prevent it from tipping, falling, collapsing, rolling or
spreading?
□
Are dock boards or bridge plates used when transferring
materials between docks and trucks or rail cars?
EXITING OR EGRESS
□
Are all exits marked with an exit sign and illuminated by a
reliable light source?
□
Are the directions to exits, when not immediately apparent,
marked with visible signs?
□
Are doors, passageways or stairways, that are neither exits
nor access to exits and which could be mistaken for exits,
appropriately marked "NOT AN EXIT", "TO BASEMENT",
"STOREROOM", and the like?
□
Are exit signs provided with the word "EXIT" in lettering at
least 5 inches high and the stroke of the lettering at least 1/2
inch wide?
Page 8 of 27
□
Are exit doors side-hinged?
□
Are all exits kept free of obstructions?
□
Are at least two means of egress provided from elevated
platforms, pits or rooms where the absence of a second exit
would increase the risk of injury from hot, poisonous,
corrosive, suffocating, flammable, or explosive substances?
□
Are there sufficient exits to permit prompt escape in case of
emergency?
□
Are special precautions taken to protect employees during
construction and repair operations?
□
Is the number of exits from each floor of a building, and the
number of exits from the building itself, appropriate for the
building occupancy load?
□
Are exit stairways which are required to be separated from
other parts of a building enclosed by at least two hour fire-
resistive construction in buildings more than four stories in
height, and not less than one-hour fire resistive construction
elsewhere?
□
When ramps are used as part of required exiting from a
building, is the ramp slope limited to 1- foot vertical and 12
feet horizontal?
□
Where exiting will be through frameless glass doors, glass
exit doors, storm doors, and such are the doors fully
tempered and meet the safety requirements for human
impact?
EXIT DOORS
□
Are doors that are required to serve as exits designed and
constructed so that the way of exit travel is obvious and
direct?
□
Are windows that could be mistaken for exit doors, made
inaccessible by means of barriers or railings?
□
Are exit doors openable from the direction of exit travel
without the use of a key or any special knowledge or effort,
when the building is occupied?
□
Is a revolving, sliding or overhead door prohibited from
serving as a required exit door?
□
Where panic hardware is installed on a required exit door,
will it allow the door to open by applying a force of 15
pounds or less in the direction of the exit traffic?
□
Are doors on cold storage rooms provided with an inside
release mechanism that will release the latch and open the
door even if it's padlocked or otherwise locked on the
outside?
□
Where exit doors open directly onto any street, alley or other
area where vehicles may be operated, are adequate barriers
and warnings provided to prevent employees stepping into
the path of traffic?
□
Are doors that swing in both directions and are located
between rooms where there is frequent traffic, provided
with viewing panels in each door?
PORTABLE LADDERS
□
Are all ladders maintained in good condition, joints between
steps and side rails tight, all hardware and fittings securely
attached, and moveable parts operating freely without
binding or undue play?
□
Are non-slip safety feet provided on each ladder?
□
Are non-slip safety feet provided on each metal or rung
ladder?
□
Are ladder rungs and steps free of grease and oil?
□
Is it prohibited to place a ladder in front of doors opening
toward the ladder except when the door is blocked open,
locked or guarded?
□
Is it prohibited to place ladders on boxes, barrels, or other
unstable bases to obtain additional height?
□
Are employees instructed to face the ladder when ascending
or descending?
□
Are employees prohibited from using ladders that are
broken, missing steps, rungs, or cleats, broken side rails or
other faulty equipment?
□
Are employees instructed not to use the top 2 steps of
ordinary stepladders as a step?
□
When portable rung ladders are used to gain access to
elevated platforms, roofs, and the like does the ladder
always extend at least 3 feet above the elevated surface?
□
Is it required that when portable rung or cleat type ladders
are used the base is so placed that slipping will not occur, or
it is lashed or otherwise held in place?
□
Are portable metal ladders legibly marked with signs reading
"CAUTION" "Do Not Use Around Electrical Equipment" or
equivalent wording?
□
Are employees prohibited from using ladders as guys,
braces, skids, gin poles, or for other than their intended
purposes?
□
Are employees instructed to only adjust extension ladders
while standing at a base (not while standing on the ladder or
from a position above the ladder)?
□
Are metal ladders inspected for damage?
□
Are the rungs of ladders uniformly spaced at 12 inches,
center to center?
HAND TOOLS & EQUIPMENT
□
Are all tools and equipment (both, company and employee-
owned) used by employees at their workplace in good
condition?
□
Are hand tools such as chisels, punches, which develop
mushroomed heads during use, reconditioned or replaced as
necessary?
Page 9 of 27
□
Are broken or fractured handles on hammers, axes and
similar equipment replaced promptly?
□
Are worn or bent wrenches replaced regularly?
□
Are appropriate handles used on files and similar tools?
□
Are employees made aware of the hazards caused by
faulty or improperly used hand tools?
□
Are appropriate safety glasses, face shields, and similar
equipment used while using hand tools or equipment that
might produce flying materials or be subject to breakage?
□
Are jacks checked periodically to assure they are in good
operating condition?
□
Are tool handles wedged tightly in the head of all tools?
□
Are tool cutting edges kept sharp so the tool will
move smoothly without binding or skipping?
□
Are tools stored in dry, secure location where they won't be
tampered with?
□
Is eye and face protection used when driving hardened or
tempered spuds or nails?
PORTABLE (POWER OPERATED) TOOLS & EQUIPMENT
□
Are grinders, saws, and similar equipment provided with
appropriate safety guards?
□
Are power tools used with the correct shield, guard or
attachment recommended by the manufacturer?
□
Are portable circular saws equipped with guards above and
below the base shoe?
□
Are circular saw guards checked to assure they are not
wedged up, thus leaving the lower portion of the blade
unguarded?
□
Are rotating or moving parts of equipment guarded
to prevent physical contact?
□
Are all cord-connected, electrically operated tools and
equipment effectively grounded or of the approved double
insulated type?
□
Are effective guards in place over belts, pulleys, chains,
and sprockets, on equipment such as concrete mixers, air
compressors, and the like?
□
Are portable fans provided with full guards or screens having
openings 1/2 inch or less?
□
Is hoisting equipment available and used for lifting heavy
objects, and are hoist ratings and characteristics appropriate
for the task?
□
Are ground-fault circuit interrupters provided on all temporary
electrical 15 and 20 ampere circuits, used during periods of
construction?
□
Are pneumatic and hydraulic hoses on power-operated
tools checked regularly for deterioration or damage?
ABRASIVE WHEEL EQUIPMENT GRINDERS
□
Is the work rest used and kept adjusted to within 1/8 inch of
the wheel?
□
Is the adjustable tongue on the top side of the grinder used
and kept adjusted to within 1/4 inch of the wheel?
□
Do side guards cover the spindle, nut, and flange and 75
percent of the wheel diameter?
□
Are bench and pedestal grinders permanently mounted?
□
Are goggles or face shields always worn when grinding?
□
Is the maximum RPM rating of each abrasive wheel
compatible with the RPM rating of the grinder motor?
□
Are fixed or permanently mounted grinders connected to
their electrical supply system with metallic conduit or other
permanent wiring method?
□
Does each grinder have an individual on and off control
switch?
□
Is each electrically operated grinder effectively grounded?
□
Before new abrasive wheels are mounted, are they visually
inspected and ring tested?
□
Are dust collectors and powered exhausts provided on
grinders used in operations that produce large amounts of
dust?
□
Are splashguards mounted on grinders that use coolant, to
prevent the coolant reaching employees?
□
Is cleanliness maintained around grinder?
POWDER ACTUATED TOOLS
□
Are employees who operate powder-actuated tools trained in
their use and carry a valid operator's card?
□
Do the powder-actuated tools being used have written
approval of the Division of Occupational Safety and Health?
□
Is each powder-actuated tool stored in its own locked
container when not being used?
□
Is a sign at least 7" by 10" with bold type reading "POWDER-
ACTUATED TOOL IN USE" conspicuously posted when the
tool is being used?
□
Are powder-actuated tools left unloaded until they are
actually ready to be used?
□
Are powder-actuated tools inspected for obstructions or
defects each day before use?
□
Do powder-actuated tools operators have and use
appropriate personal protective equipment such as hard
hats, safety goggles, safety shoes and ear protectors?
Page 10 of 27
MACHINE GUARDING
□
Is there a training program to instruct employees on safe
methods of machine operation?
□
Is there adequate supervision to ensure that employees are
following safe machine operating procedures?
□
Is there a regular program of safety inspection of machinery
and equipment?
□
Is all machinery and equipment kept clean and properly
maintained?
□
Is sufficient clearance provided around and between
machines to allow for safe operations, set up and servicing,
material handling and waste removal?
□
Is equipment and machinery securely placed and anchored,
when necessary to prevent tipping or other movement that
could result in personal injury?
□
Is there a power shut-off switch within reach of the operator's
position at each machine?
□
Can electric power to each machine be locked out for
maintenance, repair, or security?
□
Are the noncurrent-carrying metal parts of electrically
operated machines bonded and grounded?
□
Are foot-operated switches guarded or arranged to prevent
accidental actuation by personnel or falling objects?
□
Are manually operated valves and switches controlling the
operation of equipment and machines clearly identified and
readily accessible?
□
Are all emergency stop buttons colored red?
□
Are all pulleys and belts that are within 7 feet of the floor or
working level properly guarded?
□
Are all moving chains and gears properly guarded?
□
Are splashguards mounted on machines that use coolant, to
prevent the coolant from reaching employees?
□
Are methods provided to protect the operator and other
employees in the machine area from hazards created at the
point of operation, ingoing nip points, rotating parts, flying
chips, and sparks?
□
Are machinery guards secure and so arranged that they do
not offer a hazard in their use?
□
If special hand tools are used for placing and removing
material, do they protect the operator's hands?
□
Are revolving drums, barrels, and containers required to be
guarded by an enclosure that is interlocked with the drive
mechanism, so that revolution cannot occur unless the guard
enclosure is in place, so guarded?
□
Do arbors and mandrels have firm and secure bearings and
are they free from play?
□
Are provisions made to prevent machines from automatically
starting when power is restored after a power failure or
shutdown?
□
Are machines constructed so as to be free from excessive
vibration when the largest size tool is mounted and run at full
speed?
□
If machinery is cleaned with compressed air, is air pressure
controlled and personal protective equipment or other
safeguards used to protect operators and other workers from
eye and body injury?
□
Are fan blades protected with a guard having openings no
larger than 1/2 inch, when operating within 7 feet of the
floor?
□
Are saws used for ripping, equipped with anti-kick back
devices and spreaders?
□
Are radial arm saws so arranged that the cutting head will
gently return to the back of the table when released?
LOCKOUT BLOCKOUT PROCEDURES
□
Is all machinery or equipment capable of movement,
required to be de-energized or disengaged and blocked or
locked out during cleaning, servicing, adjusting or setting up
operations, whenever required?
□
Is the locking-out of control circuits in lieu of locking-out main
power disconnects prohibited?
□
Are all equipment control valve handles provided with a
means for locking-out?
□
Does the lockout procedure require that stored energy (i.e.
mechanical, hydraulic, air,) be released or blocked before
equipment is locked-out for repairs?
□
Are appropriate employees provided with individually keyed
personal safety locks?
□
Are employees required to keep personal control of their
key(s) while they have safety locks in use?
□
Is it required that employees check the safety of the lock out
by attempting a start up after making sure no one is
exposed?
□
Where the power disconnecting means for equipment does
not also disconnect the electrical control circuit:
□
Are the appropriate electrical enclosures identified?
□
Is means provide to assure the control circuit can also be
disconnected and locked out?
Page 11 of 27
WELDING, CUTTING & BRAZING
□
Are only authorized and trained personnel permitted to use
welding, cutting or brazing equipment?
□
Do all operator have a copy of the appropriate operating
instructions and are they directed to follow them?
□
Are compressed gas cylinders regularly examined for
obvious signs of defects, deep rusting, or leakage?
□
Is care used in handling and storage of cylinders, safety
valves, relief valves, and the like, to prevent damage?
□
Are precautions taken to prevent the mixture of air or oxygen
with flammable gases, except at a burner or in a standard
torch?
□
Are only approved apparatus (torches, regulators, pressure-
reducing valves, acetylene generators, manifolds) used?
□
Are cylinders kept away from sources of heat?
□
Is it prohibited to use cylinders as rollers or supports?
□
Are empty cylinders appropriately marked their valves closed
and valve-protection caps on?
□
Are signs reading: DANGER NO-SMOKING, MATCHES,
OR OPEN LIGHTS, or the equivalent posted?
□
Are cylinders, cylinder valves, couplings, regulators, hoses,
and apparatus keep free of oily or greasy substances?
□
Is care taken not to drop or strike cylinders?
□
Unless secured on special trucks, are regulators removed
and valve-protection caps put in place before moving
cylinders?
□
Do cylinders without fixed hand wheels have keys, handles,
or non-adjustable wrenches on stem valves when in service?
□
Are liquefied gases stored and shipped valve-end up with
valve covers in place?
□
Are employees instructed to never crack a fuel-gas cylinder
valve near sources of ignition?
□
Before a regulator is removed, is the valve closed and gas
released form the regulator?
□
Is red used to identify the acetylene (and other fuel-gas)
hose, green for oxygen hose, and black for inert gas and air
hose?
□
Are pressure-reducing regulators used only for the gas and
pressures for which they are intended?
□
Is open circuit (No Load) voltage of arc welding and cutting
machines as low as possible and not in excess of the
recommended limits?
□
Under wet conditions, are automatic controls for reducing
no-load voltage used?
□
Is grounding of the machine frame and safety ground
connections of portable machines checked periodically?
□
Are electrodes removed from the holders when not in use?
□
Is it required that electric power to the welder be shut off
when no one is in attendance?
□
Is suitable fire extinguishing equipment available for
immediate use?
□
Is the welder forbidden to coil or loop welding electrode
cable around his body?
□
Are wet machines thoroughly dried and tested before being
used?
□
Are work and electrode lead cables frequently inspected for
wear and damage, and replaced when needed?
□
Do means for connecting cables' lengths have adequate
insulation?
□
When the object to be welded cannot be moved and fire
hazards cannot be removed, are shields used to confine
heat, sparks, and slag?
□
Are firewatchers assigned when welding or cutting is
performed, in locations where a serious fire might develop?
□
Are combustible floors kept wet, covered by damp sand, or
protected by fire-resistant shields?
□
When floors are wet down, are personnel protected from
possible electrical shock?
□
When welding is done on metal walls, are precautions taken
to protect combustibles on the other side?
□
Before hot work is begun, are used drums, barrels, tanks,
and other containers so thoroughly cleaned that no
substances remain that could explode, ignite, or produce
toxic vapors?
□
Is it required that eye protection helmets, hand shields and
goggles meet appropriate standards?
□
Are employees exposed to the hazards created by welding,
cutting, or bracing operations protected with personal
protective equipment and clothing?
□
Is a check made for adequate ventilation in and where
welding or cutting is preformed?
□
When working in confined places are environmental
monitoring tests taken and means provided for quick
removal of welders in case of an emergency?
COMPRESSORS & COMPRESSED AIR
□
Are compressors equipped with pressure relief valves, and
pressure gauges?
□
Are compressor air intakes installed and equipped to ensure
that only clean uncontaminated air enters the compressor?
Page 12 of 27
□
Are air filters installed on the compressor intake?
□
Are compressors operated and lubricated in accordance with
the manufacturer's recommendations?
□
Are safety devices on compressed air systems checked
frequently?
□
Before any repair work is done on the pressure system of a
compressor, is the pressure bled off and the system locked-
out?
□
Are signs posted to warn of the automatic starting feature of
the compressors?
□
Is the belt drive system totally enclosed to provide protection
for the front, back, top, and sides?
□
Is it strictly prohibited to direct compressed air towards a
person?
□
Are employees prohibited from using highly compressed air
for cleaning purposes?
□
If compressed air is used for cleaning off clothing, is the
pressure reduced to less than 10 psi?
□
When using compressed air for cleaning, do employees use
personal protective equipment?
□
Are safety chains or other suitable locking devices used at
couplings of high pressure hose lines where a connection
failure would create a hazard?
□
Before compressed air is used to empty containers of liquid,
is the safe working pressure of the container checked?
□
When compressed air is used with abrasive blast cleaning
equipment, is the operating valve a type that must be held
open manually?
□
When compressed air is used to inflate auto tires, is a clip-on
chuck and an inline regulator preset to 40 psi required?
□
Is it prohibited to use compressed air to clean up or move
combustible dust if such action could cause the dust to be
suspended in the air and cause a fire or explosion hazard?
COMPRESSED AIR RECEIVERS
□
Is every receiver equipped with a pressure gauge and with
one or more automatic, spring-loaded safety valves?
□
Is the total relieving capacity of the safety valve capable of
preventing pressure in the receiver from exceeding the
maximum allowable working pressure of the receiver by
more than 10 percent?
□
Is every air receiver provided with a drainpipe and valve at
the lowest point for the removal of accumulated oil and
water?
□
Are compressed air receivers periodically drained of
moisture and oil?
□
Are all safety valves tested frequently and at regular
intervals to determine whether they are in good operating
condition?
□
Is there a current operating permit issued by the Division of
Occupational Safety and Health?
□
Is the inlet of air receivers and piping systems kept free of
accumulated oil and carbonaceous materials?
COMPRESSED GAS & CYLINDERS
□
Are cylinders with a water weight capacity over 30 pounds
equipped with means for connecting a valve protector
device, or with a collar or recess to protect the valve?
□
Are cylinders legibly marked to clearly identify the gas
contained?
□
Are compressed gas cylinders stored in areas which are
protected from external heat sources such as flame
impingement, intense radiant heat, electric arcs, or high
temperature lines?
□
Are cylinders located or stored in areas where they will not
be damaged by passing or falling objects, or subject to
tampering by unauthorized persons?
□
Are cylinders stored or transported in a manner to prevent
them creating a hazard by tipping, falling or rolling?
□
Are cylinders containing liquefied fuel gas, stored or
transported in a position so that the safety relief device is
always in direct contact with the vapor space in the cylinder?
□
Are valve protectors always placed on cylinders when the
cylinders are not in use or connected for use?
□
Are all valves closed off before a cylinder is moved, when
the cylinder is empty, and at the completion of each job?
□
Are low pressure fuel-gas cylinders checked periodically for
corrosion, general distortion, cracks, or any other defect that
might indicate a weakness or render it unfit for service?
□
Does the periodic check of low pressure fuel-gas cylinders
include a close inspection of the cylinders' bottom?
HOIST & AUXILIARY EQUIPMENT
□
Is each overhead electric hoist equipped with a limit device
to stop the hook travel at its highest and lowest point of safe
travel?
□
Will each hoist automatically stop and hold any load up to
125 percent of its rated load, if its actuating force is
removed?
□
Is the rated load of each hoist legibly marked and visible to
the operator?
□
Are stops provided at the safe limits of travel for trolley
hoist?
□
Are the controls of hoists plainly marked to indicate the
direction of travel or motion?
□
Is each cage-controlled hoist equipped with an effective
warning device?
Page 13 of 27
□
Are close-fitting guards or other suitable devices installed on
hoist to assure hoist ropes will be maintained in the sheave
groves?
□
Are all hoist chains or ropes of sufficient length to handle the
full range of movement for the application while still
maintaining two full wraps on the drum at all times?
□
Are nip points or contact points between hoist ropes and
sheaves which are permanently located within 7 feet of the
floor, ground or working platform, guarded?
□
Is it prohibited to use chains or rope slings that are kinked or
twisted?
□
Is it prohibited to use the hoist rope or chain wrapped around
the load as a substitute, for a sling?
□
Is the operator instructed to avoid carrying loads over
people?
□
Are only employees who have been trained in the proper use
of hoists allowed to operate them?
INDUSTRIAL TRUCKS - FORKLIFTS
□
Are only trained personnel allowed to operate industrial
trucks?
□
Is substantial overhead protective equipment provided on
high lift rider equipment?
□
Are the required lift truck operating rules posted and
enforced?
□
Is directional lighting provided on each industrial truck that
operates in an area with less than 2 foot candles per square
foot of general lighting?
□
Does each industrial truck have a warning horn, whistle,
gong or other device which can be clearly heard above the
normal noise in the areas where operated?
□
Are the brakes on each industrial truck capable of bringing
the vehicle to a complete and safe stop when fully loaded?
□
Will the industrial truck's parking brake effectively prevent
the vehicle from moving when unattended?
□
Are industrial trucks operating in areas where flammable
gases or vapors, or combustible dust or ignitable fibers may
be present in the atmosphere, approved for such locations?
□
Are motorized hand and hand/rider trucks so designed that
the brakes are applied, and power to the drive motor shuts
off when the operator releases his/her grip on the device that
controls the travel?
□
Are industrial trucks with internal combustion engine
operated in buildings or enclosed areas, carefully checked to
ensure such operations do not cause harmful concentration
of dangerous gases or fumes?
SPRAYING OPERATIONS
□
Is adequate ventilation assured before spray operations are
started?
□
Is mechanical ventilation provided when spraying operation
is done in enclosed areas?
□
When mechanical ventilation is provided during spraying
operations, is it so arranged that it will not circulate the
contaminated air?
□
Is the spray area free of hot surfaces?
□
Is the spray area at least 20 feet from flames, sparks,
operating electrical motors and other ignition sources?
□
Are portable lamps used to illuminate spray areas suitable
for use in a hazardous location?
□
Is approved respiratory equipment provided and used when
appropriate during spraying operations?
□
Do solvents used for cleaning have a flash point of 100"W F
or more?
□
Are fire control sprinkler heads kept clean?
□
Are "NO SMOKING" signs posted in spray areas, paint
rooms, paint booths, and paint storage areas?
□
Is the spray area kept clean of combustible residue?
□
Are spray booths constructed of metal, masonry, or other
substantial noncombustible material?
□
Are spray booth floors and baffles noncombustible and
easily cleaned?
□
Is infrared drying apparatus kept out of the spray area during
spraying operations?
□
Is the spray booth completely ventilated before using the
drying apparatus?
□
Is the electric drying apparatus properly grounded?
□
Are lighting fixtures for spray booths located outside of the
booth and the interior lighted through sealed clear panels?
□
Are the electric motors for exhaust fans placed outside
booths or ducts?
□
Are belts and pulleys inside the booth fully enclosed?
□
Do ducts have access doors to allow cleaning?
□
Do all drying spaces have adequate ventilation?
Page 14 of 27
ENTERING CONFINED SPACES
□
Are confined spaces thoroughly emptied of any corrosive or
hazardous substances, such as acids or caustics, before
entry?
□
Before entry, are all lines to a confined space, containing
inert, toxic, flammable, or corrosive materials valved off and
blanked or disconnected and separated?
□
Is it required that all impellers, agitators, or other moving
equipment inside confined spaces be locked-out if they
present a hazard?
□
Is either natural or mechanical ventilation provided prior to
confined space entry?
□
Before entry, are appropriate atmospheric tests performed to
check for oxygen deficiency, toxic substance and explosive
concentrations in the confined space before entry?
□
Is adequate illumination provided for the work to be
performed in the confined space?
□
Is the atmosphere inside the confined space frequently
tested or continuously monitor during conduct of work?
□
Is there an assigned safety standby employee outside of the
confined space, whose sole responsibility is to watch the
work in progress, sound an alarm if necessary, and render
assistance?
□
Is the standby employee or other employees prohibited from
entering the confined space without lifelines and respiratory
equipment if there is any questions as to the cause of an
emergency?
□
In addition to the standby employee, is there at least one
other trained rescuer in the vicinity?
□
Are all rescuers appropriately trained and using approved,
recently inspected equipment?
□
Does all rescue equipment allow for lifting employees
vertically from a top opening?
□
Are there trained personnel in First Aid and CPR
immediately available?
□
Is there an effective communication system in place
whenever respiratory equipment is used and the employee
in the confined space is out of sight of the standby person?
□
Is approved respiratory equipment required if the
atmosphere inside the confined space cannot be made
acceptable?
□
Is all portable electrical equipment used inside confined
spaces either grounded and insulated, or equipped with
ground fault protection?
□
Before gas welding or burning is started in a confined space,
are hoses checked for leaks, compressed gas bottles
forbidden inside of the confined space, torches lighted only
outside of the confined area and the confined area tested for
an explosive atmosphere each time before a lighted torch is
to be taken into the confined space?
□
If employees will be using oxygen-consuming equipment
such as salamanders, torches, furnaces, in a confined
space, is sufficient air provided to assure combustion without
reducing the oxygen concentration of the atmosphere below
19.5 percent by volume?
□
Whenever combustion-type equipment is used in confined
space, are provisions made to ensure the exhaust gases are
vented outside of the enclosure?
□
Is each confined space checked for decaying vegetation or
animal matter, which may produce methane?
□
Is the confined space checked for possible industrial waste,
which could contain toxic properties?
□
If the confined space is below the ground and near areas
where motor vehicles will be operating, is it possible for
vehicle exhaust or carbon monoxide to enter the space?
ENVIRONMENTAL CONTROLS
□
Are all work areas properly illuminated?
□
Are employees instructed in proper first aid and other
emergency procedures?
□
Are hazardous substances identified which may cause harm
by inhalation, ingestion, skin absorption or contact?
□
Are employees aware of the hazards involved with the
various chemicals they may be exposed to in their work
environment, such as ammonia, chlorine, epoxies, and
caustics?
□
Is employee exposure to chemicals in the workplace kept
within acceptable levels?
□
Can a less harmful method or product be used?
□
Is the work area's ventilation system appropriate for the work
being performed?
□
Are spray painting operations done in spray rooms or booths
equipped with an appropriate exhaust system?
□
Is employee exposure to welding fumes controlled by
ventilation, use of respirators, exposure time, or other
means?
□
Are welders and other workers nearby provided with flash
shields during welding operations?
□
If forklifts and other vehicles are used in buildings or other
enclosed areas, are the carbon monoxide levels kept below
maximum acceptable concentration?
□
Has there been a determination that noise levels in the
facilities are within acceptable levels?
Page 15 of 27
□
Are steps being taken to use engineering controls to reduce
excessive noise levels?
□
Are proper precautions being taken when handling asbestos
and other fibrous materials?
□
Are caution labels and signs used to warn of asbestos?
□
Are wet methods used, when practicable, to prevent the
emission of airborne asbestos fibers, silica dust and similar
hazardous materials?
□
Is vacuuming with appropriate equipment used whenever
possible rather than blowing or sweeping dust?
□
Are grinders, saws, and other machines that produce
respirable dusts vented to an industrial collector or central
exhaust system?
□
Are all local exhaust ventilation systems designed and
operating properly such as airflow and volume necessary for
the application? Are the ducts free of obstructions or the
belts slipping?
□
Is personal protective equipment provided, used and
maintained wherever required?
□
Are there written standard operating procedures for the
selection and use of respirators where needed?
□
Are restrooms and washrooms kept clean and sanitary?
□
Is all water provided for drinking, washing, and cooking
potable?
□
Are all outlets for water not suitable for drinking clearly
identified?
□
Are employees' physical capacities assessed before being
assigned to jobs requiring heavy work?
□
Are employees instructed in the proper manner of lifting
heavy objects?
□
Where heat is a problem, have all fixed work areas been
provided with spot cooling or air conditioning?
□
Are employees screened before assignment to areas of high
heat to determine if their health condition might make them
more susceptible to having an adverse reaction?
□
Are employees working on streets and roadways where they
are exposed to the hazards of traffic, required to wear bright
colored (traffic orange) warning vest?
□
Are exhaust stacks and air intakes located that contaminated
air will not be recirculated within a building or other enclosed
area?
□
Is equipment producing ultra-violet radiation properly
shielded?
FLAMMABLE & COMBUSTIBLE MATERIALS
□
Are combustible scrap, debris and waste materials (i.e. oily
rags) stored in covered metal receptacles and removed from
the worksite promptly?
□
Is proper storage practiced to minimize the risk of fire
including spontaneous combustion?
□
Are approved containers and tanks used for the storage and
handling of flammable and combustible liquids?
□
Are all connections on drums and combustible liquid piping,
vapor and liquid tight?
□
Are all flammable liquids kept in closed containers when not
in use (e.g. parts cleaning tanks, pans)?
□
Are bulk drums of flammable liquids grounded and bonded
to containers during dispensing?
□
Do storage rooms for flammable and combustible liquids
have explosion-proof lights?
□
Do storage rooms for flammable and combustible liquids
have mechanical or gravity ventilation?
□
Is liquefied petroleum gas stored, handled, and used in
accordance with safe practices and standards?
□
Are liquefied petroleum storage tanks guarded to prevent
damage from vehicles?
□
Are all solvent wastes and flammable liquids kept in fire-
resistant covered containers until they are removed from the
worksite?
□
Is vacuuming used whenever possible rather than blowing or
sweeping combustible dust?
□
Are fire separators placed between containers of
combustibles or flammables, when stacked one upon
another, to assure their support and stability?
□
Are fuel gas cylinders and oxygen cylinders separated by
distance, fire resistant barriers or other means while in
storage?
□
Are fire extinguishers selected and provided for the types of
materials in areas where they are to be used?
Class A: Ordinary combustible material fires.
Class B: Flammable liquid, gas or grease fires.
Class C: Energized-electrical equipment fires.
□
If a Halon 1301 fire extinguisher is used, can employees
evacuate within the specified time for that extinguisher?
□
Are appropriate fire extinguishers mounted within 75 feet of
outside areas containing flammable liquids, and within 10
feet of any inside storage area for such materials?
□
Is the transfer/withdrawal of flammable or combustible
liquids performed by trained personnel?
Page 16 of 27
□
Are fire extinguishers mounted so that employees do not
have to travel more than 75 feet for a class "A" fire or 50 feet
for a class "B" fire?
□
Are employees trained in the use of fire extinguishers?
□
Are extinguishers free from obstructions or blockage?
□
Are all extinguishers serviced, maintained and tagged at
intervals not to exceed one year?
□
Are all extinguishers fully charged and in their designated
places?
□
Is a record maintained of required monthly checks of
extinguishers?
□
Where sprinkler systems are permanently installed, are the
nozzle heads directed or arranged so that water will not be
sprayed into operating electrical switchboards and
equipment?
□
Are "NO SMOKING" signs posted where appropriate in
areas where flammable or combustible materials are used or
stored?
□
Are "NO SMOKING" signs posted on liquefied petroleum gas
tanks?
□
Are "NO SMOKING" rules enforced in areas involving
storage and use of flammable materials?
□
Are safety cans used for dispensing flammable or
combustible liquids at a point of use?
□
Are all spills of flammable or combustible liquids cleaned up
promptly?
□
Are storage tanks adequately vented to prevent the
development of excessive vacuum or pressure as a result of
filling, emptying, or atmosphere temperature changes?
□
Are storage tanks equipped with emergency venting that will
relieve excessive internal pressure caused by fire exposure?
□
Are spare portable or butane tanks, which are sued by
industrial trucks stored in accord with regulations?
FIRE PROTECTION
□
Do you have a fire prevention plan?
□
Does your plan describe the type of fire protection
equipment and/or systems?
□
Have you established practices and procedures to control
potential fire hazards and ignition sources?
□
Are employees aware of the fire hazards of the material and
processes to which they are exposed?
□
Is your local fire department well acquainted with your
facilities, location and specific hazards?
□
If you have a fire alarm system, is it tested at least annually?
□
If you have a fire alarm system, is it certified as required?
□
If you have interior standpipes and valves, are they
inspected regularly?
□
If you have outside private fire hydrants, are they flushed at
least once a year and on a routine preventive maintenance
schedule?
□
Are fire doors and shutters in good operating condition?
□
Are fire doors and shutters unobstructed and protected
against obstructions, including their counterweights?
□
Are fire door and shutter fusible links in place?
□
Are automatic sprinkler system water control valves, air and
water pressures checked weekly/periodically as required?
□
Is maintenance of automatic sprinkler system assigned to
responsible persons or to a sprinkler contractor?
□
Are sprinkler heads protected by metal guards, when
exposed to physical damage?
□
Is proper clearance maintained below sprinkler heads?
□
Are portable fire extinguishers provided in adequate number
and type?
□
Are fire extinguishers mounted in readily accessible
locations?
□
Are fire extinguishers recharged regularly and noted on the
inspection tag?
□
Are employees periodically instructed in the use of
extinguishers and fire protection procedures?
HAZARDOUS CHEMICAL EXPOSURES
□
Are employees trained in the safe handling practices of
hazardous chemicals such as acids, caustics, and the like?
□
Are employees aware of the potential hazards involving
various chemicals stored or used in the workplace--such as
acids, bases, caustics, epoxies, and phenols?
□
Is employee exposure to chemicals kept within acceptable
levels?
□
Are eye wash fountains and safety showers provided in
areas where corrosive chemicals are handled?
□
Are all containers, such as vats and storage tanks labeled as
to their contents--e.g. "CAUSTICS"?
□
Are all employees required to use personal protective
clothing and equipment when handling chemicals (i.e.
gloves, eye protection, and respirators)?
□
Are flammable or toxic chemicals kept in closed containers
when not in use?
Page 17 of 27
□
Are chemical piping systems clearly marked as to their
content?
□
Where corrosive liquids are frequently handled in open
containers or drawn from storage vessels or pipelines, is
adequate means readily available for neutralizing or
disposing of spills or overflows properly and safely?
□
Have standard operating procedures been established and
are they being followed when cleaning up chemical spills?
□
Where needed for emergency use, are respirators stored in
a convenient, clean and sanitary location?
□
Are respirators intended for emergency use adequate for the
various uses for which they may be needed?
□
Are employees prohibited from eating in areas where
hazardous chemicals are present?
□
Is personal protective equipment provided, used and
maintained whenever necessary?
□
Are there written standard operating procedures for the
selection and use of respirators where needed?
□
If you have a respirator protection program, are your
employees instructed on the correct usage and limitations of
the respirators?
□
Are the respirators NIOSH approved for this particular
application?
□
Are they regularly inspected and cleaned sanitized and
maintained?
□
If hazardous substances are used in your processes, do you
have a medical or biological monitoring system in operation?
□
Are you familiar with the Threshold Limit Values or
Permissible Exposure Limits of airborne contaminants and
physical agents used in your workplace?
□
Have control procedures been instituted for hazardous
materials, where appropriate, such as respirators, ventilation
systems, handling practices, and the like?
□
Whenever possible, are hazardous substances handled in
properly designed and exhausted booths or similar
locations?
□
Do you use general dilution or local exhaust ventilation
systems to control dusts, vapors, gases, fumes, smoke,
solvents or mists which may be generated in your
workplace?
□
Is ventilation equipment provided for removal of
contaminants from such operations as production grinding,
buffing, spray painting, and/or vapor decreasing, and is it
operating properly?
□
Do employees complain about dizziness, headaches,
nausea, irritation, or other factors of discomfort when they
use solvents or other chemicals?
□
Is there a dermatitis problem--do employees complain about
skin dryness, irritation, or sensitization?
□
Have you considered the use of an industrial hygienist or
environmental health specialist to evaluate your operation?
□
If internal combustion engines are used, is carbon monoxide
kept within acceptable levels?
□
Is vacuuming used, rather than blowing or sweeping dusts
whenever possible for clean up?
□
Are materials, which give off toxic, asphyxiant, suffocating
or anesthetic fumes, stored in remote or isolated locations
when not in use?
HAZARDOUS SUBSTANCES COMMUNICATION
□
Is there a list of hazardous substances used in your
workplace?
□
Is there a written hazard communication program dealing
with Safety Data Sheets (SDS) labeling, and employee
training?
□
Who is responsible for SDSs, container labeling, employee
training?
□
Is each container for a hazardous substance (i.e. vats,
bottles, storage tanks,) labeled with product identity and a
hazard warning (communication of the specific health
hazards and physical hazards)?
□
Is there a Safety Data Sheet readily available for each
hazardous substance used?
□
How will you inform other employers whose employees
share the same work area where the hazardous substances
are used?
□
Is there an employee training program for hazardous
substances?
□
Does this program include:
□
An explanation of what an SDS is and how to use and
obtain one?
□
SDS contents for each hazardous substance or class of
substances?
□
Explanation of "Right to Know"?
□
Identification of where employees can see the employer's
written hazard communication program and where
hazardous substances are present in their work area?
□
The physical and health hazards of substances in the work
area, how to detect their presence, and specific protective
measures to be used?
□
Details of the hazard communication program, including how
to use the labeling system and SDSs?
□
How employees will be informed of hazards of non-routine
tasks, and hazards of unlabeled pipes?
Page 18 of 27
ELECTRICAL
□
Are your workplace electricians familiar with the Cal/OSHA
Electrical Safety Orders?
□
Do you specify compliance with Cal/OSHA for all contract
electrical work?
□
Are all employees required to report as soon as practicable
any obvious hazard to life or property observed in
connection with electrical equipment or lines?
□
Are employees instructed to make preliminary inspections
and/or appropriate tests to determine what conditions exist
before starting work on electrical equipment or lines?
□
When electrical equipment or lines are to be serviced,
maintained or adjusted, are necessary switches opened,
locked-out and tagged whenever possible?
□
Are portable electrical tools and equipment grounded or of
the double insulated type?
□
Are electrical appliances such as vacuum cleaners,
polishers, vending machines grounded?
□
Do extension cords being used have a grounding conductor?
□
Are multiple plug adapters prohibited?
□
Are ground-fault circuit interrupters installed on each
temporary 15 or 20 ampere, 120 volt AC circuit at locations
where construction, demolition, modifications, alterations or
excavations are being performed?
□
Are all temporary circuits protected by suitable disconnecting
switches or plug connectors at the junction with permanent
wiring?
□
Is exposed wiring and cords with frayed or deteriorated
insulation repaired or replaced promptly?
□
Are flexible cords and cables free of splices or taps?
□
Are clamps or other securing means provided on flexible
cords or cables at plugs, receptacles, tools, and equipment
and is the cord jacket securely held in place?
□
Are all cord, cable and raceway connections intact and
secure?
□
In wet or damp locations, are electrical tools and equipment
appropriate for the use or location or otherwise protected?
□
Is the location of electrical power lines and cables
(overhead, underground, underfloor, other side of walls)
determined before digging, drilling or similar work is begun?
□
Are metal measuring tapes, ropes, handlines or similar
devices with metallic thread woven into the fabric prohibited
where they could come in contact with energized parts of
equipment or circuit conductors?
□
Is the use of metal ladders prohibited in area where
the ladder or the person using the ladder could come
in contact with energized parts of equipment, fixtures
or circuit conductors?
□
Are all disconnecting switches and circuit breakers labeled to
indicate their use or equipment served?
□
Are disconnecting means always opened before fuses are
replaced?
□
Do all interior wiring systems include provisions for
grounding metal parts of electrical raceways, equipment and
enclosures?
□
Are all electrical raceways and enclosures securely fastened
in place?
□
Are all energized parts of electrical circuits and equipment
guarded against accidental contact by approved cabinets or
enclosures?
□
Is sufficient access and working space provided and
maintained about all electrical equipment to permit ready
and safe operations and maintenance?
□
Are all unused openings (including conduit knockouts) in
electrical enclosures and fittings closed with appropriate
covers, plugs or plates?
□
Are electrical enclosures such as switches, receptacles,
junction boxes, etc., provided with tight-fitting covers or
plates?
□
Are disconnecting switches for electrical motors in excess of
two horsepower, capable of opening the circuit when the
motor is in a stalled condition, without exploding? (Switches
must be horsepower rated equal to or in excess of the motor
hp rating).
□
Is low voltage protection provided in the control device of
motors driving machines or equipment, which could cause
probably injury from inadvertent starting?
□
Is each motor disconnecting switch or circuit breaker located
within sight of the motor control device?
□
Is each motor located within sight of its controller or the
controller disconnecting means capable of being locked in
the open position or is a separate disconnecting means
installed in the circuit within sight of the motor?
□
Is the controller for each motor in excess of two horsepower,
rated in horsepower equal to or in excess of the rating of the
motor is serves?
□
Are employees who regularly work on or around energized
electrical equipment or lines instructed in the
cardiopulmonary resuscitation (CPR) methods?
□
Are employees prohibited from working alone on energized
lines or equipment over 600 volts?
Page 19 of 27
NOISE
□
Are there areas in the workplace where continuous noise
levels exceed 85 dBA? (To determine maximum allowable
levels for intermittent or impact noise, see Title 8, Section
5097.)
□
Are noise levels being measured using a sound level meter
or an octave band analyzer and records being kept?
□
Have you tried isolating noisy machinery from the rest of
your operation?
□
Have engineering controls been used to reduce excessive
noise levels?
□
Where engineering controls are determined not feasible, are
administrative controls (i.e. worker rotation) being used to
minimize individual employee exposure to noise?
□
Is there an ongoing preventive health program to educate
employees in safe levels of noise and exposure, effects of
noise on their health, and use of personal protection?
□
Is the training repeated annually for employees exposed to
continuous noise above 85 dBA?
□
Have work areas where noise levels make voice
communication between employees difficult been identified
and posted?
□
Is approved hearing protective equipment (noise attenuating
devices) available to every employee working in areas where
continuous noise levels exceed 85 dBA?
□
If you use ear protectors, are employees properly fitted and
instructed in their use and care?
□
Are employees exposed to continuous noise above 85 dBA
given periodic audiometric testing to ensure that you have an
effective hearing protection system?
FUELING
□
Is it prohibited to fuel an internal combustion engine with a
flammable liquid while the engine is running?
□
Are fueling operations done in such a manner that likelihood
of spillage will be minimal?
□
When spillage occurs during fueling operations, is the spilled
fuel cleaned up completely, evaporated, or other measures
taken to control vapors before restarting the engine?
□
Are fuel tank caps replaced and secured before starting the
engine?
□
In fueling operations is there always metal contact between
the container and fuel tank?
□
Are fueling hoses of a type designed to handle the specific
type of fuel?
□
Is it prohibited to handle or transfer gasoline in open
containers?
□
Are open lights, open flames, or sparking or arcing
equipment prohibited near fueling or transfer of fuel
operations?
□
Is smoking prohibited in the vicinity of fueling operations?
□
Are fueling operations prohibited in building or other
enclosed areas that are not specifically ventilated for this
purpose?
□
Where fueling or transfer of fuel is done through a gravity
flow system, are the nozzles of the self-closing type?
IDENTIFICATION OF PIPING SYSTEMS
□
When nonpotable water is piped through a facility, are
outlets or taps posted to alert employees that it is unsafe and
not to be used for drinking, washing or other personal use?
□
When hazardous substances are transported through above
ground piping, is each pipeline identified at points where
confusion could introduce hazards to employees?
□
When pipelines are identified by color painting, are all visible
parts of the line so identified?
□
When pipelines are identified by color painted bands or
tapes, are the bands or tapes located at reasonable intervals
and at each outlet, valve or connection?
□
When pipelines are identified by color, is the color code
posted at all locations where confusion could introduce
hazards to employees?
□
When the contents of pipelines are identified by name or
name abbreviation, is the information readily visible on the
pipe near each valve or outlet?
□
When pipelines carrying hazardous substances are identified
by tags, are the tags constructed of durable materials, the
message carried clearly ad permanently distinguishable and
are tags installed at each valve or outlet?
□
When pipelines are heated by electricity, steam or other
external source, are suitable warning signs or tags placed at
unions, valves, or other serviceable parts of the system?
MATERIAL HANDLING
□
Is there safe clearance for equipment through aisles and
doorways?
□
Are aisleways designated, permanently marked, and kept
clear to allow unhindered passage?
□
Are motorized vehicles and mechanized equipment
inspected daily or prior to use?
□
Are vehicles shut off and brakes set prior to loading or
unloading?
□
Are containers or combustibles or flammables, when stacked
while being moved, always separated by dunnage sufficient
to provide stability?
Page 20 of 27
□
Are dock boards (bridge plates) used when loading or
unloading operations are taking place between vehicles and
docks?
□
Are trucks and trailers secured from movement during
loading and unloading operations?
□
Are dock plates and loading ramps constructed and
maintained with sufficient strength to support imposed
loading?
□
Are hand trucks maintained in safe operating condition?
□
Are chutes equipped with sideboards of sufficient height to
prevent the materials being handled from falling off?
□
Are chutes and gravity roller sections firmly placed or
secured to prevent displacement?
□
At the delivery end of rollers or chutes, are provisions made
to brake the movement of the handled materials.
□
Are pallets usually inspected before being loaded or moved?
□
Are hooks with safety latches or other arrangements used
when hoisting materials so that slings or load attachments
won't accidentally slip off the hoist hooks?
□
Are securing chains, ropes, chockers or slings adequate for
the job to be performed?
□
When hoisting material or equipment, are provisions made to
assure no one will be passing under the suspended loads?
□
Are Safety Data Sheets available to employees
handling hazardous substances?
TRANSPORTING EMPLOYEES & MATERIALS
□
Do employees who operate vehicles on public thoroughfares
have valid operator's licenses?
□
When seven or more employees are regularly transported in
a van, bus or truck, is the operator's license appropriate for
the class of vehicle being driven?
□
Is each van, bus or truck used regularly to transport
employees, equipped with an adequate number of seats?
□
When employees are transported by truck, are provision
provided to prevent their falling from the vehicle?
□
Are vehicles used to transport employees, equipped with
lamps, brakes, horns, mirrors, windshields and turn signals
in good repair?
□
Are transport vehicles provided with handrails, steps, stirrups
or similar devices, so placed and arranged that employees
can safely mount or dismount?
□
Are employee transport vehicles equipped at all times with at
least two reflective type flares?
□
Is a full charged fire extinguisher, in good condition, with at
least 4 B:C rating maintained in each employee transport
vehicle?
□
When cutting tools with sharp edges are carried in
passenger compartments of employee transport vehicles,
are they placed in closed boxes or containers which are
secured in place?
□
Are employees prohibited from riding on top of any load,
which can shift, topple, or otherwise become unstable?
CONTROL OF HARMFUL SUBSTANCES BY VENTILATION
□
Is the volume and velocity of air in each exhaust system
sufficient to gather the dusts, fumes, mists, vapors or gases
to be controlled, and to convey them to a suitable point of
disposal?
□
Are exhaust inlets, ducts and plenums designed,
constructed, and supported to prevent collapse or failure of
any part of the system?
□
Are clean-out ports or doors provided at intervals not to
exceed 12 feet in all horizontal runs of exhaust ducts?
□
Where two or more different type of operations are being
controlled through the same exhaust system, will the
combination of substances being controlled, constitute a fire,
explosion or chemical reaction hazard in the duct?
□
Is adequate makeup air provided to areas where exhaust
systems are operating?
□
Is the intake for makeup air located so that only clean, fresh
air, which is free of contaminates, will enter the work
environment?
□
Where two or more ventilation systems are serving a work
area, is their operation such that one will not offset the
functions of the other?
SANITIZING EQUIPMENT & CLOTHING
□
Is personal protective clothing or equipment, that employees
are required to wear or use, of a type capable of being easily
cleaned and disinfected?
□
Are employees prohibited from interchanging personal
protective clothing or equipment, unless it has been properly
cleaned?
□
Are machines and equipment, which processes, handle or
apply materials that could be injurious to employees,
cleaned and/or decontaminated before being overhauled or
placed in storage?
□
Are employees prohibited from smoking or eating in any
area where contaminates are present that could be injurious
if ingested?
□
When employees are required to change from street clothing
into protective clothing, is a clean changeroom with separate
storage facility for street and protective clothing provided?
Page 21 of 27
□
Are employees required to shower and wash their hair as
soon as possible after a known contact has occurred with a
carcinogen?
□
When equipment, materials, or other items are taken into or
removed from a carcinogen regulated area, is it done in a
manner that will not contaminate non-regulated areas or the
external environment?
TIRE INFLATION
□
Where tires are mounted and/or inflated on drop center
wheels is a safe practice procedure posted and enforced?
□
Where tires are mounted and/or inflated on wheels with split
rims and/or retainer rings is a safe practice procedure posted
and enforced?
□
Does each tire inflation hose have a clip-on chuck with at
least 24 inches of hose between the chuck and an in-line
hand valve and gauge?
□
Does the tire inflation control valve automatically shut off the
airflow when the valve is released?
□
Is a tire restraining device such as a cage, rack or other
effective means used while inflating tires mounted on split
rims, or rims using retainer rings?
□
Are employees strictly forbidden from taking a position
directly over or in front of a tire while it's being inflated?
EMERGENCY ACTION PLAN
□
Are you required to have an emergency action plan?
□
Does the emergency action plan comply with requirements
of T8CCR 3220(a)?
□
Have emergency escape procedures and routes been
developed and communicated to all employers?
□
Do employees, who remain to operate critical plant
operations before they evacuate, know the proper
procedures?
□
Is the employee alarm system that provides a warning for
emergency action recognizable and perceptible above
ambient conditions?
□
Are alarm systems properly maintained and tested regularly?
□
Is the emergency action plan reviewed and revised
periodically?
□
Do employees now their responsibilities:
□
For reporting emergencies?
□
During an emergency?
□
For conducting rescue and medical duties?
INFECTION CONTROL
□
Are employees potentially exposed to infectious agents in
body fluids?
□
Have occasions of potential occupational exposure been
identified and documented?
□
Has a training and information program been provided for
employees exposed to or potentially exposed to blood and/or
body fluids?
□
Have infection control procedures been instituted where
appropriate, such as ventilation, universal precautions,
workplace practices, and personal protective equipment?
□
Are employees aware of specific workplace practices to
follow when appropriate? (Hand washing, handling sharp
instruments, handling of laundry, disposal of contaminated
materials, reusable equipment.)
□
Is personal protective equipment provided to employees,
and in all appropriate locations?
□
Is the necessary equipment (i.e. mouthpieces, resuscitation
bags, and other ventilation devices) provided for
administering mouth-to-mouth resuscitation on potentially
infected patients?
□
Are facilities/equipment to comply with workplace practices
available, such as hand-washing sinks, biohazard tags and
labels, needle containers, detergents/disinfectants to clean
up spills?
□
Are all equipment and environmental and working surfaces
cleaned and disinfected after contact with blood or
potentially infectious materials?
□
Is infectious waste placed in closable, leak proof containers,
bags or puncture-resistant holders with proper labels?
□
Has medical surveillance including HBV evaluation, antibody
testing and vaccination been made available to potentially
exposed employees?
□
Training on universal precautions?
□
Training on personal protective equipment?
□
Training on workplace practices, which should include blood
drawing, room cleaning, laundry handling, clean up of blood
spills?
□
Training on needlestick exposure/management?
□
Hepatitis B vaccinations?
ERGONOMICS
□
Can the work be performed without eyestrain or glare to the
employees?
□
Does the task require prolonged raising of the arms?
□
Do the neck and shoulders have to be stooped to view the
task?
Page 22 of 27
□
Are there pressure points on any parts of the body (wrists,
forearms, back of thighs)?
□
Can the work be done using the larger muscles of the body?
□
Can the work be done without twisting or overly bending the
lower back?
□
Are there sufficient rest breaks, in addition to the regular rest
breaks, to relieve stress from repetitive-motion tasks?
□
Are tools, instruments and machinery shaped, positioned
and handled so that tasks can be performed comfortably?
□
Are all pieces of furniture adjusted, positioned and arranged
to minimize strain on all parts of the body?
VENTILATION FOR INDOOR AIR QUALITY
□
Does your HVAC system provide at least the quantity of
outdoor air required by the State Building Standards Code,
Title 24, Part 2 at the time the building was constructed?
□
Is the HVAC system inspected at least annually, and
problems corrected?
□
Are inspection records retained for at least 5 years?
CRANE CHECKLIST
□
Are the cranes visually inspected for defective components
prior to the beginning of any work shift?
□
Are all electrically operated cranes effectively grounded?
□
Is a crane preventive maintenance program established?
□
Is the load chart clearly visible to the operator?
□
Are operating controls clearly identified?
□
Is a fire extinguisher provided at the operator's station?
□
Is the rated capacity visibly marked on each crane?
□
Is an audible warning device mounted on each crane?
□
Is sufficient illumination provided for the operator to perform
the work safely?
□
Are cranes of such design, that the boom could fall over
backward, equipped with boomstops?
□
Does each crane have a certificate indicating that required
testing and examinations have been performed?
□
Are crane inspection and maintenance records maintained
and available for inspection?
Page 23 of 27
Page 24 of 27
HAZARD ASSESSMENT AND CORRECTION RECORD
Date of Inspection: Person Conducting Inspection:
Unsafe Condition or Work Practice:
Corrective Action Taken:
Date of Inspection: Person Conducting Inspection:
Unsafe Condition or Work Practice:
Corrective Action Taken:
Date of Inspection: Person Conducting Inspection:
Unsafe Condition or Work Practice:
Corrective Action Taken:
Page 25 of 27
ACCIDENT/EXPOSURE INVESTIGATION REPORT
Date & Time of Accident:
Location:
Accident Description:
Employees Involved:
Preventive Action Recommendations:
corrective Actions Taken:
Manager Responsible: Date Completed:
WORKER TRAINING AND INSTRUCTION RECORD
EMPLOYEE NAME
TRAINING DATES
TYPE OF TRAINING
TRAINERS
Page 26 of 27
On-site Assistance Program Area Offices
Northern California
2424 Arden Way, Suite 410
Sacramento, CA 95825
(916) 263-0704
San Francisco Bay Area
1515 Clay Street, Suite 1103
Oakland, CA 94612
(510) 622-2891
San Fernando Valley
6150 Van Nuys Blvd., Suite 307
Van Nuys, CA 91401
(818) 901-5754
Central Valley
1901 North Gateway Blvd., Suite 102
Fresno, CA 93727
(559) 454-1295
San Bernardino
464 West 4th Street, Suite 339
San Bernardino, CA 92401
(909) 383-4567
Santa Fe Springs/LA/Orange
1 Centerpointe Dr., Suite 150
La Palma, CA 90670
(714) 562-5525
San Diego/ Imperial
7575 Metropolitan Dr., Suite 204
San Diego, CA 92108
(619) 767-2060
Cal/OSHA Consultation Programs
• Toll-free Number: 1-800-963-9424 • Internet: www.dir.ca.gov
Page 27 of 27
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