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Printing Instructions Safety and Health Program Check-Up If you want to find out how your safety and health program measures up, take a few minutes to complete the following survey. There are no right or wrong answers. This check up will help identify areas where improvements can be made. I. Management Leadership and Employee Involvement A. Clear worksite safety and health policy 1. We have a S&H policy and all employees accept, can explain, and fully understand it We have a S&H policy and majority of employees can explain it We have a S&H policy and some employees can explain it We have a written (or oral, where appropriate) policy We have no policy B. Clear goals and objectives are set and communicated 2. All employees are involved in developing goals and can explain desired results and how results are measured Majority of employees can explain results and measures for achieving them Some employees can explain results and measures for achieving them We have written (or oral, where appropriate) goals and objectives We have no safety and health goals and objectives C-1. Management Leadership 3. All employees can give examples of management’s commitment to safety and health Majority of employees can give examples of management’s active commitment to safety and health Some employees can give examples of management’s commitment to safety and health Some evidence exists that top management is committed to safety and health Safety and health is not a top management value or concern C-2. Management example 4. All employees recognize that managers in this company always follow the rules and address the safety behavior of others Managers follow the rules and usually address the safety behavior of others Managers follow the rules and occasionally address the safety behavior of others Managers generally follow basic safety and health rules Managers do not follow basic safety and health rules D. Employee involvement 5. All employees have ownership of safety and health and can explain their roles Majority of employees feel they have a positive impact on identifying and resolving safety and health issues Some employees feel that they have a positive impact on safety and health Employees generally feel that their safety and health input will be considered by supervisors Employee involvement in safety and health issues is not encouraged nor rewarded E. Assigned safety and health responsibilities 6. All employees can explain what performance is expected of them Majority of employees can explain what performance is expected of them Some employees can explain what performance is expected of them Performance expectations are generally spelled out for all employees Specific job responsibilities and performance expectations are generally unknown or hard to find F. Authority and resources for safety and health 7. All employees believe they have the necessary authority and resources to meet their responsibilities Majority of employees believe they have the necessary authority and resources to meet their responsibilities Authority and resources are spelled out for all, but there is often a reluctance to use them Authority and resources exist, but most are controlled by supervisors All authority and resources come from supervision and are not delegated G. Accountability 8. Employees are held accountable and all performance is addressed with appropriate consequences Accountability systems are in place, but consequences used tend to be for negative performance only Employees are generally held accountable, but consequences and rewards do not always follow performance There is some accountability, but it is generally hit or miss There is no effort towards accountability H. Program Review (Quality Assurance) 9. In addition to a comprehensive review, a process is used which drives continuous correction A comprehensive review is conducted at least annually and drives appropriate program modifications A program review is conducted, bit it doesn’t drive all necessary program changes Changes in programs are driven by events such as accidents or near misses There is no program review process II. Workplace Analysis A-1. Hazard identification (Expert survey) 10. Comprehensive expert surveys are conducted regularly and result in corrective action and updated hazard inventories Comprehensive expert surveys are conducted periodically and drive appropriate corrective action Comprehensive expert surveys are conducted, but corrective actions sometimes lags Expert surveys in response to accidents, complaints, or compliance activity only No comprehensive surveys have been conducted A-2. Hazard identification (Change analysis) 11. Every planned or new facility, process, material, or equipment is fully reviewed by a competent team, along with affected workers Every planned or new facility, process, material, or equipment is fully reviewed by a competent team High hazard planned or new facility, process, material or equipment are reviewed Hazard reviews of planned or new facilities, processes, materials, or equipment are problem driven No system for hazard review of planned or new facilities exists A-3. Hazard identification (Job and process analysis) 12. A current hazard analysis exists for all jobs, processes, and material; it is understood by all employees; and employees have had input into the analysis for their jobs A current hazard analysis exists for all jobs, processes, and material and it is understood by all employees A current hazard analysis exists for all jobs, processes, or phases and is understood by many employees A hazard analysis program exists, but few are aware of it There is no routine hazard analysis system in place A-4. Hazard identification (Inspection) 13. Employees and supervisors are trained, conduct routine joint inspections, and all items are corrected Inspections are conducted and all items are corrected; repeat hazards are seldom found Inspections are conducted and most items are corrected, but some hazards are still uncorrected An inspection program exists, but corrective action is not complete; hazards remain uncorrected There is no routine inspection program in place and many hazards can be found B. Hazard Reporting System 14. A system exists for hazard reporting, employees feel comfortable using it, and employees feel comfortable correcting hazards on their own initiative A system exists for hazard reporting and employees feel comfortable using it A system exists for hazard reporting and employees feel they can use it, but the system is slow to respond A system exists for hazard reporting but employees find it unresponsive or are unclear how to use it There is no hazard reporting system and/or employees are not comfortable reporting hazards C. Accident/ Incident Investigation 15. All loss-producing incidents and near-misses are investigated for root cause with effective prevention All OSHA-reportable incidents are investigated and effective prevention is implemented OSHA-reportable incidents are generally investigated; accident cause and/correction may be inadequate Some investigation of incidents takes place, but root cause is seldom identified and correction is spotty Injuries are either not investigated or investigation is limited to report writing required for compliance D. Injury/ illnesses analysis 16. Data trends are fully analyzed and displayed, common causes are communicated, management ensures prevention; and employees are fully aware of trends, causes and means of prevention Data trends are fully analyzed and displayed, common causes are communicated and management ensures prevention Data is centrally collected and analyzed and common causes are communicated to supervisors Data is centrally collected and analyzed but not widely communicated for prevention Little or no effort is made to analyze data for trends, causes and prevention III. Hazard Prevention and Control A. Timely and effective hazard control 17. Hazard controls are fully in place, known to and supported by workforce, with concentration on engineering controls and safe work procedures Hazard controls are fully in place with priority to engineering controls, safe work procedures, administrative controls, and personal protective equipment (in that order) Hazard controls are fully in place, but there is some reliance on personal protective equipment Hazard controls are generally in place, but there is heavy reliance on personal protective equipment Hazard control is not complete, effective, and appropriate B. Facility and Equipment Maintenance 18. Operators are trained to recognize maintenance needs and perform and order maintenance on schedule An effective preventive maintenance schedule is in place and applicable to all equipment A preventive maintenance schedule is in place and is usually followed except for higher priorities A preventive maintenance schedule is in place but is often allowed to slide There is little or no attention paid to preventive maintenance; break-down maintenance is the rule C-1. Emergency Planning and Preparation 19. There is an effective emergency response plan and employees know immediately how to respond as a result of effective planning, training, and drills There is an effective emergency response plan and employees have a good understanding of responsibilities as a result of plans, training, and drills There is an effective emergency response plan and team, but other employees may be uncertain of their responsibilities There is an effective emergency response plan, but training and drills are weak and roles may be unclear Little effort is made to prepare for emergencies C-2. Emergency Equipment 20. Facility is fully equipped for emergencies; all systems and equipment are in place and regularly tested; all personnel know how to use equipment and communicate during emergencies Facility is well equipped for emergencies with appropriate emergency phones and directions; majority of personnel know how to use equipment and communicate during emergencies Emergency phones, directions and equipment are in place, but only emergency teams know what to do Emergency phones, directions and equipment are in place, but employees show little awareness There is little or no effort made to provide emergency equipment and information D-1. Medical Program (Health Providers) 21. Occupational health providers are regularly on-site and fully involved Occupational health providers are involved in hazard assessment and training Occupational health providers are consulted about significant health concerns in addition to accidents Occupational health providers are available, but normally concentrate on employees who get hurt Occupational health assistance is rarely requested or provided D-2. Medical Program (Emergency Care) 22. Personnel fully trained in emergency medicine are always available on-site Personnel with basic first aid skills are always available on-site, all shifts Either on-site or near-by community aid is always available on day shift Personnel with basic first aid skills are usually available, with community assistance nearby Neither on-site nor community aid can be ensured at all times IV. Safety and Health Training A. Employees Learn Hazards (How to Protect Themselves and Others) 23. Facility is committed to high quality employee hazard training, ensures all participate, and provides regular updates; in addition, employees can demonstrate proficiency in, and support of, all areas covered by training Facility is committed to high quality employee hazard training, ensures all participate, and provides regular updates Facility provides legally required training and makes effort to include all employees Training is provided when the need is apparent; experienced employees are assumed to know the material Facility depends on experience and informal peer training to meet needs B-1. Supervisors Learn Responsibilities and Underlying Reasons 24. All supervisors assist in worksite hazard analysis, ensure physical protections, reinforce training, enforce discipline and can explain work procedures based on the training provided to them Most supervisors assist in worksite hazard analysis, ensure physical protections, reinforce training, enforce discipline and can explain work procedures based on the training provided to them Supervisors have received basic training, appear to understand and demonstrate importance of worksite hazard analysis, physical protections, training reinforcement, discipline and knowledge of work procedures Supervisors make responsible efforts to meet safety and health responsibilities, but have limited training There is no formal effort to train supervisors in safety and health responsibilities B-2. Managers Learn Safety and Health Program Management 25. All managers have received formal training in safety and health management responsibilities All managers follow, and can explain, their roles in safety and health program management Managers generally show a good understanding of their safety and health roles and usually model them Managers are generally able to describe their safety and health roles, but often have trouble modeling them Managers generally show little understanding of their safety and health management responsibilities

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