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SAFETY AND OCCUPATIONAL HEALTH ASSESSMENT PRE-VISIT QUESTIONNAIRE ** PLEASE COMPLETE AND FAX TO THE REGIONAL SAFETY OFFICE ** Your location is scheduled for a safety and health assessment by the Safety Office on: _________________. Your prompt return of this questionnaire will allow us to better serve you regarding safety program development needs. If you have any questions while completing the form, please call. ** If a Complex, please include all locations in your responses ** Name of Station(s): Address: Org. Code(s): Telephone: No. Employees: Project Leader: Completed By: Date Completed: SECTION A - ADMINISTRATIVE YES NO N/A REFERENCE 1. Does the facility have a current, complete copy of Service Manual chapters 240, 241, and 242 available to all employees? (Available on the web.) 29 CFR 1960.12 2. Is the DOI poster or equivalent OSHA “Occupational Safety and Health Protection for Employees” posted in a conspicuous place (e.g., employee lounge, official bulletin board, etc.? (copies available from the Safety Office). 29 CFR 1960.12 3. Is the poster “What a Federal Employee Should Do When Injured at Work”, CA-10, posted in a conspicuous place? (Copies available from Safety Office). 29 CFR 1960.12 4. Does facility have a Station Safety Plan reviewed/updated annually? (Basic safety plans available from the Safety Office.) 240 FW 1.9 5. Are Job Hazard Assessments (JHAs) developed as part of the safety plan? (Safety Office and website have samples). 240 FW 1.10 6. Is an OSHA Form 300A - annual summary of work related injuries and illnesses - posted in a conspicuous place? Posting of the summary is required each year Feb 1-April 30 and covers the preceding calendar year (Jan-Dec). 29 CFR 1904.32(6) 7. Has an annual physical security assessment been completed? 432 FW 1 8. Has a Continuity of Operations Plan (COOP) been developed? Reviewed annually? Available to everyone? 900 DM 2 9. Are there sufficient lavatories for all personnel? Are these areas free of rodents, insects, and pests? 29 CFR 1910.141(c)(2)(i) 29 CFR 1910.141(a)(5) 10. Is food stored and consumed in approved areas only? Are there clean areas for eating and changing? 29 CFR 1910.141(g)(2) 29 CFR 1910.141(h)&(e) 11. Is there potable water for employees and are backflow prevention devices installed at all deep sinks? Are non-potable water supplies clearly labeled? 29 CFR 1910.141(b)(1) 29 CFR 1910.141(2)(i)(ii) 12. Are all areas properly maintained (housekeeping), floors clean and free of tripping hazards, supplies stored orderly and free from accumulation of materials that may constitute falling hazards or fire hazards? 29 CFR 1910.22(a)(1) & (2) 1 FWS 3-2237 June 2011 SECTION B - COLLATERAL DUTY SAFETY OFFICER (CDSO) YES NO N/A REFERENCE 1. Does the Station have an employee designated as the Collateral Duty Safety Officer or Station safety officer? 240 FW 1.6 2. CDSO Name: 3. Has the CDSO received hazard-recognition training? (e.g., OSHA 6000 course, DOI Safety CD-ROM, National Safety Council courses) 29 CFR 1960.58 4. Does each work activity conduct self-evaluations to detect safety and occupational health hazards? (Project Leader, Supervisor, and CDSO) 240 FW 5.4 Telephone: SECTION C - STATION SAFETY MEETINGS YES NO N/A REFERENCE 1. Has a safety committee been organized and hold meetings at least quarterly? (Small facilities of 8 or less employees need not have one). 240 FW 1.6 2. Are safety committee minutes reviewed by the Supervisors/Project Leaders? Minutes should be retained at the Station for five years, and the CDSO should keep copies of all safety training as well. 240 FW 1.8 SECTION D - ORIENTATION/TRAINING YES NO N/A REFERENCE 1. Have all employees (including new, transferred, part-time, and seasonal) received a safety orientation which includes all elements in 240 FW 3? 240 FW 3.8 2. Do employees receive special skills training (e.g., equipment operators, welders, chainsaw operators, etc.)? 240 FW 3.5 3. Do employees receive hazardous-environment training (e.g., electrofishing, heavy equipment operator, explosives, etc.)? 240 FW 3.5 4. Is required training documented, e.g. confined spaces, lockout/tagout, power presses, powered platforms, hazmat, and forklifts? 29 CFR 1910 SECTION E - EMERGENCY PROCEDURES YES NO N/A REFERENCE 1. Does the Station have an Emergency Action Plan (EAP) or Station Safety Plan outlining emergency procedures? Is the SOP for spills of hazardous chemicals included in the Emergency Action Plan? 240 FW 1.1 29 CFR 1910.38(a) 29 CFR 1910.120 2. Does each work activity (i.e., field crew or work site) have at least one person currently trained in First Aid/CPR? 240 FW 3.7 3. Are first aid supplies available at each work site? 29 CFR 1910.151,Apx A 4. Are emergency communications available? Are emergency numbers posted? 240 FW 1.9 5. Does each employee know what to do in event of an emergency? 240 FW 3.8 6. Is emergency protection equipment maintained, clearly visible, and sufficient to accommodate prompt escape such as exit signs, egress lighting, egress routes, and number of exits? 29 CFR 1910.36 7. Do exits discharge directly to space that allows people to move away from the building? Are exit doors clearly marked, self closing, and have dormitory exit locksets or panic bar locksets? 29 CFR 1910.37 8. Are supervised alarm systems tested annually and a fire drill conducted? Are non-supervised alarm systems tested bi-monthly? 29 CFR 1910.165(d)(2) & (4) 9. Do employees know how to report unsafe/unhealthful conditions? 240 FW 6.7 10. Is a SMIS report completed for every accident/incident? (SMIS is the official DOI accident/incident reporting system, found on the Internet) 240 FW 7.7B http://www.smis.doi.gov 2 FWS 3-2237 June 2011 11. Are the applicable forms completed when an accident occurs which involves employees or the public: a) SMIS; b) SF-91 (Report of Motor Vehicle Accident); c) SF-94 (Statement of Witness - if applicable); d) DI-103 (Report of Survey - sent to CGS)? SECTION F - PUBLIC SAFETY 1. 240 FW 7B & E 310 FW 6 YES NO N/A Are all areas which are open to the public periodically inspected to ensure that conditions are safe for use (e.g., tripping/falling hazards, uneven/wet surfaces, etc.)? SECTION G - HAZARD COMMUNICATION PROGRAM REFERENCE 240 FW 1.2 240 FW 5 YES NO N/A REFERENCE 1. Does the Station need and have a written HazCom Program? (Sample plans available from the Safety Office). 242 FW 2.8 2. Is a list of hazardous chemicals present in the workplace maintained? 242 FW 2.8B 3. Are Material Safety Data Sheets (MSDSs) maintained for all chemicals in the workplace on a current basis and available for employees review? 242 FW 2.A 4. Are employees familiar with the “Right -to- Know” standard? Is training provided when a new physical or health hazard is introduced into the work area? 29 CFR 1910.1200(h) 5. Are flammable materials stored in flammable cabinets? 29 CFR 1910.106(d)(3) 6. Are all hazardous containers labeled appropriately? 29 CFR 1910.1200 242 FW 2.8D 7. Are small quantities of gas/fuel stored in safety cans? 29 CFR 1910.106(a)(29) 8. Are all required signs posted in hazardous storage areas? 29 CFR 1910.106(d)7)(iii) 9. Are employees who apply restricted use pesticides either State or EPA trained and certified, or under the direct supervision of someone who is? 242 FW 7.6I(2) 10. Do chemical mixing areas have emergency showers and eyewash stations? 29 CFR 1910.151(c) ANSI Z358.1 SECTION H - NOISE/HEARING YES NO N/A REFERENCE 1. Do employees who are routinely exposed to noise exceeding 85 dBA wear hearing protection? Are awareness level safety talks given annually? 242 FW 3.5H(2) 2. Are baseline/annual audiometric tests being given to all employees routinely exposed to noise levels exceeding 85 dBA? 242 FW 3.12C(1) & (2) 3. Are the audiometric test results sent to the Regional Servicing Human Resource Office for inclusion into the employee’s medical file? 242 FW 3.16B 4. Are warning signs posted on equipment and in areas where noise levels exceed 85 dBA? 242 FW 3.10 SECTION I - BLOODBORNE PATHOGEN PROGRAM YES NO N/A REFERENCE 1. Have you evaluated the risk for Station employees who may be exposed to bloodborne pathogens (e.g., firefighters, Refuge LE officers, first aid/CPR responders, etc.)? Are awareness level safety talks given annually? 29 CFR 1910.1030 242 FW 12.2A 2. If required, does the Station have a written Bloodborne Pathogen Program/Exposure Control Plan? Is it updated annually? 29 CFR 1910.1030 242 FW 12.7B & 7G 3. If required, have employees received Bloodborne Pathogen training (typically included in CPR/First Aid courses)? 29 CFR 1910.1030 242 FW 12.7.8A 3 FWS 3-2237 June 2011 4. Do all first-aid kits contain bloodborne pathogen supplies (e.g., gloves, waste bags, etc.)? 29 CFR 1910.1030 242 FW 12.7D(2) 5. Are materials contaminated by bloodborne pathogens stored and disposed of properly? 29 CFR 1910.1030 242 FW 12.7C(5) 6. Have employees who are exposed to bloodborne pathogens been offered hepatitis B vaccine? Documentation? 29 CFR 1910.1030(f)(1)(i) 242 FW 12.7F(1) SECTION J - RESPIRATORY PROTECTION PROGRAM YES NO N/A REFERENCE 1. Is there a need for employees to wear respirators (Hantavirus exposure, welding on galvanized metals, chemical handling, etc.)? Does voluntary respirator use comply with 29 CFR 1910.134, Appendix D? 29 CFR 1910.134 242 FW 14.3 & 14.14 2. If so, is a written Respiratory Protection Program in place? Are awareness level safety talks given annually? 29 CFR 1910.134(k) 242 FW 14G(2)A 3. Are employees fit tested annually, and do they undergo medical evaluation, if required? 29 CFR 1910.134 242 FW 14.9 & 14.11B SECTION K - LABORATORY/CHEMICAL HYGIENE YES NO N/A REFERENCE 1. Does the Station participate in laboratory activities? 242 FW 8 2. Does the Station have a Chemical Hygiene (Lab Safety) Plan? (Sample plans are available from the Safety Office.) 242 FW 8F(1) SECTION L - PERSONAL PROTECTIVE EQUIPMENT (PPE) YES NO N/A REFERENCE 1. Has a job hazard assessment (JHA) been completed for each job task requiring PPE? 29 CFR 1910.132 241 FW 3.9 2. Do all employees who use PPE receive training in the proper use, cleaning, maintenance, and storage of their PPE? Is required PPE provided at no cost to the employees? 29 CFR 1910.132 241 FW 3.10 & 3.24 3. Is PPE inspected periodically to ensure all is in good working order, properly maintained, clean, and stored correctly? 29 CFR 1910.132 241 FW 3.23 4. Are PPE requirements reviewed with new employees, and as procedures change, and annually for respiratory protection? 29 CFR 1910.132 241 FW 3.24 SECTION M - MEDICAL SURVEILLANCE 1. YES Are medical surveillance exams provided for: NO N/A REFERENCE 242 FW 4.9 a. Refuge law enforcement personnel? b. Firefighters? c. Employees who must wear respirators during work activities? d. Contaminants Specialists? e. Service SCUBA divers? 2. Have employees at risk received information and training on Lyme disease prevention and tick-bite follow-up? 4 242 FW 5.4D FWS 3-2237 June 2011 SECTION N - MOTORIZED VEHICLES YES NO N/A REFERENCE 1. Are all passenger vehicles equipped with seatbelts? Do all lights, horn, brakes, etc. work properly? 243 FW 1.1.4G(3) & (9) 2. Do all operators of government vehicles maintain a valid State driver’s license from the State in which they reside? Have they signed an authorization to operate a motor vehicle or equipment? 321 FW 1.10 321 FW 1.13A (FWS Form 3-2267) 3. Are vehicles given an operator’s inspection before each use? 4. Is each vehicle inspected by a competent mechanic once a year? 5. Are DI-135 Accident Packets placed in vehicle glove boxes and are employees aware of accident reporting procedures? 6. Have all ATV operators received formal training (e.g. ATV Training Institute, etc.)? 321 FW 1.17 243 FW 6.5 7. Does each ATV operator wear proper PPE (Snell- or DOT-approved helmet, gloves, etc.)? 243 FW 6.6A 8. Are only trained and authorized operators permitted to operate PITs? Are PITs checked before each use? Is training recertified every 3 years? 243 FW 4 321 FW 1.19C(2) 9. Are name plates and load ratings for PITs legible? 29 CFR 1910.178(a)(6) 243.1.4G(9) SECTION O - HEAVY EQUIPMENT 320 FW 6.11B 243 FW 1.11B YES NO N/A REFERENCE 1. Are all employees who operate heavy equipment trained, tested, and authorized? 321 FW 1.19A 2. Is all heavy equipment with an obstructed view to the rear equipped with a backup warning system (alarm)? 243 FW 3.3 3. Do all wheeled tractors and other units that travel public roadways at speeds of 25 mph or less have slow moving vehicle signs displayed? 243 FW 3.10 4. Have all heavy equipment operators received training in proper load securement procedures? 243 FW 5.14 5. Has an evaluation of all motor vehicle equipment been completed to ensure compliance with Service policy? 243 FW 1.1 SECTION P - WATERCRAFT YES NO N/A REFERENCE 1. Does the Station operate watercraft? (Airboats, barges, motorboats, etc.) 241 FW 1, 485 DM 22 2. Have all motorboat operators completed the MOCC basic training? Refresher training every 5 years? 241 FW 1.7A & B 485 DM 22 3. Does everyone on board a watercraft less than 26 feet long wear a USCGapproved PFD (international orange with retroreflective tape)? 241 FW 1.8A(1)(a) 485 DM 22 4. Is each watercraft inspected periodically to ensure proper maintenance? 241 FW 1.6I(1)(b) 485 DM 22 5. If the Station operates airboats, do airboat operators and passengers wear hearing protection in addition to other safety equipment? 241 FW 1 485 DM 22 241 FW 3.13 – Exhibit 2 6. Have airboat operators received the required MOCC training, plus eight hours of specialized airboat training, and 40 hours of documented airboat driving time before they operate an airboat independently? 240 FW 3 241 FW 1.7E 5 FWS 3-2237 June 2011 7. Is at least one USCG-approved fire extinguisher on board each motorized watercraft? SECTION Q - ELECTROFISHING 241 FW 1.8B YES NO N/A REFERENCE 1. If the Station conducts electrofishing, is the electrofishing team leader current in First Aid/CPR training? 241 FW 6.5G(9) 2. Have employees operating the boat who participate in electrofishing been trained in the safe use of the boat and the electrofishing equipment? 241 FW 1 241 FW 6.6A (1)(b) 3. Has the electrofishing team leader and crew received adequate training in electrofishing techniques and safety precautions? 241 FW 6.6 B & C 4. Is all electrofishing equipment given an annual preventive maintenance and safety inspection? Is the equipment inspected prior to each use? 241 FW 6.5G (1) & (2) 5. Is proper PPE available and worn for electrofishing activities? 241 FW 6.11E SECTION R - FIRE EXTINGUISHERS/FIRE SAFETY YES NO N/A REFERENCE 1. Are all portable fire extinguishers checked monthly and inspected annually (tags on extinguishers should reflect both)? 29 CFR 1910.157(e) 2. Are all portable ABC dry chemical fire extinguishers recharged at 6 year intervals and hydrostatically checked every 12 years? 29 CFR 1910.157(e) NFPA 10-7.3.1.2.1 3. Is an ABC portable fire extinguisher (min. 80 B:C rated) located at least 25 feet but not more than 75 feet from aboveground fuel storage tanks? NFPA 30A-9.2.5.2 4. Is a portable fire extinguisher of not less than 40:B located outside the HazMat building, within10 feet of entry door? NFPA 30-9.10.2 5. Are all portable fire extinguishers mounted 3-5 feet from floor surface, and if outdoors, mounted in vented/tinted glass cabinets? NFPA 10-6.1.3.8.1 NFPA 10-6.1.3.10.4 6. Are portable fire extinguishers provided in all Government vehicles per 243 FW 1? 243 FW 1.12 7. Are all portable fire extinguishers kept in their designated places, maintained, fully operable, and fully charged? 29 CFR 1910.157(c) 8. Are employees trained annually to operate portable fire extinguishers? 29 CFR 1910.157(g) 9. Are all fire extinguishers, alarm pull boxes, and fire safety equipment appropriately marked? 29 CFR 1910.157(c) 29 CFR 1910.165(e) Do all sprinkler systems have a main drain flow test conducted annually and is an inspector’s test valve inspected and opened every 2 years? 29 CFR 1910.159(c)(2) 11. Are transfer containers of flammable liquids bonded and grounded appropriately? NFPA 77-6.8.3 12. Are monthly inspections conducted on smoke alarms? 29 CFR 1910.165, Appendix B 13. Are pumps and liquid petroleum (L.P.) tanks guarded from physical damage from vehicles and equipment? Are they located away from buildings and other flammable storage? NFPA 58 NFPA 30 14. Do all fuel dispensing areas have an electrical disconnect switch for pumps that are accessible and identified? NFPA 30A – 6.7 15. Are emergency lights tested monthly for 30 seconds and annually for 1.5 hours, and is testing documented? NFPA – 14.13.2 10. 6 SECTION S - ELECTRICAL YES NO N/A REFERENCE 1. Are all outlets equipped with 3-prong sockets? 29 CFR 1910.304(a)(2)(iii) 2. Is GFCI protection provided for outlets in wet areas and all exterior receptacles (e.g., bathrooms, kitchens, outdoors, etc.)? Are weather-proof receptacle enclosures used in wet areas and outdoors? NFPA 70-210.8 NFPA 70-406.9 3. Are all switches and circuit breakers in main electrical boxes labeled? Are disconnects labeled as to what equipment they service? 29 CFR 1910.303(f)(1) & (2) 4. Are extension cords used only as temporary (not to exceed 90 days) wiring? 29 CFR 1910.305(a)(2) 5. Are all panels, junction boxes, and conduit connections free from unused openings or missing covers? 29 CFR 1910.305(b)(1) 6. Are all receptacles, covers, and conduit free of recognized hazards, professionally installed and secure? 29 CFR 1910.303(b)(1) 7. Do all electrical panels have 36 inch clearance and are not blocked by stored equipment? 29 CFR 1910.303(g)(1) 8. Are all appliances and lamps grounded or approved for their application? 29 CFR 1910.304(g)(6)(vi)(C) 29 CFR 1910.399 9. Is all electrical wiring in shops/pole barns, etc., enclosed in conduit? NFPA 70-300.4 10. Are ceiling florescent and incandescent bulbs in shop/maintenance areas covered with wire mesh/lexan sleeves to capture debris in event bulbs break? 29 CFR 1910.303(g)(2) SECTION T - SHOP TOOLS YES NO N/A REFERENCE 1. Are all power tool cords in good condition? Is the strain relief undamaged? Are plugs “dead front” construction? 1910.334(a)(1) & (2) NFPA 70-406.7A 2. Are all electrically-powered machines properly grounded with third-wire or double insulation? 29 CFR 1926.302(a)(1) 3. Are portable powered tools inspected prior to use, properly guarded, and equipped with constant pressure switches where required? 29 CFR 1910.243(a)(1) 29 CFR 1910.243(a)(2) 29 CFR 1910.242(a) 4. Are all machines which are designed for a fixed location securely anchored to prevent “walking” (e.g., drill press, band saw, etc.)? 29 CFR 1910.212(b)(5) 5. Are all woodworking machines equipped with guards (exposed blades, pulleys, belts, etc.)? 29 CFR 1910.213(a)(9) 6. Is the radial arm saw installed so the cutting head returns to the starting position when released by the operator? 29 CFR 1910.213(h)(4) 7. Do all bench/pedestal grinders have guards in place and rests properly positioned? Is the tool rest gap no greater than 1/8th of an inch? Is tongue guard gap no greater than 1/4 inch? 29 CFR 1910.215(a)(4) 29 CFR 1910.215(b)(9) 8. Are required eye protection signs posted where applicable, and is personal protective equipment available and used? 29 CFR 1910.133(a) 29 CFR 1910.145(c)(3) 9. Is all stationary woodworking machinery such as table saws, lathes, etc., equipped with low voltage drop out switches or devices? (Magnetic restart switch)? 29 CFR 1910.213(b)(3) 10. Are all hoists, jacks and rigging equipment plainly marked for their rated load capacity? 29 CFR 1910.179(b)(5) 7 FWS 3-2237 June 2011 Are all ladders appropriate for application, e.g., metal ladders not used for electrical work? Are all ladders inspected before each use and stored properly? Are all ladders equipped with non-slip bases? 29 CFR 1910.25(d)(1) 12 CFR 1926.951(c) If compressed air is used for cleaning, are air gun nozzles used that reduce back pressure < 30 psi if blocked, and are they equipped with chip guards? 29 CFR 1910.241(b) Are operators of Hilti guns and explosive actuated devices properly trained and certified? 29 CFR 1926.302(e) Do lawnmowers and snow blowers meet applicable codes for safety equipment, e.g., dead man controls where applicable, warning signs, etc.? 29 CFR 1910.243 ANSI B71.3 15. Is a GFCI protection device used whenever electrical power tools are used outdoors? Is a GFCI device used whenever electrical power tools are used with an extension cord that is not plugged into a GFCI protected circuit? 29 CFR 1926.404(b)(1)(ii) 16. Have Service employees who use chainsaws received training? 17. For chainsaws, are all required personal protective devices such as chaps, hard hats, face shields and hearing protection, available in good condition and used? 241 FW 3 – Exhibit 2 18. Are all chainsaws equipped with appropriate chains, brakes, spark arrestors and vibration dampeners? 241 FW 12.11 11. 12. 13. 14. SECTION U - LOFTS, STAIRS, Scaffolding and Floor Openings 241 FW 12, non-fire personnel 621 FW 1, fire personnel YES NO N/A REFERENCE 1. Has loft storage area load limit been determined and posted? 29 CFR 1910.22(d) 2. Are platforms guarded by standard railings and toeboards? 29 CFR 1910.23(c)(1) 3. Are fixed ladders designed to meet criteria of use? Do stairs meet minimum requirements for handrails? 29 CFR 1910.23(d)(1) 29 CFR 1910.27 4. Are all floor openings or skylights guarded? 29 CFR 1910.23(a)(4) SECTION V - EXPLOSIVES YES NO N/A REFERENCE 1. If the Station utilizes explosives for blasting or netting, is an inventory of all explosives kept up to date? 244 FW 1.10D 2. Have all employees who use explosives been trained? 244 FW 2 3. Has a Job Hazard Assessment (JHA) & Blast Plan been completed and reviewed prior to any explosives use activity? 244 FW 2 244 FW 3 4. Are explosives stored properly? 244 FW 1.7, 1.8 & 1.9 5. Does transportation of explosives comply with Service policy? 244 FW 1.11 SECTION W - HIGH HAZARD AREAS/HAZARDOUS TASKS YES NO N/A REFERENCE 1. Have high-hazard areas and tasks been identified (e.g. 242 FW 7, pesticide mixing/chemical use areas, welding, etc.)? 240 FW 1.10 2. Has training been done more frequently in these areas? 240 FW 3.5 3. Have hazardous job tasks been identified (e.g., any activity that requires a respirator; use of power-actuated equipment, etc.)? 240 FW 1.10 4. Has a Job Hazard Assessment (JHA) been done for each hazardous job task, and reviewed by the Project Leader and Safety Office? 240 FW 1.10 8 FWS 3-2237 June 2011 5. Is PPE for these tasks available and in good working condition? 241 FW 3 6. Are all weapons and ammunition securely stored? 442 FW 1.15C SECTION X - UNDERWATER DIVING (SCUBA) 1. YES NO N/A Are all employees participating in underwater diving activities currently authorized to dive for the Service? SECTION Y - CONFINED SPACE PROGRAM REFERENCE 29 CFR 1910 Subpart T, Appendix B 485 DM 27 241 FW 10.6H(1) YES NO N/A REFERENCE 1. Is there a documented inventory of confined spaces? 29 CFR 1910.146(c)(1) 242 FW 11.9 2. Do all confined spaces have appropriate warning signs? Are all permit required spaces locked to keep unauthorized individuals from entering? 29 CFR 1910.146(c)(2) 29 CFR 1910.146(c)(3) 242 FW 11.10C 3. If there are permit required confined spaces identified, is there a written plan for entering and is it updated annually? 29 CFR 1910.146(c)(4) 242 FW 11.10 SECTION Z - LOCKOUT/TAGOUT PROGRAM (LOTO) YES NO N/A REFERENCE 1. Are employees who perform work on electrical or other equipment with stored energy, e.g., hydraulic, pneumatic, kinetic, heat, etc., trained and knowledgeable in LOTO procedures? 29 CFR 1910.147(c)(7)(i) 241 FW 8.4D &E 2. Is there an inventory of equipment that needs to be locked out? Are there written LOTO procedures for the equipment that does not have one step, easily identified LOTO procedures? 29 CFR 1910.147(c)(1) 241 FW 8.7 Form 3-2280 & Form 3-2281 3. Are authorized employees recertified on LOTO procedures annually? 29 CFR 1910.147(c))(7)(iii)(3)(A) (B) & (C) 241 FW 8.16 4. Is LOTO equipment available for all authorized employees, e.g., individual locks and tags? 29 CFR 1910.147(c)(5) 241 FW 8.10, 8.11, 8.12 & 8.13 SECTION AA - ASBESTOS AND LEAD MANAGEMENT YES NO N/A REFERENCE 1. Are asbestos and lead surveys completed for all buildings? 561 FW 8.5A FWS Auditing Handbook (Mgmt. Practice) 2. Are appropriate signs posted if asbestos is present? 561 FW 8.7A 29 CFR 1910.1001(j)(4) 3. Are awareness level safety talks given annually? 29 CFR 1910.1001(j)(7)(ii) 4. Are training and safety work practices established, if applicable? 29 CFR 1910.1001(j)(7) 5. Is the identified asbestos or lead paint in good condition? 561 FW 8.6 FWS Auditing Handbook (Mgmt. Practice) SECTION BB – CONTRACTOR SAFETY 1. YES If contractors are present, have they reviewed safety requirements and signed off on Preconstruction Safety Checklist? 9 NO N/A REFERENCE 360 FW 4.5D FWS 3-2237 June 2011 2. Is PPE used at the work-site by contractors appropriately? 360 FW 4.5E(3) 3. Is area construction appropriately barricaded to prevent unauthorized entry? Is equipment locked out? 360 FW 4.5E(3) 4. Has the contractor been made aware of areas that contain asbestos, lead paint, or other hazardous materials? Are precautions initiated? 360 FW 4.3B – (SCIH) Section 4.2 SECTION CC – BURNING / WELDING YES NO N/A REFERENCE 1. Is a non-flammable shield provided to prevent arc flash to bystanders during welding operations? 29 CFR 1910.252(b)(ii) 2. Are oxygen / acetylene burning hoses equipped with gauge mounted flashback arrestors? 29 CFR 1910.252(a)(xiii) 3. Are oxygen tanks for welding stored 20 feet or more from flammable gas cylinders, or are separated by a 5 foot wall with a half hour fire rating? Are all cylinders secured in an upright position and have covers on when not in use? 29 CFR 1910.253(a)(2) 29 CFR 1910.253(b)(III) 4. Are fire hazards removed from welding areas or adequately guarded before welding begins? Is a fire watch established? 29 CFR 1910.252(a)(1)(i) & (2)(iii) SECTION DD – CRANES, HOISTS, LIFTING DEVICES 1. Are periodic crane inspections conducted on all cranes and lifting devices? YES NO N/A REFERENCE 29 CFR 1910.179 (j)(3) Thank you for completing the questionnaire. Please fax to the Regional Safety Office and if you have any questions, please call. 10 FWS 3-2237 June 2011