Hsp Audit Form

8/9/2019 Hsp Audit Form

1/65

OFFICE AUDIT

Office: Date:

Office Manager: Safety Officer:

Auditor: Signature:

EMPLOYER POSTING

[ ] [ ] [ ] EP1 Is the OSHA (State-OSHA) Poster "Safety and Health Protection on the Job" displayedin a prominent location here all employees are li!ely to see it

# $ # $ # $ EP% Are emer&ency telephone n'mbers posted here they can be readily fo'nd in case of

emer&ency

# $ # $ # $ EP here employees may be e*posed to any to*ic s'bstances or harmf'l physical a&ents+has appropriate information concernin& employee access to medical and e*pos're records+

and ",aterial Safety ata Sheets"+ etc.+ been posted or otherise made readily a/ailable to

affected employees

# $ # $ # $ EP0 Are si&ns concernin& "E*itin& from b'ildin&s"+ room capacities+ floor loadin&+e*pos'res to *-ray+ microa/e+ or other harmf'l radiation or s'bstances posted here

appropriate

# $ # $ # $ EP Are si&ns concernin& ha2ardo's s'bstances posted here appropriate

# $ # $ # $ EP3 Is the location of H4SP, posted

# $ # $ # $ EP5 Is the location of the ritten 6espiratory Protection Pro&ram posted

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e 1 of 3


2/65

# $ # $ # $ EP: Is the location of the ritten Ha2ard


3/65

# $ # $ # $ 6 o employees !no here and hat H4SP, is

# $ # $ # $ 63 Are records !ept in the Employee Health and Safety History @ile as to health and

safety trainin& recei/ed by employees

# $ # $ # $ 65 Are accidents bein& in/esti&ated by the site s'per/isor ith the s'pport of the

Safety Officer and reported to OE= All employees sho'ld ha/e an Employees Health and

Safety History file e*cept office and administrati/e personnel ho ha/e not had a or!

related illness or in?'ry in/esti&ated.

# $ # $ # $ 69 Are records of physical e*aminations and other medical records remo/ed from the

Employee Health and Safety History file Only medical clearance forms and asbestos

B'estionnaires sho'ld be fo'nd in the file.

# $ # $ # $ 61; Are si&ned employee ac!noled&ements from the


4/65

# $ # $ # $ 61% Are operatin& permits and records 'p-to-date for s'ch items as ele/ators+ air press'retan!s+ liB'efied petrole'm &as tan!s in e*cess of 1%; ater &allons+ etc. (chec! ith fire

department for specifics+ # &allons of flammable liB'ids inside+ 1; &allons o'tside$ #%&allons of comb'stible liB'ids inside+ 3; &allons o'tside$ #abo/e &ro'nd flammable liB'id

stora&e tan!s$ #ha2ardo's materials 1;; po'nds solid+ &allons liB'id+ 1;; c'bic feet&as$)

RADIATION SAFETY

# $ # $ # $ 6S1 Is the @ederal license c'rrent and not e*pired

# $ # $ # $ 6S% Is the State license c'rrent and not e*pired

# $ # $ # $ 6S Has the license been amended to reflect c'rrent 'sers

# $ # $ # $ 6S0 Are the reB'ired doc'ments present in each &a'&e case

A. Cist of a'thori2ed HF6OGEOCOGIO.

88888888888888888888888888888888888888888888888888 888888888888888

88888888888888888888888888888888888888888888888888 888888888888888 88888888888888888888888888888888888888888888888888 888888888888888

88888888888888888888888888888888888888888888888888 888888888888888 88888888888888888888888888888888888888888888888888 888888888888888

88888888888888888888888888888888888888888888888888 888888888888888 88888888888888888888888888888888888888888888888888 888888888888888

88888888888888888888888888888888888888888888888888 888888888888888



5/65

# $ # $ # $ 6S3 Has the license been amended to reflect the c'rrent Acti/ity 6adiation Safety Officer(A6SO) ith contact n'mbers

# $ # $ # $ 6S5 Has the license been amended to reflect the c'rrent


6/65

# $ # $ # $ 6S1 Is a copy of the c'rrent applicable radiation control re&'lations located in the office

# $ # $ # $ 6S13 Are film bad&e reports ithin re&'latory limits and e*pos'res considered as lo as

reasonably achie/able (ACA6A)

# $ # $ # $ 6S15 oes the A6SO ha/e on file complete dosimetry records

# $ # $ # $ 6S1: Are radioacti/e shipment handlin& and s'r/ey records c'rrent and complete

# $ # $ # $ 6S19 Has the A6SO established and maintained proper transportation proced'res ith

proper labels+ placards+ forms and records

# $ # $ # $ 6S%; Is there a "Shippin& Paper" for each n'clear so'rce to be carried on the seat ne*t to

the dri/er or on the dri/ers door hen transportin& the n'clear so'rce

# $ # $ # $ 6S%1 Is the I> 7 O lo& 'p to date oes it acc'rately reflect the contents of the stora&e

cabinet

# $ # $ # $ 6S%% Ha/e there been any radiation or contamination incidents (i.e. dama&ed n'clear

so'rces)

# $ # $ # $ 6S% Are records of semi-ann'al in/entories of n'clear so'rces c'rrent and complete



7/65

# $ # $ # $ 6S%0 Ha/e ann'al or semi-ann'al lea! test of sealed so'rces been completed and recorded(Cea! tests are d'e each October for all so'rces and also in April for ell lo&&ers and ,AP).

# $ # $ # $ 6S% oes the Acti/ity 6adiation Safety Officer (A6SO) ens're that the licensed materials

are 'sed only by those indi/id'als ho ha/e satisfactorily completed appropriate trainin&

pro&rams or ho are a'thori2ed by the license (


8/65

# $ # $ # $ 6S% Is each n'clear so'rce loc!ed 'p or sec'red hen not in the direct control of thea'thori2ed 'ser

# $ # $ # $ 6S oes each HF6OGEOCOGIame=88888888888888888888888888888888888888888888888888

>ame=88888888888888888888888888888888888888888888888888

>ame=88888888888888888888888888888888888888888888888888

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e : of 3


9/65

# $ # $ # $ SH Is the IIPP bein& properly implemented

# $ # $ # $ SH3 Is the IIPP re/ieed and 'pdated as necessary

# $ # $ # $ SH5 Is the ritten 6espiratory Protection Pro&ram completed

# $ # $ # $ SH: Is the ritten Ha2ard


10/65

# $ # $ # $ SH1 Is there a system for employee comm'nication on health and safety iss'es in place# $ b'lletin board

# $ distrib'tion of monthly safety b'lletins (


11/65


12/65

MEDICAL SERVICES

# $ # $ # $ ,S1 oes each field employee that may contact ha2ardo's materials ha/e a pre-employment physical e*amination

# $ # $ # $ ,S% Is the Safety Officer informed by H'man 6eso'rces hen an employee is lea/in& thecompany

# $ # $ # $ ,S Is each field employee ho is on the ,edical ,onitorin& Pro&ram e/al'ated as to

need to ha/e an e*it physical

# $ # $ # $ ,S0 oes each field employee+ hose last physical is o/er 3 months old+ ha/e an e*it physical before lea/in& the company

here is the hospital+ clinic+ or infirmary 'sed for emer&ency medical care in pro*imity of

the or!place

# $ # $ # $ ,S Are medical personnel readily a/ailable for ad/ice and cons'ltation on matters of

employee health

# $ # $ # $ ,S3 Is there a ret'rn to or! or modified ?ob pro&ram in place for employees ho are

in?'red or become ill on the ?ob

# $ # $ # $ ,S5 Are employees instr'cted on ho they are to &o to for or! related illness and

in?'ries

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e 1% of 3


13/65

# $ # $ # $ ,S: Is the identity of the contract medical pro/ider for medical monitorin& physicals andor!man compensation treatment posted

# $ # $ # $ ,S9 Is the protocol for each type of physical bein& folloed

# $ # $ # $ ,S1; Are abnormalities fo'nd on the medical monitorin& physical reported to the

employee

# $ # $ # $ ,S11 Is the report of abnormalities+ hich is reported to the employee+ doc'mented on the

6es'lts and 6ecommendations for ,edical


14/65

# $ # $ # $ @A0 Ha/e first aid !it s'pplies been appro/ed by a physician+ indicatin& that they areadeB'ate for a partic'lar area or operation

# $ # $ # $ @A Are means pro/ided for B'ic! drenchin& or fl'shin& of the eyes and body in areas

here corrosi/e liB'ids or materials are handled

# $ # $ # $ @A3 Ha/e these eyeashes and shoers been inspected and !ept ready for 'se

FIRE PROTECTION

# $ # $ # $ @P1 Is yo'r local fire department ell acB'ainted ith yo'r facilities+ its location and

specific ha2ards

# $ # $ # $ @P% Is there a ritten @ire Pre/ention Plan readily a/ailable

# $ # $ # $ @P Ha/e fire ha2ards been identified in the /ario's facilities controlled by the office and

listed in the @ire Pre/ention Plan

# $ # $ # $ @P0 Are proper ho'se!eepin& proced'res folloed to minimi2e the ris!s of fire

# $ # $ # $ @P Is a clearance of ; inches maintained beteen comb'stibles and heat prod'cin&

appliances

# $ # $ # $ @P3 Has the person responsible for the maintenance of the fire pre/ention eB'ipment7fire

s'ppression eB'ipment been desi&nated in the @ire Pre/ention Plan



15/65

# $ # $ # $ @P5 Are the facility fire e*tin&'ishers bein& inspected on a monthly basis by the person desi&nated the @ire Pre/ention Plan

# $ # $ # $ @P: If yo' ha/e a fire alarm system+ is it certified as reB'ired

# $ # $ # $ @P9 Is the fire alarm system tested at least ann'ally

# $ # $ # $ @P1; Are the sprin!ler /al/es loc!ed in the open position+ accessible and 'nobstr'cted.

# $ # $ # $ @P11 Are there spare sprin!ler heads+ pl'& (or cap)+ and a sprin!ler head rench a/ailable

in the b'ildin&

# $ # $ # $ @P1% Are sprin!ler heads protected by metal &'ards+ hen e*posed to physical dama&e

# $ # $ # $ @P1 Is proper clearance maintained belo sprin!ler heads (1:")

# $ # $ # $ @P10 Is proper clearance maintained belo ceilin&s in b'ildin&s itho't sprin!lers (%0")

# $ # $ # $ @P1 Are all ceilin& tiles in their proper place

# $ # $ # $ @P13 Are all bro!en ceilin& tiles or ceilin& tiles ith holes replaced as needed (Small

holes for drop cords are O)



16/65

# $ # $ # $ @P15 Are fire department connection caps in place and are they or!in& freely

# $ # $ # $ @P1: Are portable fire e*tin&'ishers pro/ided in adeB'ate n'mber

# $ # $ # $ @P19 Are fire e*tin&'ishers selected and pro/ided for the types of materials in areas here

they are to be 'sed


17/65

# $ # $ # $ @P% Are fire e*tin&'ishers o/erchar&ed7'nderchar&ed

# $ # $ # $ @P%3 Are all e*tin&'ishers f'lly char&ed and in their desi&nated places

FLAMMABLE AND COMBUSTIBLE MATERIALS

# $ # $ # $ @


18/65

PERSONAL PROTECTIVE EQUIPMENT AND CLOTHING

# $ # $ # $ PP1 Are protecti/e &o&&les or safety &lasses pro/ided and orn here there is any dan&erof flyin& particles+ corrosi/e materials+ or splashin& chemicals

# $ # $ # $ PP% Are appro/ed safety &lasses reB'ired to be orn at all times in areas here there is aris! of eye in?'ries s'ch as p'nct'res+ abrasions+ cont'sions or b'rns

# $ # $ # $ PP Are employees ho need correcti/e lenses (&lasses or contacts)+ or!in& in

en/ironments here there is a ris! of eye in?'ry+ reB'ired to ear only appro/ed safety

&lasses+ protecti/e &o&&les+ or 'se other medically appro/ed preca'tionary proced'res

# $ # $ # $ PP0 Are protecti/e &lo/es+ aprons+ shields+ co/eralls or other means pro/ided and 'sed

a&ainst c'ts+ corrosi/e liB'ids and chemicals

# $ # $ # $ PP Is appropriate foot protection reB'ired here there is the ris! of foot in?'ries from hot+

corrosi/e+ poisono's s'bstances+ fallin& ob?ects+ cr'shin& or penetratin& actions

# $ # $ # $ PP3 Are appro/ed respirators and cartrid&es orn for protection from respiratory ha2ards

# $ # $ # $ P65 Are employees ho are reB'ired to ear respirators trained in respirator 'se+ fit tested

ann'ally (e/ery 3 months for asbestos) and ha/e recei/ed a medical clearance to ear

respirators ann'ally

# $ # $ # $ P6: Is all protecti/e eB'ipment maintained in a sanitary condition and ready for 'se

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e 1: of 3


19/65

GENERAL WORK ENVIRONMENT

# $ # $ # $ G1 Are all or! sites clean and orderly

# $ # $ # $ G% Are all spilled materials or liB'ids cleaned 'p immediately

# $ # $ # $ G Are all or! areas adeB'ately ill'minated

# $ # $ # $ G0 Are there a minim'm n'mber of toilets and ashin& facilities pro/ided

# $ # $ # $ G Are rest rooms and ashrooms !ept clean and sanitary

ERGONOMICS

# $ # $ # $ E61 Are the companys &'idelines for or! bein& folloed

# $ # $ # $ E6% Are employees or!in& at s 'tili2in& proper post're

# $ # $ # $ E6 Are employees or!in& at s ta!in& appropriate alternate or! brea!s

# $ # $ # $ E60 Has f'rnit're appropriate for the tas! bein& performed been pro/ided



20/65

# $ # $ # $ E6 Has the f'rnit're been ad?'sted+ positioned and 'tili2ed properly so as to minimi2estrain

# $ # $ # $ E63 Are all employees periodically trained in proper er&onomic or! practices

# $ # $ # $ E65 Are li&htin& le/els appropriate for the tas!s bein& performed

# $ # $ # $ E6:


21/65

# $ # $ # $ E61 Are there s'fficient rest brea!s+ in addition to the re&'lar rest brea!s+ to relie/e stressfrom repetiti/e motion tas!s

# $ # $ # $ E613 Are tools+ instr'ments and machinery shaped+ positioned and handled so that the

reB'ired tas!s can be performed comfortably

WALKWAYS

# $ # $ # $ A1 Are aisles and passa&eays !ept clear

# $ # $ # $ A% Are aisles and al!ays mar!ed as appropriate

# $ # $ # $ A Are any holes in the floor+ sideal! or other al!in& s'rface repaired properly+

co/ered or otherise made safe

STAIRS AND STAIRWAYS

# $ # $ # $ SS1 here stairs or stairays e*it directly into any area here /ehicles may be operated+

are adeB'ate barriers and arnin&s pro/ided to pre/ent employees steppin& into the path of

traffic

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e %1 of 3


22/65

ELEVATED SURFACES

# $ # $ # $ ES1 Is the material on ele/ated s'rfaces piled+ stac!ed or rac!ed in a manner to pre/ent itfrom tippin&+ fallin&+ collapsin&+ rollin& or spreadin&

# $ # $ # $ ES% Are all ele/ated s'rfaces (beneath hich people or machinery co'ld be e*posed tofallin& ob?ects) pro/ided ith standard 0 inch toe boards

# $ # $ # $ ES Are all shel/es and cabinets attached to the all or other solid member

EXITING OR EGRESS

# $ # $ # $ EE1 Are all e*its mar!ed ith an e*it si&n and ill'minated by a reliable li&ht so'rce

# $ # $ # $ EE% Are the directions to e*its+ hen not immediately apparent+ mar!ed ith /isible si&ns

# $ # $ # $ EE Are doors+ passa&eays or stairays+ that are neither e*its nor access to e*its and

hich co'ld be mista!en for e*its+ appropriately mar!ed ">O EKI" (>OE= E*istin&si&ns do not ha/e to be chan&ed to this standard.)

# $ # $ # $ EE0 Are e*it si&ns pro/ided and the ord "EKI" in letterin& at least 3 inches hi&h and the

stro!e of the letterin& at least 70 inch ide

# $ # $ # $ EE Are e*it doors side-hin&ed or of the pi/oted sin&in& type

# $ # $ # $ EE3 Are all e*its !ept free of obstr'ctions

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e %% of 3


23/65

# $ # $ # $ EE5 Are doors hich are reB'ired to ser/e as e*its desi&ned and constr'cted so that the ayof e*it tra/el is ob/io's and direct

# $ # $ # $ EE: Are e*it doors able to be opened from the direction of e*it tra/el itho't the 'se of a

!ey or any special !noled&e or effort hen the b'ildin& is occ'pied

# $ # $ # $ EE9 here panic hardare is installed on a reB'ired e*it door+ ill it allo the latch to bereleased by applyin& a force of 1 po'nds or less in the direction of the e*it traffic

# $ # $ # $ EE1; Are /iein& panels pro/ided in doors that sin& in both directions and are located

beteen rooms here there is freB'ent traffic

# $ # $ # $ EE11 Is there stora&e beneath enclosed stairs (m'st be protected by 1 ho'r constr'ction)

# $ # $ # $ EE1% Are all e*it paths li&hted at all times that the b'ildin& occ'pied. (If the e*it pathli&hts are s'b?ect to bein& t'rned off or fail're+ has emer&ency li&htin& been pro/ided)

HAND TOOLS AND EQUIPMENT

# $ # $ # $ H1 Are all tools and eB'ipment (both company and employee-oned) 'sed by employees

at their or!place in &ood condition

# $ # $ # $ H% Are bro!en or fract'red handles on hammers+ a*es and similar eB'ipment replaced

promptly

# $ # $ # $ H Are orn or bent renches replaced re&'larly

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e % of 3


24/65

# $ # $ # $ H0 Are appropriate handles 'sed on files and similar tools

# $ # $ # $ H Are employees made aare of the ha2ards ca'sed by fa'lty or improperly 'sed hand

tools

# $ # $ # $ H3 Are appropriate safety &lasses or &o&&les orn by employees hile 'sin& hand tools

or eB'ipment hich mi&ht prod'ce flyin& materials or be s'b?ect to brea!a&e

# $ # $ # $ H5 Are tool handles ed&ed ti&htly in the head of all tools

PORTABLE (POWER OPERATED) TOOLS AND EQUIPMENT

# $ # $ # $ P1 Are the rotatin& or mo/in& parts of eB'ipment &'arded to pre/ent physical contact

# $ # $ # $ P% Are all cord-connected+ electrically-operated tools and eB'ipment effecti/ely &ro'ndedor of the appro/ed do'ble ins'lated type

# $ # $ # $ P Are the portable fans in 'se pro/ided ith f'll &'ards or screens ha/in& openin&s 17%

inch or less

# $ # $ # $ P0 Are pne'matic and hydra'lic hoses on poer-operated tools chec!ed re&'larly for

deterioration or dama&e



25/65

ABRASIVE WHEEL EQUIPMENT - GRINDERS

# $ # $ # $ A1 Is the or! rest !ept ad?'sted to ithin 17: inch of the heel and 'sed hen inoperation

# $ # $ # $ A% Is the ad?'stable ton&'e on the top side of the &rinder !ept ad?'sted to ithin 170Linchof the heel and 'sed hen in operation

# $ # $ # $ A o side &'ards co/er the spindle+ n't+ and flan&e and 5 percent of the heel

diameter

# $ # $ # $ A0 Are bench and pedestal &rinders permanently mo'nted

# $ # $ # $ A oes each &rinder ha/e an indi/id'al on and off control sitch

# $ # $ # $ A3 Are &o&&les or face shields alays orn hen &rindin&

PORTABLE LADDERS

# $ # $ # $ PC1 Are all ladders maintained in &ood condition+ ?oints beteen steps and side rails ti&ht+

hardare and fittin&s sec'rely attached and mo/eable parts operatin& freely itho't bindin&

or 'nd'e play

# $ # $ # $ PC% Are non-slip safety feet pro/ided on each ladder

# $ # $ # $ PC Are ladder r'n&s and steps free of &rease and oil or other debris



26/65

# $ # $ # $ PC0 Are employees pro/ided doc'mented ladder safety and 'se trainin&

# $ # $ # $ PC hen portable r'n& e*tension ladders are 'sed to &ain access to ele/ated platforms+

roofs+ etc.+ does the ladder alays e*tend at least feet abo/e the ele/ated s'rface

# $ # $ # $ PC3 Are e*tension ladders tied off before 'se or ha/e someone holdin& the ladder hen in

'se

# $ # $ # $ PC5 Are portable metal ladders le&ibly mar!ed ith si&ns readin& " - o >ot

se Aro'nd Electrical EB'ipment" or eB'i/alent ordin&

# $ # $ # $ PC: Are ladders inspected for dama&e

COMPRESSORS AND COMPRESSED AIR

# $ # $ # $


27/65

COMPRESSED GAS CYLINDERS

# $ # $ # $


28/65

# $ # $ # $ E


29/65

# $ # $ # $ EC3 Are fl'orescent li&hts protected from dama&e either by an enclosed fi*t're or'nbrea!able slee/es aro'nd the t'bes here there is a potential for dama&e

# $ # $ # $ EC5 Are fle*ible cords and cables free of splices or taps

# $ # $ # $ EC: Are clamps of other sec'rin& means pro/ided of fle*ible cords or cables at pl'&s+

receptacles+ tools+ eB'ipment+ and is the cord ?ac!et sec'rely held in place

# $ # $ # $ EC9 Is the 'se of metal ladders prohibited in areas here the ladder or the person 'sin& the

ladder co'ld come in contact ith ener&i2ed parts of eB'ipment+ fi*t'res or circ'it

cond'ctors

# $ # $ # $ EC1; Are all disconnectin& sitches and circ'it brea!ers labeled to indicate their 'se oreB'ipment ser/ed

# $ # $ # $ EC11 Are all 'n'sed openin&s (incl'din& cond'it !noc!o'ts) in electrical enclos'res and

fittin&s closed ith appropriate co/ers+ pl'&s or plates

# $ # $ # $ EC1% Are electrical enclos'res s'ch as sitches+ receptacles+ ?'nction bo*es pro/ided ithti&ht-fittin& co/ers or plates

# $ # $ # $ EC1 Is the location of electrical poer lines and cables (o/erhead+ 'nder&ro'nd+ 'nderfloor+ other side of alls+ etc.) determined before di&&in&+ drillin& or similar or! is be&'n

# $ # $ # $ EC10 Is there a foot clearance aro'nd all electrical panels



30/65

# $ # $ # $ EC1 Ha/e e*tension cords been affi*ed to or e*tended thro'&h alls+ ceilin&s+ floors+ or'nder doors

HAZARDOUS CHEMICAL EXPOSURES

# $ # $ # $ H


31/65

# $ # $ # $ H


32/65

# $ # $ # $ HS5 o employees !no hat information is contained on an ,aterial Safety ata Sheet(,SS)

# $ # $ # $ HS: Is there a ,SS readily a/ailable for each ha2ardo's s'bstance 'sed

# $ # $ # $ HS9 o employees !no here ,SSs are !ept

# $ # $ # $ HS1; Is there an employee trainin& pro&ram for ha2ardo's s'bstances to incl'de ane*planation of hat an ,SS is and ho to 'se and obtain one+ ,SS contents for each

ha2ardo's s'bstance or class of s'bstances+ e*planation of the "6i&ht to no"+ location of

ritten ha2ard comm'nication pro&ram+ location of ha2ardo's s'bstances+ ho to detect the

presence of ha2ardo's s'bstances+ and hat specific protecti/e meas'res to be 'sed

SANITIZING EQUIPMENT AND CLOTHING

# $ # $ # $ SE1 Is personal protecti/e clothin& or eB'ipment that employees are reB'ired to ear or

'se+ of a type capable of bein& cleaned easily and disinfected

# $ # $ # $ SE% Are employees prohibited from interchan&in& personal protecti/e clothin& or

eB'ipment+ 'nless it has been properly cleaned

# $ # $ # $ SE Are machines and eB'ipment+ hich processes+ handles or applies materials hich

co'ld be in?'rio's to employees+ cleaned and7or decontaminated before bein& o/erha'led or placed in stora&e



33/65

MATERIAL HANDLING

# $ # $ # $ ,H1 Is there safe clearance for eB'ipment thro'&h aisles and doorays

# $ # $ # $ ,H% Are aisle ays desi&nated and !ept clear to allo 'nhindered passa&e

# $ # $ # $ ,H% Are tr'c!s and trailers sec'red from mo/ement d'rin& loadin& and 'nloadin&operations

# $ # $ # $ ,H Are hand tr'c!s maintained in safe operatin& condition

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e of 3


34/65

EQUIPMENT STORAGE


# $ # $ # $ E@


35/65

# $ # $ # $ E,G3 Is the machinery maintained by a ser/ice contract

# $ # $ # $ E,G5 Is there a poer sh't-off sitch ithin reach of the operators position at each

machine

# $ # $ # $ E,G:


36/65

# $ # $ # $ EES0 Are instr'ments decontaminated before ret'rn to stora&e

# $ # $ # $ EES Are instr'ments decontaminated before bein& sent for repair



37/65

FIELD OB SITE AUDIT

EMPLOYER POSTING

# $ # $ # $ @EP1 Is the OSHA (State-OSHA) Poster "Safety and Health Protection on the Job"displayed in a prominent location at semi-permanent ?ob sites here all employees are li!ely

to see it

# $ # $ # $ @EP% Are emer&ency telephone n'mbers posted here they can be readily fo'nd in case of

emer&ency

# $ # $ # $ @EP Are si&ns concernin& "E*itin& from b'ildin&s"+ room capacities+ floor loadin&+

e*pos'res to *-ray+ microa/e+ or other harmf'l radiation or s'bstances posted here

appropriate

RECORD KEEPING

# $ # $ # $ @61 Are operatin& permits and records 'p-to-date for s'ch items as ele/ators+ air press're

tan!s+ liB'efied petrole'm &as tan!s+ etc.

# $ # $ # $ @6% Are health and safety trainin& records !ept on the ?ob site

# $ # $ # $ @6 Is there a Site Specific Health and Safety Plan on each ?ob site



38/65

# $ # $ # $ @60 o /isitors participatin& in an orientation and ac!noled&in& participation in theorientation by si&nin& the /isitors lo& to incl'de=

# $ &eneral site information

# $ operations

# $ history

# $ specific ha2ards

# $ principal reB'irements

# $ a/ailability of Site Specific Health and Safety Plan

RADIATION SAFETY

# $ # $ # $ @6S1 Are the reB'ired doc'ments present in each &a'&e case

A. Cist of a'thori2ed HF6OGEOCOGI


39/65

# $ # $ # $ @6S0 Are radioacti/e shipment handlin& and s'r/ey records c'rrent and complete

# $ # $ # $ @6S Has the A6SO established and maintained proper transportation proced'res ith

proper labels+ placards+ forms and records

# $ # $ # $ @6S3 Is there a "Shippin& Paper" for each n'clear so'rce to be carried on the seat ne*t to

the dri/er or on the dri/ers door hen transportin& the n'clear so'rce

# $ # $ # $ @6S5 Is the I> 7 O lo& 'p to date oes it acc'rately reflect the contents of the stora&e

cabinet

# $ # $ # $ @6S: oes the 6adiation Safety Officer (6SO) ens're that the licensed materials are 'sed

only by those indi/id'als ho ha/e satisfactorily completed appropriate trainin& pro&ramsor ho are a'thori2ed by the license (chec! the si&n o't lo& for each &a'&e)

# $ # $ # $ @6S9 oes the A6SO ha/e a "trainin& certificate" on file for each &a'&e 'ser

# $ # $ # $ @6S1; oes the A6SO ens're that the 'sers ear personal monitorin& eB'ipment (film

bad&es)

# $ # $ # $ @6S11 Is each n'clear so'rce loc!ed 'p or sec'red hen not in the direct control of the

a'thori2ed 'ser

# $ # $ # $ @6S1% oes each HF6OGEOCOGI


40/65

# $ # $ # $ @6S1 Are methods of personal radiation monitorin& employed here there is a potentialfor radiation e*pos're (e.&. dosimetry bad&es at a landfill field pro&ram)

# $ # $ # $ @6S10 Is radiation field monitorin& eB'ipment a/ailable for detection of possible

radioacti/e materials on the site

SAFETY AND HEALTH PROGRAM

# $ # $ # $ @SH1 Are ail Gate Safety ,eetin&s ta!in& place and are records of the s'b?ect of the

meetin& bein& !ept alon& ith the names of attendees

# $ # $ # $ @SH% Ha/e all personnel e*posed to ha2ardo's astes completed the 0; ho'r or %0 ho'rtrainin& as appropriate

# $ # $ # $ @SH Are all personnel e*posed to ha2ardo's asted c'rrent in their trainin&

# $ # $ # $ @SH0 Ha/e all field personnel recei/ed the %0 ho'r or : ho'r s'per/ised field e*perience

trainin& as reB'ired

# $ # $ # $ @SH Ha/e all personnel completed a refresher co'rse if needed

# $ # $ # $ @SH3 Ha/e the s'per/isors completed an ei&ht ho'r s'per/isor co'rse

# $ # $ # $ @SH5 Ha/e employees recei/ed speciali2ed trainin& as reB'ired Masbestos+ confined entry+

etc.N

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e 0; of 3


41/65

# $ # $ # $ @SH: Ha/e employees recei/ed trainin& in first aid+


42/65

MEDICAL SERVICES

# $ # $ # $ @,S1 Are directions to the hospital+ clinic+ or infirmary for medical care in pro*imity ofyo'r or!place posted

FIRST AID

# $ # $ # $ @@A1 Are first aid !its easily accessible to each or! area+ ith necessary s'pplies

a/ailable+ periodically inspected and replenished as needed

# $ # $ # $ @@A% Ha/e first aid !it s'pplies been appro/ed by a physician+ indicatin& that they areadeB'ate for a partic'lar area or operation

# $ # $ # $ @@A Are the first aid !its periodically inspected and replenished as needed

# $ # $ # $ @@A0 Are means pro/ided for B'ic! drenchin& or fl'shin& of the eyes and body in areas

here corrosi/e liB'ids or materials are handled

FIRE PROTECTION

# $ # $ # $ @@P1 Is yo'r local fire department ell acB'ainted ith yo'r facilities+ its location and

specific ha2ards

# $ # $ # $ @@P% Are fire e*tin&'ishers selected and pro/ided for the types of materials in areas here

they are to be 'sed


43/65

# $ # $ # $ @@P Are all e*tin&'ishers ser/iced+ maintained and ta&&ed at inter/als not to e*ceed oneyear

# $ # $ # $ @@P0 Are all e*tin&'ishers f'lly char&ed and in their desi&nated places

# $ # $ # $ @@P Are portable fire e*tin&'ishers pro/ided in adeB'ate n'mber and type

# $ # $ # $ @@P3 Is there a portable fire e*tin&'isher pro/ided in each /ehicle

# $ # $ # $ @@P5 Are fire e*tin&'ishers mo'nted in readily accessible locations and free from

obstr'ction

# $ # $ # $ @@P: Are employees periodically instr'cted in the 'se of e*tin&'ishers and fire protection

proced'res

# $ # $ # $ @@P9 Are appropriate fire e*tin&'ishers mo'nted ithin 5 feet of o'tside areas containin&

flammable liB'ids+ and ithin 1; feet of any inside stora&e area for s'ch materials


# $ # $ # $ @@


44/65

# $ # $ # $ @@


45/65

# $ # $ # $ @PP Are employees ho need correcti/e lenses (&lasses or contacts) in or!in&en/ironments ha/in& harmf'l e*pos'res+ reB'ired to ear only appro/ed safety &lasses+

protecti/e &o&&les+ or 'se other medically appro/ed preca'tionary proced'res

# $ # $ # $ @PP0 Are protecti/e &lo/es+ aprons+ shields+ or other means pro/ided a&ainst c'ts+ corrosi/e

liB'ids and chemicals

# $ # $ # $ @PP Are hard hats pro/ided and orn here dan&er of fallin& ob?ects e*ists

# $ # $ # $ @PP3 Are the hard hats inspected periodically for dama&e to the shell and s'spension

system

# $ # $ # $ @PP5 Are safety /ests orn hen traffic or mo/in& eB'ipment is present

# $ # $ # $ @PP: Is appropriate foot protection reB'ired here there is the ris! of foot in?'ries from hot+corrosi/e+ poisono's s'bstances+ fallin& ob?ects+ cr'shin& or penetratin& actions

# $ # $ # $ @PP9 If yo' ha/e a respirator protection pro&ram+ are yo'r employees instr'cted on the

correct 'sa&e and limitations of the respirators

# $ # $ # $ @PP1; Are the respirators and cartrid&es >IOSH appro/ed for the partic'lar application

# $ # $ # $ @@P11 Ha/e the respirators 'sed at the site been cleaned and repaired after 'se



46/65

# $ # $ # $ @@P1% Ha/e the employees ho are reB'ired to ear respirators been fit tested asappropriate

# $ # $ # $ @@P1 Ha/e the employees reB'ired to ear respirators recei/ed a medical clearance to

ear the respirators

# $ # $ # $ @PP10 Is all protecti/e eB'ipment maintained in a sanitary condition and ready for 'se

# $ # $ # $ @PP1 Are adeB'ate or! proced'res+ protecti/e clothin& and eB'ipment pro/ided and 'sed

hen cleanin& 'p spilled to*ic or otherise ha2ardo's materials or liB'ids

# $ # $ # $ @PP13 Are ear pl'&s 7 m'ffs pro/ided hen so'nd le/els ma!e con/ersation diffic'lt at a

distance of feet (arms len&th)

GENERAL WORK ENVIRONMENT

# $ # $ # $ @G1 Are all or! areas adeB'ately ill'minated

# $ # $ # $ @G% Are there a minim'm n'mber of toilets and ashin& facilities pro/ided

WALKWAYS

# $ # $ # $ @A1 Are aisles and al!ays !ept clear

# $ # $ # $ @A% Are aisles and al!ays mar!ed as appropriate



47/65

# $ # $ # $ @A Are holes in the floor+ sideal! or other al!in& s'rface repaired properly+ co/eredor otherise made safe

STAIRS AND STAIRWAYS

# $ # $ # $ @SS1 Are standard stair rails or handrails on all stairays ha/in& fo'r or more risers

# $ # $ # $ @SS% Are all stairays at least %% inches ide

# $ # $ # $ @SS o stairs ha/e at least a 5 o/erhead clearance

# $ # $ # $ @SS0 Are step risers on stairs 'niform from top to bottom

# $ # $ # $ @SS Are steps on stairs and stairays desi&ned or pro/ided ith a s'rface that renders

them slip resistant

# $ # $ # $ @SS3 o stairay handrails ha/e at appro*imately inches of clearance beteen the

handrails and the all or s'rface that they are mo'nted on

# $ # $ # $ @SS5 here stairs or stairays e*it directly into any area here /ehicles may be operated+are adeB'ate barriers and arnin&s pro/ided to pre/ent employees steppin& into the path of

traffic



48/65

ELEVATED SURFACES

# $ # $ # $ @ES1 Is material on ele/ated s'rfaces piled+ stac!ed or rac!ed in a manner to pre/ent it

from tippin&+ fallin&+ collapsin&+ rollin& or spreadin&

# $ # $ # $ @ES% Are all ele/ated s'rfaces (beneath hich people or machinery co'ld be e*posed to

fallin& ob?ects) pro/ided ith standard 0 inch toe boards

EXITING OR EGRESS

# $ # $ # $ @EE1 Are all e*its !ept free of obstr'ctions

HAND TOOLS AND EQUIPMENT

# $ # $ # $ @H1 Are all tools and eB'ipment (both company and employee-oned) 'sed by

employees at their or!place in &ood condition

# $ # $ # $ @H% Are bro!en or fract'red handles on hammers+ a*es and similar eB'ipment replaced

promptly

# $ # $ # $ @H Are orn or bent renches replaced re&'larly

# $ # $ # $ @H0 Are appropriate handles 'sed on files and similar tools

# $ # $ # $ @H Are employees made aare of the ha2ards ca'sed by fa'lty or improperly 'sed handtools

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e 0: of 3


49/65

# $ # $ # $ @H3 Are appropriate safety &lasses or &o&&les 'sed hile 'sin& hand tools or eB'ipmenthich mi&ht prod'ce flyin& materials or be s'b?ect to brea!a&e

# $ # $ # $ @H5 Are tool handles ed&ed ti&htly in the head of all tools

# $ # $ # $ @H: Is eye and face protection 'sed hen dri/in& hardened or tempered sp'ds or nails

PORTABLE (POWER OPERATED) TOOLS AND EQUIPMENT

# $ # $ # $ @P1 Are rotatin& or mo/in& parts of eB'ipment &'arded to pre/ent physical contact

# $ # $ # $ @P% Are all cord-connected+ electrically-operated tools and eB'ipment effecti/ely

&ro'nded or of the appro/ed do'ble ins'lated type

# $ # $ # $ @P Are effecti/e &'ards in place o/er belts+ p'lleys+ chains+ sproc!ets+ on eB'ipments'ch as concrete mi*ers+ air compressors+ etc.

# $ # $ # $ @P0 Are portable fans pro/ided ith f'll &'ards or screens ha/in& openin&s 17% inch or

less

# $ # $ # $ @P Are pne'matic and hydra'lic hoses on poer-operated tools chec!ed re&'larly for

deterioration or dama&e



50/65

ABRASIVE WHEEL EQUIPMENT - GRINDERS

# $ # $ # $ @A1 Is the or! rest 'sed and !ept ad?'sted to ithin 17: inch of the heel

# $ # $ # $ @A% Is the ad?'stable ton&'e &'ard on the top side of the &rinder 'sed and !ept ad?'sted

to ithin 170 inch of the heel

# $ # $ # $ @A o side &'ards co/er the spindle+ n't+ and flan&e and 5 percent of the heel

diameter

# $ # $ # $ @A0 Are bench and pedestal &rinders permanently mo'nted

# $ # $ # $ @A oes each &rinder ha/e an indi/id'al on and off control sitch

# $ # $ # $ @A3 Are &o&&les or face shields alays orn hen &rindin&

PORTABLE LADDERS

# $ # $ # $ @PC1 Are all ladders maintained in &ood condition+ ?oints beteen steps and side rails ti&ht+all hardare and fittin&s sec'rely attached and mo/eable parts operatin& freely itho't

bindin& or 'nd'e play

# $ # $ # $ @PC% Are non-slip safety feet pro/ided on each ladder

# $ # $ # $ @PC Are ladder r'n&s and steps free of &rease and oil and other debris

7/ar77apps7con/ersion7tmp7scratch837%9:;%13.doc Pa&e ; of 3


51/65

# $ # $ # $ @PC0 Are employees instr'cted in ladder safety

# $ # $ # $ @PC hen portable r'n& ladders are 'sed to &ain access to ele/ated platforms+ roofs+ etc.+

does the ladder alays e*tend at least feet abo/e the ele/ated s'rface

# $ # $ # $ @PC3 Are e*tension ladders tied off or held to pre/ent to pre/ent the ladder from shiftin& or

fallin&

# $ # $ # $ @PC5 Are portable metal ladders le&ibly mar!ed ith si&ns readin& "" - o >ot

se Aro'nd Electrical EB'ipment" or eB'i/alent ordin&

# $ # $ # $ @PC: Are metal ladders inspected for dama&e

MACHINE GUARDING (I.E., STEAM CLEANERS)

# $ # $ # $ @,G1 Are man'fact'rers operatin& man'als a/ailable to technicians

# $ # $ # $ @,G% Is there a trainin& pro&ram to instr'ct employees on safe methods of machine

operation

# $ # $ # $ @,G Is there adeB'ate s'per/ision to ens're that employees are folloin& safe machine

operatin& proced'res

# $ # $ # $ @,G0 Is there a re&'lar pro&ram of safety inspection of machinery and eB'ipment



52/65

# $ # $ # $ @,G Is all machinery and eB'ipment !ept clean and properly maintained

# $ # $ # $ @,G3 Are all oil and &as fired de/ices eB'ipped ith flame fail're controls that ill

pre/ent the flo of f'el if pilots or main b'rners are not or!in&

# $ # $ # $ @,G5 Is there a poer sh't-off sitch ithin reach of the operators position at each

machine

# $ # $ # $ @,G:


53/65

COMPRESSORS AND COMPRESSED AIR

# $ # $ # $ @


54/65

# $ # $ # $ @


55/65

# $ # $ # $ @


56/65

# $ # $ # $ @E


57/65

# $ # $ # $ @E


58/65

# $ # $ # $ @EC9 Is the 'se of metal ladders prohibited in areas here the ladder or the person 'sin&the ladder co'ld come in contact ith ener&i2ed parts of eB'ipment+ fi*t'res or circ'it

cond'ctors

# $ # $ # $ @EC1; Are all disconnectin& sitches and circ'it brea!ers labeled to indicate their 'se or

eB'ipment ser/ed

# $ # $ # $ @EC11 Are all 'n'sed openin&s (incl'din& cond'it !noc!o'ts) in electrical enclos'res and

fittin&s closed ith appropriate co/ers+ pl'&s or plates

# $ # $ # $ @EC1% Are electrical enclos'res s'ch as sitches+ receptacles+ ?'nction bo*es pro/ided ith

ti&ht-fittin& co/ers or plates

# $ # $ # $ @EC1 Is s'fficient access and or!in& space pro/ided and maintained abo't all electrical

eB'ipment to permit ready and safe operations and maintenance

HAZARDOUS CHEMICAL EXPOSURES

# $ # $ # $ @H


59/65

# $ # $ # $ @H


60/65

HAZARDOUS SUBSTANCES COMMUNICATION

# $ # $ # $ @HS1 Is each container for a ha2ardo's s'bstance (i.e.+ /ats+ bottles+ stora&e tan!s+ etc.)labeled ith prod'ct identity and a ha2ard arnin& (comm'nication of the specific health

ha2ards and physical ha2ards)

SANITIZING EQUIPMENT AND CLOTHING

# $ # $ # $ @SE1


61/65

MATERIAL HANDLING

# $ # $ # $ @,H1 Are tr'c!s and trailers sec'red from mo/ement d'rin& loadin& and 'nloadin&operations

# $ # $ # $ @,H% Are hand tr'c!s maintained in safe operatin& condition

TRANSPORTING EMPLOYEES AND MATERIALS

# $ # $ # $ @E1 o employees ho operate /ehicles on p'blic thoro'&hfares ha/e /alid operators

licenses

# $ # $ # $ @E% Are seat belts orn at all times in any /ehicles 'sed on company b'siness

# $ # $ # $ @E Are /ehicles 'sed to transport employees eB'ipped ith lamps+ bra!es+ horns+

mirrors+ indshields and t'rn si&nals in &ood repair

# $ # $ # $ @E0 Is a f'll char&ed fire e*tin&'isher+ in &ood condition+ ith at least 0 D=< ratin&maintained in each employee transport /ehicle

# $ # $ # $ @E hen c'ttin& tools or tools ith sharp ed&es are carried in passen&er compartments

of employee transport /ehicles+ are they placed in closed bo*es or containers hich are

sec'red in place



62/65

CONTROL OF HARMFUL SUBSTANCES BY VENTILATION

# $ # $ # $ @


63/65

# $ # $ # $ @: Are traffic cones set 'p (if location is in or by a road or traffic area)

# $ # $ # $ @9 Is barrier tape or other appropriate means 'sed to delineate the e*cl'sion 2one

# $ # $ # $ @1; Are appropriate air monitorin& instr'ments bein& 'sed

# $ # $ # $ @11 Are the air monitorin& instr'ments properly calibrated

# $ # $ # $ @1% Ha/e field personnel been instr'cted in the relati/e responses of the /ario'scalibration &ases and of the e*pected contaminants

# $ # $ # $ @1 Are tools stored in s'ch a ay as to not ca'se a ha2ard to personnel hen the

/ehicle is in motion or par!ed in 'se at a site

# $ # $ # $ @10 Is there a Site Specific Health and Safety Plan (HASP) on site and si&ned by allemployees and s'bcontractors at the site

# $ # $ # $ @1 Are all /isitors reB'ired to read the Site Specific Health and Safety Plan (HASP)

and si&n the /isitors lo&

# $ # $ # $ @13 Are all /isitors reB'ired to ha/e proper trainin& to be on site

# $ # $ # $ @15 o all /isitors ha/e the proper PPE



64/65

# $ # $ # $ @1: Are fans needed7'sed to dispense airborne contaminants at the borin&

# $ # $ # $ @19 If e*plosi/e &ases are present+ is spar!in& eB'ipment located aay for the area

here the &ases can be fo'nd

# $ # $ # $ @%; At contaminated sites (or potentially contaminated sites) is a temporary

decontamination station set 'p

# $ # $ # $ @%1 Is proper PPE bein& orn by field personnel (eye protection+ hearin& protection+

respirators+ steel toed footear+ co/eralls+ ty/e!+ hard hats+ etc.)

# $ # $ # $ @%% Are copies of trainin&+ fit testin&+ etc. certificates on site

# $ # $ # $ @% Is there means to minimi2e heat or cold stress on site (shelter+ coolin& fans+ heat+

etc.)

# $ # $ # $ @%0 Is there a /isible ind mar!er shoin& ind direction on site

# $ # $ # $ @% Are tail&ate safety meetin&s ta!in& place at the site on a re&'lar basis (before the

?ob starts on one day ?obs)

# $ # $ # $ @%3 If a &enerator is 'sed+ is it located aay from the sample point to minimi2e noise

and to a/oid inhalation of e*ha'st



65/65

# $ # $ # $ @%5 Are acid bottles ti&htly capped and stored properly in the !it

# $ # $ # $ @%: Is there a desi&nated Site Safety Officer (SSO) at the field site

# $ # $ # $ @%9 Is the Site Safety Officer (SSO) aare of his 7 her d'ties

Hsp Audit Form

Documents

Transcript of Hsp Audit Form