Safety Program Assessment

Facility Name		 ___________________________
Date			____________________

COMMON HAZARDS

Material handling		__________
Chemical Exposure		__________
Equipment Operation		__________
Forklift / Vehicle		__________
Slip/Fall			__________
Temperature Extremes	__________
Repetitive Motion		__________
Cuts / Laceration		__________
Struck-by			__________
Electrical			__________

POLICY AND PROCEDURE

Written safety manual 		______
Accident Investigation Policy 		______
Return to Work Policy			______
OSHA 300 log available		______
Drug Testing				______
Fire Safety 				______
Hazard Communication		______
PPE Assessment			______
Confined Space Entry			______
Respirator Program			______
Hearing Conservation			______
Lockout / Tagout			______	
Bloodborne Pathogens		______
Forklift					______
First-Aid				______
Machine Guarding			______
Welding, Cutting, and Brazing	______
Toxic and Hazardous Substances	______
Other					______

TRAINING

Do you have a safety orientation program?			__________			
How soon is it completed after hire?				__________
Do you have annual safety training program?		__________
If yes, is documentation available?				__________	
Is departmental training conducted?				__________
What would happen if some staff chose not to attend?	__________
Is training effective?						__________

PERSONAL PROTECTIVE EQUIPMENT

Is proper PPE provided to employees to protect them from identified hazards? _______
Do employees wear PPE as required? ______
Are supervisors accountable for ensuring employees wear it as required? ______
Is there a disciplinary policy in place?
How often is it enforced? 

MANAGEMENT COMMITMENT

Are supervisors accountable for safety?				_______________
How long does it take for noted hazards to be corrected?		_______________
Are safety hazards made a top priority for maintenance staff?	_______________  
Who conducts accident investigations?				_______________
Is there a safety committee?						_______________
Is management represented?						_______________
Are supervisors accountable for accidents in their department?	_______________
Is safety on supervisor’s performance appraisals?			_______________
Are accidents tracked and trended?					_______________ 

TRENDS

In what department do most accidents occur?			_______________
What is the most hazardous injury exposure?			_______________
What are the most frequent injuries?					_______________
What is the biggest safety concern?					_______________
 Is there a process that poses a high risk of injury?			_______________ 

COMMENTS
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________