2011 Safety Excellence Award Training

Field Audit Form Review

Houston Business Roundtable

Presented by: Larry McElroy

Safety Audit Form

¨ Current Form. (Revised September 2010)

¨ 11 Page Document.¨ Will be emailed out

and can be found on the HBR website. www.houbrt.com

¨ Use the Form as a Format for your Audit.

Safety Audit Form Sections

28 Sections Audited:

Safety Training Education

Hazard Communication Program

Process Safety Management

Respiratory Protection Program

Hearing Conservation Program

Emergency Evacuation Plan

Personal Protective Equipment

Substance Abuse Control Program

Audit Inspection Program

Behavioral Based Safety

Incident Investigations

Recordkeeping

Medical / First Aid Program

Work Permits

Houskeeping

Fire Protection and Prevention

Environmental Management

Tool/Equipment Inspections

Electrical Safety

Sign, Signals and Barricades

LPG/Compressed Gases/Flammable Liquids

Ladders

Scaffolds

Excavation

Industrial Hygiene Program

Workforce Development

Best Practices

Accident Prevention Program

Section 1:

ITEM FIELDVERIFIED

COMMENTS SCORE

0 1 2 3 N/A

A. Management Involvement in safety Programs

B. Written Safety PolicyC. Safety policy communicated to and understood by

all employees X

D. Safety and Health ManualE. Written procedures for safety activities (JSA, JHA ,

committee, etc.) X

F. Written operating procedures/work practices X

G. Safety handbook for employees X

ITEM FIELDVERIFIED

COMMENTS SCORE

0 1 2 3 N/AH. Annual safety goals set for continuous

improvement

I. Company safety recognition program in place

J. Company safety representative identifiedK. Safety representative participates in safety

problems/activities

L. Safety representative inspects all jobsites X

M. Disciplinary action programN. Copy of all federal safety and health regulations

available on jobs and/or posted as required XO. Participation in a safety professional association

(Safety Council, ABC, , ASSE, HBR, Etc.)

Section 1: Accident PreventionProgram, cont.

Section 26: Best Practices

ITEM FIELDVERIFIED

COMMENTS SCORE

0 1 2 3 N/A

A. Are Best Practice(s) Fully Implemented at Site X

B. Year to Year Improvement in Site Statistics X

C. OSHA Challenge, VPP, OSHA SHARP, OSHA Star X

Section 26- Best Practices and Year to Year Improvements

¨ Highlight Company Programs that are considered to be the strongholds of your organizations.

¨ Focus on a select few.¨ Emphasize Site and total Company EH&S Statistical Data.

SCORING: For each item listed below, decide if the entry meets the criteria as follows:

Audit Scoring System

Score – 0 (Below Average)

¨ No Program in place.

Score – 1 (Average)¨ Program in place and

meets the minimum requirements.

¨ Employees in the field have knowledge of the program.

1 = Average N/A = Not Applicable 0 = Below Average 2 = Above Average 3 = Excellent

SCORING: For each item listed below, decide if the entry meets the criteria as follows:

Audit Scoring System

Score – 2 (Above Average)

¨ The Program is in place and exceeds industrial standards.

¨ Employees in the field are knowledgeable and participation is high.

1 = Average N/A = Not Applicable 0 = Below Average 3 = Excellent2 = Above Average

SCORING: For each item listed below, decide if the entry meets the criteria as follows:

Audit Scoring System

Score – 3 (Excellent)¨ The Program is in

place and exceeds industrial standards.

¨ Employees in the field are knowledgeable and participation is high and exceeds requirements to the extent to where it is recognized as a “Best Practice”.

1 = Average N/A = Not Applicable 0 = Below Average 2 = Above Average 3 = Excellent

SCORING: For each item listed below, decide if the entry meets the criteria as follows:

Audit Scoring System

Score – N/A¨ Should be

checked if it is non applicable.

¨ Is not counted against the overall score.

¨ Calculation is based on an overall percentage.

1 = Average 0 = Below Average 2 = Above Average 3 = ExcellentN/A = Not Applicable

Section 29: Final Score

Section 29- Final Score Each individual page is totaled

for the number of items evaluated and the points scored.

(bottom of each page)

The Sum of the Sub-totals are then divided by the sum of the number of items.

141

385

2.73

Number of Items Evaluated

Subtotal of Score Points

Sections 30-32: Comments and Commitment

• Completed by auditors.

• Importance of Client comments.

• Commitment verified through the audit process.

• Can be the tie breaker section.

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

Written Safety Policy:

A. Corporate

B. Site X

i. Safety policy communicated to and understood by all employees

X

ii. Safety and Health Manual

iii. Written procedures for safety activities (JSA, JHA , committee, etc.)

X

iv. Written operating procedures X

v. Safety handbook for employees X

vi. Annual safety goals set for continuous improvement

vii. Company safety recognition program in place

viii. Company safety representative identified

ix. Safety representative participates in safety problems/activities

x. Safety representative inspects all jobsites X

xi. Disciplinary action program

xii. Copy of all federal safety and health regulations available on jobs and/or posted as required

X

xiii. Participation in a Contractor Safety Council

Section 1Accident Prevention Program

1. Accident Prevention Program

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

i. Safety policy communicated to and understood by all employees

X

ii. Safety and Health Manual

iii. Written procedures for safety activities (JSA, JHA , committee, etc.)

X

iv. Written operating procedures X

v. Safety handbook for employees X

vi. Annual safety goals set for continuous improvement

vii. Company safety recognition program in place

viii. Company safety representative identified

ix. Safety representative participates in safety problems/activities

x. Safety representative inspects all jobsites X

xi. Disciplinary action program

xii. Copy of all federal safety and health regulations available on jobs and/or posted as required

X

xiii. Participation in a Contractor Safety Council

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

i. Safety policy communicated to and understood by all employees

X

ii. Safety and Health Manual

iii. Written procedures for safety activities (JSA, JHA , committee, etc.)

X

i. Safety policy communicated to and understood by all employees

X

ii. Safety and Health Manual

iii. Written procedures for safety activities (JSA, JHA , committee, etc.)

X

iv. Written operating procedures X

v. Safety handbook for employees X

vi. Annual safety goals set for continuous improvement

vii. Company safety recognition program in place

viii. Company safety representative identified

ix. Safety representative participates in safety problems/activities

x. Safety representative inspects all jobsites X

xi. Disciplinary action program

xii. Copy of all federal safety and health regulations available on jobs and/or posted as required

X

xiii. Participation in a Contractor Safety Council

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Management Involvement in safety Programs

B. Written Safety Policy X

C. Safety policy communicated to and understood by all employees

X

D. Safety and Health Manual

E. Written procedures for safety activities (JSA, JHA , committee, etc.)

X

F. Written operating procedures X

G. Safety handbook for employees X

H. Annual safety goals set for continuous improvement

I. Company safety recognition program in place

J. Company safety representative identified

K. Safety representative participates in safety problems/activities

L. Safety representative inspects all jobsites X

M. Disciplinary action program

N. Copy of all federal safety and health regulations available on jobs and/or posted as required

X

O. Participation in a Contractor Safety Council

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Management Involvement in safety Programs

B. Written Safety Policy X

C. Safety policy communicated to and understood by all employees

X

D. Safety and Health Manual

E. Written procedures for safety activities (JSA, JHA , committee, etc.)

X

F. Written operating procedures X

G. Safety handbook for employees X

H. Annual safety goals set for continuous improvement

I. Company safety recognition program in place

J. Company safety representative identified

K. Safety representative participates in safety problems/activities

L. Safety representative inspects all jobsites X

M. Disciplinary action program

N. Copy of all federal safety and health regulations available on jobs and/or posted as required

X

O. Participation in a Contractor Safety Council

RemovedAddedRemovedRemovedAdded

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. High noise area and operations identification

(Owner or Contractor?)X

B. Hearing protection and records training X

Sections 2 & 6Training and Hearing Protection

2. Safety Training Education

6. Hearing Conservation Program

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written new hire orientation XB. Tool box talks/safety meetings XC. Specific safety training for all employees (permits,

vessel entry, etc.)X

D. Safety incidents and activities reviewed with all employees

X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written new hire orientation XB. Tool box talks/safety meetings XC. Specific safety training for all employees (permits,

vessel entry, etc.)X

D. Safety incidents and activities reviewed with all employees

X

E. Skills training for all craft workers X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written new hire orientation XB. Tool box talks/safety meetings XC. Specific safety training for all employees (permits,

vessel entry, etc.)X

D. Safety incidents and activities reviewed with all employees

X

E. Skills training for all craft workers X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. High noise area and operations identification

(Owner or Contractor?)X

B. Hearing protection and records training XC. Noise Monitoring X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. High noise area and operations identification

(Owner or Contractor?)X

B. Hearing protection and records training XC. Noise Monitoring X

Removed

Added

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. PPE Assessment/Evaluation

B. Head protection worn by everyone in the designated area and hard hats are in good condition

X

C. Eye/face protection provided and used where operation of machines present potential eye or face injury

X

D. Hearing protection provided where required XE. Approved respiratory protection provided and used

where requiredX

F. Safety harnesses, lifelines and lanyards are provided and used where required

X

Section 8Personal Protective Equipment

B. Head protection worn by everyone in the designated area and hard hats are in good condition

X

C. Eye/face protection provided and used where operation of machines present potential eye or face injury

X

D. Hearing protection provided where required XE. Approved respiratory protection provided and used

where requiredX

F. Safety harnesses, lifelines and lanyards are provided and used where required

X

G. Dress code and minimum PPE standard XH. Safety harness and lanyards meet inspection

requirementsX

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. PPE Assessment/Evaluation

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. PPE Assessment/EvaluationB. Employee provided by Employer

C. Head protection worn by everyone in the designated area and hard hats are in good condition

X

D. Eye/face protection provided and used where operation of machines present potential eye or face injury

X

E. Hearing protection provided where required XF. Approved respiratory protection provided and used

where requiredX

G. Safety harnesses, lifelines and lanyards are provided and used where required

X

H. Dress code and minimum PPE standard XI. Safety harness and lanyards meet inspection

requirementsX

J. Proper Gloves X

8. Personal Protective EquipmentITEM

FIELDVERIFIED

COMMENTS SCORE

0 1 2 3 N/AA. PPE Assessment/EvaluationB. Employee provided by Employer

C. Head protection worn by everyone in the designated area and hard hats are in good condition

X

D. Eye/face protection provided and used where operation of machines present potential eye or face injury

X

E. Hearing protection provided where required XF. Approved respiratory protection provided and used

where requiredX

G. Safety harnesses, lifelines and lanyards are provided and used where required

X

H. Dress code and minimum PPE standard XI. Safety harness and lanyards meet inspection

requirementsX

J. Proper Gloves XAdded

Added

Sections 10 & 11Audits and BBS

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written program in placeB. Employee participation1. Tracked X2. Documented3. Communicated4. Employee Feedback XC. Management involvement and review

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written plan/procedure format for conducting safety

audits/inspectionsB. Audit results documentedC. Corrective action implemented and documented XD. Problems and remedies communicated throughout

company

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written plan/procedure format for conducting safety

audits/inspectionsB. Audit results documentedC. Corrective action implemented and documented XD. Problems and remedies communicated throughout

companyE. Frequency of Audits

10. Audit Inspection Program

11. Behavioral Based SafetyAdded Section

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written plan/procedure format for conducting safety

audits/inspectionsB. Audit results documentedC. Corrective action implemented and documented XD. Problems and remedies communicated throughout

companyE. Frequency of Audits

Added

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. First-aid supplies X

B. Qualified personnel (first-aid card minimum)/CPR

Section 14Medical/First Aid Program

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. First-aid supplies X

B. Qualified personnel (first-aid card minimum)/CPR

C. Emergency service set up

D. Emergency telephone numbers posted X

E. Medical personnel available for advice and consultation

F. In compliance with blood borne pathogens standard X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. First-aid supplies X

1. Process to manage

2. Process to monitor supply

3. Resource adequate for number of employees on site

B. Qualified personnel (first-aid card minimum)/CPR

C. Emergency service set up

D. Emergency telephone numbers posted X

E. Medical personnel available for advice and consultation

F. In compliance with blood borne pathogens standard X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. First-aid supplies X

1. Process to manage

2. Process to monitor supply

3. Resource adequate for number of employees on site

B. Qualified personnel (first-aid card minimum)/CPR

C. Emergency service set up

D. Emergency telephone numbers posted X

E. Medical personnel available for advice and consultation

F. In compliance with blood borne pathogens standard X

14. Medical/First Aid Program

Added

Added

Added

Sections 18 & 20Environmental and Electrical

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written Environmental Policy StatementB. Spill Prevention PlanC. Environmental Risk AssessmentD. Communication of Site Environmental ConcernsE. Notification to Owner of leak or upset

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written Environmental Policy StatementB. Spill Prevention PlanC. Environmental Risk AssessmentD. Communication of Site Environmental ConcernsE. Notification to Owner of leak or upsetF. Green Initiatives

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written assured grounding program/GFCI XB. Electrical tools grounded or double insulated XC. Electrical panels labeled X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written assured grounding program/GFCI XB. Electrical tools grounded or double insulated XC. Electrical panels labeled XD. State licensed/certification/qualified

18. Environmental Management

20. Electrical Safety

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written Environmental Policy StatementB. Spill Prevention PlanC. Environmental Risk AssessmentD. Communication of Site Environmental ConcernsE. Notification to Owner of leak or upsetF. Green Initiatives

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Written assured grounding program/GFCI XB. Electrical tools grounded or double insulated XC. Electrical panels labeled XD. State licensed/certification/qualified

Added

Added

A. Portable electric tools X

B. Tools are maintained in safe condition X

C. All power operated tools properly guarded XD. Abrasive wheels and tools properly equipped and

usedX

E. Woodworking tools properly equipped and used X

F. Inspection Program X

G. Powder actuated tools X

H. Powered Industrial Trucks X

I. Personnel Baskets X

J. Lifting equipment (come-alongs and chainfalls) X

K. Hydraulic cranes X

L. Gantry cranes X

M. Crawler cranes X

N. Overhead hoists X

O. Drum hoists X

P. Power platforms, aerial lifts, scissor lifts, JLG’s, etc. X

Q. Suspension scaffolds X

S. Contractor owned equipment X

R. Wire rope/chain/slings X

ITEM FIELD COMMENTS SCORE

0 1 2 3 N/A

Section 19Tools/Equipment Inspections

H. Wire rope/chain/slings, Lifting equipment (come-alongs and chainfalls)

X

I. Mobile Equipment (power industrial trucks, man lifts, cranes, fork lifts, ’s

X

B. Tool Training in Place X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Inspection Program X

B. Tool Training in Place X

C. Portable electric tools

D. Tools are maintained in safe condition X

E. All power operated tools properly guarded XF. Abrasive wheels and tools properly equipped and

usedX

G. Powder actuated tools X

H. Wire rope/chain/slings, Lifting equipment (come-alongs and chainfalls)

X

I. Mobile Equipment (power industrial trucks, man lifts, cranes, fork lifts, ’s

X

19. Tools/Equipment Inspections

Removed

Removed

Removed

Combined

CombinedCombined

Combined

Combined

Combined

Combined

Combined

Combined

Combined

RearrangedAdded

Added

Added

Section 21Signs, Signals, and Barricades

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. “Danger" and "Caution" signs available and used to

warn against potential hazards or to caution against unsafe practices

X

B. Safety instructions and directional signs posted where required

X

C. Accident prevention tags available and used where required

X

D. Flagmen used where required X

E. Crane and hoist signals posted and used X

F. Barricades provided where needed X

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. “Danger" and "Caution" signs available and used to

warn against potential hazards or to caution against unsafe practices

X

B. Safety instructions and directional signs posted where required

X

C. Accident prevention tags available and used where required

X

D. Flagmen used where required X

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. “Danger" and "Caution" signs available and used to

warn against potential hazards or to caution against unsafe practices

X

B. Safety instructions and directional signs posted where required

X

C. Accident prevention tags available and used where required

X

D. Flagmen used where required X

E. Crane/Signalman Training verified

F. Crane and hoist signals posted and used X

G. Barricades provided where needed X

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. “Danger" and "Caution" signs available and used to

warn against potential hazards or to caution against unsafe practices

X

B. Safety instructions and directional signs posted where required

X

C. Accident prevention tags available and used where required

X

D. Flagmen used where required X

E. Crane/Signalman Training verified

F. Crane and hoist signals posted and used X

G. Barricades provided where needed X

21. Signs, Signals, and Barricades

Added

Sections 23 & 24Ladders and Scaffolds

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement XD. Job made ladders according to standardsE. Retractable devices X

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement XD. Job made ladders according to standards

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement X

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement X

E. Retractable devices X

ITEMFIELD

VERFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement XD. Retractable devices X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

B. Training - User, Builder, Competent Person X

C. Inspection System/Program X

A. Training - User, Builder, Competent Person X

B. Inspection System/Program X

C. Fall Protection for Builder X

D. Records and Documentation X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Written program in place

B. Training - User, Builder, Competent Person X

C. Inspection System/Program X

D. Fall Protection for Builder X

E. Records and Documentation X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Written program in place

B. Training - User, Builder, Competent Person X

C. Inspection System/Program X

D. Fall Protection for Builder X

E. Records and Documentation X

23. Ladders

24. Scaffolds

Added

Removed

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

B. Pre-dig procedures (Excavation permit)

C. Daily inspections by competent person X

D. Sloped by classification, A, B, C/or supporting system determined and utilized according to standard

X

Section 25Excavation

A. Pre-dig procedures (Excavation permit)

B. Daily inspections by competent person X

C. Sloped by classification, A, B, C/or supporting system determined and utilized according to standard

X

D. Trenching requirements, bracing, other safeguards according to standards

X

E. Barricades utilized X

F. Competent person Identified X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Written Program in place

B. Pre-dig procedures (Excavation permit)

C. Daily inspections by competent person X

D. Sloped by classification, A, B, C/or supporting system determined and utilized according to standard

X

E. Trenching requirements, bracing, other safeguards according to standards

X

F. Barricades utilized X

G. Competent person Identified X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Written Program in place

B. Pre-dig procedures (Excavation permit)

C. Daily inspections by competent person X

D. Sloped by classification, A, B, C/or supporting system determined and utilized according to standard

X

E. Trenching requirements, bracing, other safeguards according to standards

X

F. Barricades utilized X

G. Competent person Identified X

25. Excavation

Added

Sections 26 & 27IH Program and Workforce Dev.

ITEM FIELD COMMENTS SCORE0 1 2 3 N/A

A. Asbestos Program XB. Lead Abatement Program XC. Abrasive blasting Program XD. Industrial Hygiene Program X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A1. Written program in place X2. Exposure Assessment X3. Periodically monitoring X4. Employee Communication X5. Biological Monitoring

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/AA. Formal Craft Training XB. Craft Written Assessments XC. Skills Upgrade Training XD. Performance Verification XE. Benefits & Improvements XF. Incentives and Motivation X

25. Other26. Industrial Hygiene Program

27. Workforce Development

Removed SectionAdded Section

Added Section

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Are Best Practice(s) Fully Implemented at Site X

B. Year to Year Improvement in Site Statistics X

Section 28Best Practices

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Are Best Practice(s) Fully Implemented at Site X

B. Year to Year Improvement in Site Statistics X

C. OSHA Challenge, VPP, OSHA SHARP, OSHA Star X

ITEMFIELD

VERIFIEDCOMMENTS SCORE

0 1 2 3 N/A

A. Are Best Practice(s) Fully Implemented at Site X

B. Year to Year Improvement in Site Statistics X

C. OSHA Challenge, VPP, OSHA SHARP, OSHA Star X

28. Best Practices & Year to Year Improvement

Added

2011 Safety Excellence Award Training

Field Audit Form Review

Houston Business Roundtable