Checklists - work in progress, please come back later (last updated 4/20/2001)

This is an interactive version of a worksheet distributed and used by Ky OSHA in the review of a safety and health program.  Most programs that qualify for the Voluntary Protection Program in the state of Kentucky have scores in the 50s.  The idea is to assess which areas of your program that might need further review.

I. MANAGEMENT LEADERSHIP AND EMPLOYEE PARTICIPATION
A. Clear Worksite Safety and Health Policy	score ____/4
(4) Workforce can explain, and fully embraces, S&H policy. (3) Majority of personnel can explain policy. (2) Some personnel can explain policy. (1) Management can provide or state (where appropriate) a policy. (0) There is no apparent policy.
B. Clear Goals and Objectives, Set and Communicated	score ____/4
(4) Workforce fully embraces goal, and can explain desired results and measures for achieving objectives. (3) Majority of personnel can explain desired results and measures for achieving them. (2) Some personnel can explain desired results and measures for achieving them. (1) Management can provide or state (where appropriate) a goal and objectives. (0) No apparent safety and health goal or objectives.
C. Management Leadership	score ____/4
(4) All personnel can give examples of management's active commitment to safety and health. (3) Majority of personnel can give examples of management's active commitment to safety and health. (2) Some personnel can give examples of management's active commitment to safety and health. (1) Some evidence exists that management is committed to safety and health. (0) Safety and health does not appear to be a management value or significant concern.
Management Example	score ____/4
(4) Personnel report management always follows the rules and addresses the safety behavior of others. (3) Management follows the rules and usually addresses the safety behavior of others. (2) Management follows the rules and occasionally addresses the safety behavior of others. (1) Management generally appears to follow basic safety and health rules. (0) Management does not appear to follow the basic safety and health rules set for others.
D. Employee Involvement	score ____/4
(4) All personnel have ownership of safety and health and can describe their active roles. (3) Majority of personnel feel they have a positive impact on identifying and resolving S&H issues. (2) Some personnel feel they have a positive impact on identifying and resolving S&H issues. (1) Employees frequently feel that their safety and health input will be considered by supervision. (0) Employee involvement in safety and health issues is not encouraged or rewarded.
E. Assigned Safety and Health Responsibilities	score ___/4
(4) All personnel can explain what performance is expected of them and all elements appear to be assigned. (3) Majority of personnel can explain what performance is expected of them. (2) Some personnel can explain what performance is expected of them. (1) Evidence exists that performance expectations are spelled out for all personnel. (0) Specific job requirements and performance expectations are generally unknown or hard to find.
F. Authority and Resources for Safety and Health	score ____/4
(4) All personnel believe they have the necessary authority and resources to meet their responsibilities. (3) Majority of personnel believe they have the necessary authority and resources to do their job. (2) Authority and resources are spelled out for all; but there may be a reluctance to use them. (1) Authority and resources exist, but most appear to be out of the control of the employee. (0) Personnel do not appear to have adequate authority and resources to perform assigned responsibilities.
G. Accountability	score ____/4
(4) Personnel are held accountable and all performance is addressed with appropriate consequences. (3) Accountability systems are inplace; but consequences used tend to be for negative performance only. (2) Personnel are generally held accountable; but consequences rarely follow performance. (1) Accountability exists, but it appears to be generally hit or miss and prompted by serious negative events. (0) There does not appear to be any effort at accountability.
H. Program Review (Quality Assurance)	score ____/4
(4) In addition to a comprehensive review, a process is used which drives continuous correction. (3) A comprehensive review is conducted at least annually and drives appropriate program modifications. (2) A program review is conducted, but does not appear to drive all necessary program changes. (1) Changes in programs are driven by events such as accidents or compliance activities. (0) There is no eveidence of any program review process.
total for the nine 4-pt sections in part I	score ____/36

 

II. WORKPLACE ANALYSIS
A. Hazard Indentification (Expert Survey)	score ____/4
(4) In addition to corrective action, regular expert surveys result in updated inventories. (3) Comprehensive expert surveys are conducted periodically and drive apprpriate corrective action. (2) Comprehensive expert surveys are conducted; but updates and corrective action sometimes lags. (1) Qualified safety and health experts survey in response to accidents, complaints, or compliance activity. (0) There is no evidence of any comprehensive expert hazard survey having been conducted.
Hazard Indentification (Change Analysis)	score ____/4
(4) In addition to team analysis, employees affected are involved in all reviews. (3) A review of all planned/new facility, process, material, or equipment is conducted by a competent team. (2) Planned/new facilities, processess, materials, or equipment considered high hazard are reviewed. (1) Hazard reviews of planned/new facilities, processes, materials, or equipment are problem driven. (0) No system or requirement exists for hazard review of planned/new operations.
Hazard Indentification (Routine Hazard Analysis)	score ____/4
(4) In addition, employees have had input to the analysis for their jobs. (3) A current hazard analysis exists for all jobs, processes, or phases and is understood by all employees. (2) A current hazard analysis exists for all jobs, processes, or phases and is understood by many employees. (1) A hazard analysis program exists; many not cover all jobs and/or few are aware of results. (0) There is no routine hazard analysis system in place at this facility.
Hazard Indentification (Inspection)	score ____/4
(4) Well trained employees at all levels conduct frequent and varied inspections, hazards of any kind rare. (3) Inspections are conducted by trained personnel and all items are corrected, repeated hazards seldom found. (2) Inspections are conducted by trained personnel, most items corrected; but some hazards still in evidence. (1) An inspection program exists; but coverage and corrective action is not complete; hazards in evidence. (0) There is no routine inspection program at this facility; many hazards can be found.
B. Hazard Reporting System	score ____/4
(4) In addition, employees feel comfortable identifying and self-correcting hazards. (3) A comprehensive system for gathering hazard information exists; is positive, rewarding, and effective. (2) A system exists for hazard reporting; employees feel they can use it; but it may be slow to respond. (1) A system exists for hazard reporting; but employees may find it unresponsive or be unclear on its use. (0) No formal hazard reporting system exists and/or employees do not appear comfortable reporting hazards.
C. Accident/Incident Investigation	score ____/4
(4) All loss-producing incidents and "near misses" are investigated for root cause with effective prevention. (3) All OSHA-reportable incidents are investigated and effective prevention is implemented. (2) OSHA-reportable incidents generally investigated; cause indentification/correction may be inadequate. (1) Some investigation of incidents takes place, but root cause is seldom identified, correction is spotty. (0) Injuries are either not investigated or investigation is limited to report writing required for compliance.
D. Injury/Illness Analysis	score ____/4
(4) In addition, all employees are fully aware of incident trends, causes, and means of prevention. (3) Trends fully analyzed and displayed, common causes communicated, management ensures prevention. (2) Data is centrally collected and analyzed; common causes communicated to concerned supervisors. (1) Data is centrally collected and analyzed; but not widely communicated for prevention. (0) Little or no effort is made to analyze data for trends, causes, and prevention.
total of the seven 4-pt sections in part II	score ___/28

 

III. HAZARD PREVENTION AND CONTROL
A. Timely Hazard Control	score ____/4
(4) Hazard controls fully in place, known to and supported by workforce, with concentration on engineering controls and reinforced/enforced safe work procedures. (3) Hazard controls fully in place with priority to engineering controls, safe work procedures. (2) Hazard controls fully in place; but order of priority is variable. (1) Hazard controls are generally in place; but priority and completeness varies. (0) Hazard control is not considered complete, effective and appropriate in this facility.
B. Facility/Equipment Maintenance	score ____/4
(4) Operators are trained to recognize maintenance needs and perform/order maintenance on schedule. (3) An effective preventive maintenance schedule is in place and applicable to all equipment. (2) A preventative maintenance schedule is in place and is usually followed except for higher priorities. (1) A preventative maintenance schedule is in place; but is often allowed to slide. (0) There is little or no attention paid to preventative maintenance; break-down maintenance is the rule.
C. Emergency Planning and Preparation	score ____/4
(4) All personnel know immediately how to respond as a result of effective planning, training, and drills. (3) Most employees have a good understanding of responsibilities as a result of plans, training, and drills. (2) There is an effective emergency response team; but others may be uncertain of their responsibilities. (1) There is an effective emergency response plan; but training and drills are weak and roles may be unclear. (0) Little or no effort is made to prepare for emergencies.
Emergency Equipment	score ____/4
(4) Facility is fully equipped for emergencies, all systems and equipment in place and regularly tested. (3) Well equipped with appropriate emergency phones and directions, most people know what to do. (2) Emergency phones, directions, and equipment in place; but only emergency team know what to do. (1) Emergency phones, directions, and equipment in place; but employees show little awareness. (0) There is little evidence of an effective effort at providing emergency equipment and information.
D. Medical Program (Health Providers)	score ____/4
(4) Occupational health providers reguraly on-site, fully involved in hazard identification and training. (3) Occupational health providers there when needed and generally involved in asessment and training. (2) Occupational health providers are frequently consulted about significant health concerns. (1) Occupational health providers available; but normally concentrate on clinical issues. (0) Occupational health assistance is rarely requested or provided.
Medical Program (Emergency Care)	score ____/4
(4) Personnel fully trained in emergency medicine are always available on-site. (3) Personnel with basic first aid skills are always on-site. (2) Personnel with basic first aid skills are usually available with community assistance near-by. (1) Either on-site or near-by community aid is always available on every shift. (0) Neither on-site nor community aid can not be ensured at all times.
total for the six 4-pt sections in part III	score ____/24

 

IV. SAFETY AND HEALTH TRAINING
A. Employees Learn Hazards, How to Protect Themselves and Others	score ____/4
(4) In addition, employees can demonstrate proficiency in, and support of, all area covered by training. (3) Facility commited to high quality employee hazard training, ensures all participate, regular updates. (2) Facility provides legally required training, makes effort to include all personnel. (1) Training is provided when need is apparent, experienced personnel assumed to know material. (0) Facility depends on experience and informal peer training to meet needs.
B. Supervisors Learn Responsibilites and Underlying Reasons	score ____/4
(4) All supervisors assist in workplace analysis, ensure physical protections, reinforce training, enforce discipline, and can explain work procedures, based on training rovided to them. (3) Most supervisors assist in worksite analysis, ensure physical protection, reinforce training, enforce discipline, and can explain work procedures, based on training provided to them. (2) Supervisors have received basic training, appear to understand and demonstrate importance of worksite analysis, physical protections, training reinforcement, discipline, knowledge of procedures. (1) Supervisors make reasonable effort to meet safety and health responsibilities; but have limited training. (0) There is no formal effort to train supervisors in safety and health responsibilities.
C. Managers Learn Safety and Health Program Management	score ____/4
(4) All managers have received formal training in S & H management and demonstrate full understanding. (3) All managers follow, and can explain, their roles in S & H program management. (2) Managers generally show a good understanding of their S & H management role and usually model it. (1) Managers are generally able to describe their S & H role; but often have trouble modeling it. (0) Managers generally show little understanding of their S & H management responsibilities.
total for the three 4-pt sections in part IV	score ____/12

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last review or update 2/17/2006