Every California employer must establish, implement and
maintain a written Injury and Illness Prevention (IIP) Program and a copy must be
maintained at each workplace or at a central work site if the employer has non-fixed work
sites. The requirements for establishing, implementing and maintaining an effective
written injury and illness prevention program are contained in Title 8 of the California
Code of Regulations, Section 3203 (T8 CCR 3203)
and consist of the following eight elements:
This model program has been prepared for use by employers in industries which have been
determined by Cal/OSHA to be high hazard. You are not required to use this program. This
model program was written for a broad spectrum of employers and it may not match your
establishment's exact needs. However, it does provide the essential framework required for
an Injury and Illness Prevention Program. Proper use of this model program requires the IIP Program administrator for your
establishment to carefully review the requirements for each of the eight IIP Program
elements found in this model program, fill in the appropriate blank spaces and check those
items that are applicable to your workplace. The recordkeeping section requires that the
IIP Program administrator select and implement the category appropriate for your
establishment. Sample forms for hazard assessment and correction, accident/exposure
investigation, and employee training and instruction are provided with this model program.
This model program must be maintained by the employer in order to be effective. RESPONSIBILITY The Injury and Illness Prevention Program (IIP Program) administrator, has the authority and responsibility for implementing the provisions of this program
for All managers and supervisors are responsible for implementing and maintaining the IIP
Program in their work areas and for answering worker questions about the IIP Program. A
copy of this IIP Program is available from each manager and supervisor. COMPLIANCE Management is responsible for ensuring that all safety and health policies and
procedures are clearly communicated and understood by all employees. Managers and
supervisors are expected to enforce the rules fairly and uniformly. All employees are responsible for using safe work practices, for following all
directives, policies and procedures, and for assisting in maintaining a safe work
environment. Our system of ensuring that all employees comply with the rules and maintain a safe
work environment include: 1. Informing employees of the provisions of our IIP Program; 2. Evaluating the safety performance of all employees; 3. Recognizing employees who perform safe and healthful work practices; 4. Providing training to employees whose safety performance is deficient; 5. Disciplining employees for failure to comply with safe and healthful work practices;
and 6. The following practices: ________________________________________________________ COMMUNICATION We recognize that open, two-way communication between management and staff on health
and safety issues is essential to an injury-free, productive workplace. The following
system of communication is designed to facilitate a continuous flow of safety and health
information between management and staff in a form that is readily understandable and
consists of one or more of the following checked items:
HAZARD ASSESSMENT Periodic inspections to identify and evaluate workplace hazards shall be performed by
the following competent observer(s) in the following areas of our workplace: Periodic inspections are performed according to the following schedule:
Periodic inspections consist of identification and evaluation of workplace hazards
utilizing applicable sections of the attached Hazard Assessment Checklist and any other
effective methods to identify and evaluate workplace hazards. ACCIDENT/EXPOSURE INVESTIGATIONS Procedures for investigating workplace accidents and hazardous substance exposures
HAZARD CORRECTION Unsafe or unhealthy work conditions, practices or procedures shall be corrected in a
timely manner based on the severity of the hazards. Hazards shall be corrected according
to the following procedures:
TRAINING AND INSTRUCTION All employees, including managers and supervisors, shall have training and instruction
on general and job-specific safety and health practices. Training and instruction shall be
provided as follows:
Workplace safety and health training practices for all industries include, but are not
limited to, the following:
In addition, we provide specific instructions to all employees regarding hazards unique
to their job assignment, to the extent that such information was not already covered in
other training. RECORDKEEPING We have checked one of the following categories as our recordkeeping policy.
1. Records of
hazard assessment inspections, including the person(s) conducting the inspection, the
unsafe conditions and work practices that have been identified and the action taken to
correct the identified unsafe conditions and work practices, are recorded on a hazard
assessment and correction form; and 2. Documentation of safety and health training for each employee, including the
employee's name or other identifier, training dates, type(s) of training, and training
providers. are recorded on an employee training and instruction form. We also include the
records relating to employee training provided by a construction industry occupational
safety and health training program approved by Cal/OSHA. Inspection records and training documentation will be maintained according to the
following checked schedule: We train our workers about the following checked training subjects:
PERSONAL PROTECTIVE EQUIPMENT & CLOTHING Are fire extinguishers selected and provided for the types of
materials in areas where they are to be used? Class A: Ordinary combustible material
INJURY AND ILLNESS PREVENTION PROGRAM
Competent Observer | Area
Frequency (Daily, weekly, monthly, etc.)
LIST OF TRAINING SUBJECTS
HAZARD ASSESSMENT CHECKLIST
The following checklists contain safety and health hazard assessment items commonly found in the workplace. It is the employer's responsibility to identify, evaluate and control job-specific safety and health hazards in the workplace, and to meet all applicable Cal/OSHA requirements.
GENERAL WORK ENVIRONMENT
Are all worksites clean and orderly?
Are work surfaces kept dry or appropriate means taken to assure the surfaces are
Are all spilled materials or liquids cleaned up immediately?
Is combustible scrap, debris and waste stored safely and removed from the worksite
Is accumulated combustible dust routinely removed from elevated surfaces, including
the overhead structure of buildings?
Is combustible dust cleaned up with a vacuum system to prevent the dust going into
Is metallic or conductive dust prevented from entering or accumulation on or around
electrical enclosures or equipment?
Are covered metal waste cans used for oily and paint-soaked waste?
Are all oil and gas fired devices equipped with flame failure controls that will
prevent flow of fuel if pilots or main burners are not working?
Are paint spray booths, dip tanks and the like cleaned regularly?
Are the minimum number of toilets and washing facilities provided?
Are all toilets and washing facilities clean and sanitary?
Are all work areas adequately illuminated?
Are pits and floor openings covered or otherwise guarded?
Are protective goggles or face shields provided and worn where there is any danger of
flying particles or corrosive materials?
Are approved safety glasses required to be worn at all times in areas where there is a
risk of eye injuries such as punctures, abrasions, contusions or burns?
Are employees who need corrective lenses (glasses or contacts lenses) in working
environments with harmful exposures, required to wear only approved safety glasses,
protective goggles, or use other medically approved precautionary procedures?
Are protective gloves, aprons, shields, or other means provided against cuts,
corrosive liquids and chemicals?
Are hard hats provided and worn where danger of falling objects exists?
Are hard hats inspected periodically for damage to the shell and suspension system?
Is appropriate foot protection required where there is the risk of foot injuries from
hot, corrosive, poisonous substances, falling objects, crushing or penetrating actions?
Are approved respirators provided for regular or emergency use where needed?
Is all protective equipment maintained in a sanitary condition and ready for use?
Do you have eye wash facilities and a quick drench shower within the work area where
employees are exposed to injurious corrosive materials?
Where special equipment is needed for electrical workers, is it available?
When lunches are eaten on the premises, are they eaten in areas where there is no
exposure to toxic materials or other health hazards?
Is protection against the effects of occupational noise exposure provided when sound
levels exceed those of the Cal/OSHA noise standard?
Are aisles and passageways kept clear?
Are aisles and walkways marked as appropriate?
Are wet surfaces covered with non-slip materials?
Are holes in the floor, sidewalk or other walking surface repaired properly, covered
or otherwise made safe?
Is there safe clearance for walking in aisles where motorized or mechanical handling
equipment is operating.
Are spilled materials cleaned up immediately?
Are materials or equipment stored in such a way that sharp projectiles will not
interfere with the walkway?
Are changes of direction or elevations readily identifiable?
Are aisles or walkways that pass near moving or operating machinery, welding
operations or similar operations arranged so employees will not be subjected to potential
Is adequate headroom provided for the entire length of any aisle or walkway?
Are standard guardrails provided wherever aisle or walkway surfaces are elevated more
than 30 inches above any adjacent floor or the ground?
Are bridges provided over conveyors and similar hazards?
FLOOR & WALL OPENINGS
Are floor openings guarded by a cover, guardrail, or equivalent on all sides (except
at entrance to stairways or ladders)?
Are toeboards installed around the edges of a permanent floor opening (where persons
may pass below the opening)?
Are skylight screens of such construction and mounting that they will withstand a load
of at least 200 pounds?
Is the glass in windows, doors, glass walls which are subject to human impact, of
sufficient thickness and type for the condition of use?
Are grates or similar type covers over floor openings such as floor drains, of such
design that foot traffic or rolling equipment will not be affected by the grate spacing?
Are unused portions of service pits and pits not actually in use either covered or
protected by guardrails or equivalent?
Are manhole covers, trench covers and similar covers, plus their supports, designed to
carry a truck rear axle load of at least 20,000 pounds when located in roadways and
subject to vehicle traffic?
Are floor or wall openings in fire resistive construction provided with doors or
covers compatible with the fire rating of the structure and provided with self-closing
feature when appropriate?
STAIRS & STAIRWAYS
Are standard stair rails or handrails on all stairways having four or more risers?
Are all stairways at least 22 inches wide?
Do stairs have at least a 6'6" overhead clearance?
Do stairs angle no more than 50 and no less than 30 degrees?
Are stairs of hollow-pan type treads and landings filled to noising level with solid
Are step risers on stairs uniform from top to bottom, with no riser spacing greater
than 7-1/2 inches?
Are steps on stairs and stairways designed or provided with a surface that renders
them slip resistant?
Are stairway handrails located between 30 and 34 inches above the leading edge of
Do stairway handrails have a least 1-1/2 inches of clearance between the handrails and
the wall or surface they are mounted on?
Are stairway handrails capable of withstanding a load of 200 pounds, applied in any
Where stairs or stairways exit directly into any area where vehicles may be operated,
are adequate barriers and warnings provided to prevent employees stepping into the path of
Do stairway landings have a dimension measured in the direction of travel, at least
equal to width of the stairway?
Is the vertical distance between stairway landings limited to 12 feet or less?
Are signs posted, when appropriate, showing the elevated surface load capacity?
Are surfaces elevated more than 30 inches above the floor or ground provided with
Are all elevated surfaces (beneath which people or machinery could be exposed to
falling objects) provided with standard 4-inch toeboards?
Is a permanent means of access and egress provided to elevated storage and work
Is required headroom provided where necessary?
Is material on elevated surfaces piled, stacked or racked in a manner to prevent it
from tipping, falling, collapsing, rolling or spreading?
Are dock boards or bridge plates used when transferring materials between docks and
trucks or rail cars?
EXITING OR EGRESS
Are all exits marked with an exit sign and illuminated by a reliable light source?
Are the directions to exits, when not immediately apparent, marked with visible signs?
Are doors, passageways or stairways, that are neither exits nor access to exits and
which could be mistaken for exits, appropriately marked "NOT AN EXIT", "TO
BASEMENT", "STOREROOM", and the like?
Are exit signs provided with the word "EXIT" in lettering at least 5 inches
high and the stroke of the lettering at least 1/2 inch wide?
Are exit doors side-hinged?
Are all exits kept free of obstructions?
Are at least two means of egress provided from elevated platforms, pits or rooms where
the absence of a second exit would increase the risk of injury from hot, poisonous,
corrosive, suffocating, flammable, or explosive substances?
Are there sufficient exits to permit prompt escape in case of emergency?
Are special precautions taken to protect employees during construction and repair
Is the number of exits from each floor of a building, and the number of exits from the
building itself, appropriate for the building occupancy load?
Are exit stairways which are required to be separated from other parts of a building
enclosed by at least two hour fire-resistive construction in buildings more than four
stories in height, and not less than one-hour fire resistive construction elsewhere?
When ramps are used as part of required exiting from a building, is the ramp slope
limited to 1- foot vertical and 12 feet horizontal?
Where exiting will be through frameless glass doors, glass exit doors, storm doors,
and such, are the doors fully tempered and meet the safety requirements for human impact?
Are doors which are required to serve as exits designed and constructed so that the
way of exit travel is obvious and direct?
Are windows which could be mistaken for exit doors, made inaccessible by means of
barriers or railings?
Are exit doors openable from the direction of exit travel without the use of a key or
any special knowledge or effort, when the building is occupied?
Is a revolving, sliding or overhead door prohibited from serving as a required exit
Where panic hardware is installed on a required exit door, will it allow the door to
open by applying a force of 15 pounds or less in the direction of the exit traffic?
Are doors on cold storage rooms provided with an inside release mechanism which will
release the latch and open the door even if it's padlocked or otherwise locked on the
Where exit doors open directly onto any street, alley or other area where vehicles may
be operated, are adequate barriers and warnings provided to prevent employees stepping
into the path of traffic?
Are doors that swing in both directions and are located between rooms where there is
frequent traffic, provided with viewing panels in each door?
Are all ladders maintained in good condition, joints between steps and side rails
tight, all hardware and fittings securely attached, and moveable parts operating freely
without binding or undue play?
Are non-slip safety feet provided on each ladder?
Are non-slip safety feet provided on each metal or rung ladder?
Are ladder rungs and steps free of grease and oil?
Is it prohibited to place a ladder in front of doors opening toward the ladder except
when the door is blocked open, locked or guarded?
Is it prohibited to place ladders on boxes, barrels, or other unstable bases to obtain
Are employees instructed to face the ladder when ascending or descending?
Are employees prohibited from using ladders that are broken, missing steps, rungs, or
cleats, broken side rails or other faulty equipment?
Are employees instructed not to use the top 2 steps of ordinary stepladders as a step?
When portable rung ladders are used to gain access to elevated platforms, roofs, and
the like., does the ladder always extend at least 3 feet above the elevated surface?
Is it required that when portable rung or cleat type ladders are used the base is so
placed that slipping will not occur, or it is lashed or otherwise held in place?
Are portable metal ladders legibly marked with signs reading "CAUTION"
"Do Not Use Around Electrical Equipment" or equivalent wording?
Are employees prohibited from using ladders as guys, braces, skids, gin poles, or for
other than their intended purposes?
Are employees instructed to only adjust extension ladders while standing at a base
(not while standing on the ladder or from a position above the ladder)?
Are metal ladders inspected for damage?
Are the rungs of ladders uniformly spaced at 12 inches, center to center?
HAND TOOLS & EQUIPMENT
Are all tools and equipment (both, company and employee-owned) used by employees at
their workplace in good condition?
Are hand tools such as chisels, punches, which develop mushroomed heads during use,
reconditioned or replaced as necessary?
Are broken or fractured handles on hammers, axes and similar equipment replaced
Are worn or bent wrenches replaced regularly?
Are appropriate handles used on files and similar tools?
Are employees made aware of the hazards caused by faulty or improperly used hand
Are appropriate safety glasses, face shields, and similar equipment used while using
hand tools or equipment which might produce flying materials or be subject to breakage?
Are jacks checked periodically to assure they are in good operating condition?
Are tool handles wedged tightly in the head of all tools?
Are tool cutting edges kept sharp so the tool will move smoothly without binding or
Are tools stored in dry, secure location where they won't be tampered with?
Is eye and face protection used when driving hardened or tempered spuds or nails?
PORTABLE (POWER OPERATED) TOOLS & EQUIPMENT
Are grinders, saws, and similar equipment provided with appropriate safety guards?
Are power tools used with the correct shield, guard or attachment recommended by the
Are portable circular saws equipped with guards above and below the base shoe?
Are circular saw guards checked to assure they are not wedged up, thus leaving the
lower portion of the blade unguarded?
Are rotating or moving parts of equipment guarded to prevent physical contact?
Are all cord-connected, electrically-operated tools and equipment effectively grounded
or of the approved double insulated type?
Are effective guards in place over belts, pulleys, chains, sprockets, on equipment
such as concrete mixers, air compressors, and the like?
Are portable fans provided with full guards or screens having openings 1/2 inch or
Is hoisting equipment available and used for lifting heavy objects, and are hoist
ratings and characteristics appropriate for the task?
Are ground-fault circuit interrupters provided on all temporary electrical 15 and 20
ampere circuits, used during periods of construction?
Are pneumatic and hydraulic hoses on power-operated tools checked regularly for
deterioration or damage?
ABRASIVE WHEEL EQUIPMENT GRINDERS
Is the work rest used and kept adjusted to within 1/8 inch of the wheel?
Is the adjustable tongue on the top side of the grinder used and kept adjusted to
within 1/4 inch of the wheel?
Do side guards cover the spindle, nut, and flange and 75 percent of the wheel
Are bench and pedestal grinders permanently mounted?
Are goggles or face shields always worn when grinding?
Is the maximum RPM rating of each abrasive wheel compatible with the RPM rating of the
Are fixed or permanently mounted grinders connected to their electrical supply system
with metallic conduit or other permanent wiring method?
Does each grinder have an individual on and off control switch?
Is each electrically operated grinder effectively grounded?
Before new abrasive wheels are mounted, are they visually inspected and ring tested?
Are dust collectors and powered exhausts provided on grinders used in operations that
produce large amounts of dust?
Are splash guards mounted on grinders that use coolant, to prevent the coolant
Is cleanliness maintained around grinder?
POWDER ACTUATED TOOLS
Are employees who operate powder-actuated tools trained in their use and carry a valid
Do the powder-actuated tools being used have written approval of the Division of
Occupational Safety and Health?
Is each powder-actuated tool stored in its own locked container when not being used?
Is a sign at least 7" by 10" with bold type reading "POWDER-ACTUATED
TOOL IN USE" conspicuously posted when the tool is being used?
Are powder-actuated tools left unloaded until they are actually ready to be used?
Are powder-actuated tools inspected for obstructions or defects each day before use?
Do powder-actuated tools operators have and use appropriate personal protective
equipment such as hard hats, safety goggles, safety shoes and ear protectors?
Is there a training program to instruct employees on safe methods of machine
Is there adequate supervision to ensure that employees are following safe machine
Is there a regular program of safety inspection of machinery and equipment?
Is all machinery and equipment kept clean and properly maintained?
Is sufficient clearance provided around and between machines to allow for safe
operations, set up and servicing, material handling and waste removal?
Is equipment and machinery securely placed and anchored, when necessary to prevent
tipping or other movement that could result in personal injury?
Is there a power shut-off switch within reach of the operator's position at each
Can electric power to each machine be locked out for maintenance, repair, or security?
Are the noncurrent-carrying metal parts of electrically operated machines bonded and
Are foot-operated switches guarded or arranged to prevent accidental actuation by
personnel or falling objects?
Are manually operated valves and switches controlling the operation of equipment and
machines clearly identified and readily accessible?
Are all emergency stop buttons colored red?
Are all pulleys and belts that are within 7 feet of the floor or working level
Are all moving chains and gears properly guarded?
Are splash guards mounted on machines that use coolant, to prevent the coolant from
Are methods provided to protect the operator and other employees in the machine area
from hazards created at the point of operation, ingoing nip points, rotating parts, flying
chips, and sparks?
Are machinery guards secure and so arranged that they do not offer a hazard in their
If special hand tools are used for placing and removing material, do they protect the
Are revolving drums, barrels, and containers required to be guarded by an enclosure
that is interlocked with the drive mechanism, so that revolution cannot occur unless the
guard enclosure is in place, so guarded?
Do arbors and mandrels have firm and secure bearings and are they free from play?
Are provisions made to prevent machines from automatically starting when power is
restored after a power failure or shutdown?
Are machines constructed so as to be free from excessive vibration when the largest
size tool is mounted and run at full speed?
If machinery is cleaned with compressed air, is air pressure controlled and personal
protective equipment or other safeguards used to protect operators and other workers from
eye and body injury?
Are fan blades protected with a guard having openings no larger than 1/2 inch, when
operating within 7 feet of the floor?
Are saws used for ripping, equipped with anti-kick back devices and spreaders?
Are radial arm saws so arranged that the cutting head will gently return to the back
of the table when released?
LOCKOUT BLOCKOUT PROCEDURES
Is all machinery or equipment capable of movement, required to be de-energized or
disengaged and blocked or locked out during cleaning, servicing, adjusting or setting up
operations, whenever required?
Is the locking-out of control circuits in lieu of locking-out main power disconnects
Are all equipment control valve handles provided with a means for locking-out?
Does the lock-out procedure require that stored energy (i.e. mechanical, hydraulic,
air,) be released or blocked before equipment is locked-out for repairs?
Are appropriate employees provided with individually keyed personal safety locks?
Are employees required to keep personal control of their key(s) while they have safety
locks in use?
Is it required that employees check the safety of the lockout by attempting a start up
after making sure no one is exposed?
Where the power disconnecting means for equipment does not also disconnect the
electrical control circuit:
Are the appropriate electrical enclosures identified?
Is means provided to assure the control circuit can also be disconnected and locked
WELDING, CUTTING & BRAZING
Are only authorized and trained personnel permitted to use welding, cutting or brazing
Do all operator have a copy of the appropriate operating instructions and are they
directed to follow them?
Are compressed gas cylinders regularly examined for obvious signs of defects, deep
rusting, or leakage?
Is care used in handling and storage of cylinders, safety valves, relief valves, and
the like, to prevent damage?
Are precautions taken to prevent the mixture of air or oxygen with flammable gases,
except at a burner or in a standard torch?
Are only approved apparatus (torches, regulators, pressure-reducing valves, acetylene
generators, manifolds) used?
Are cylinders kept away from sources of heat?
Is it prohibited to use cylinders as rollers or supports?
Are empty cylinders appropriately marked, their valves closed and valve-protection
Are signs reading: DANGER NO-SMOKING, MATCHES, OR OPEN LIGHTS, or the equivalent
Are cylinders, cylinder valves, couplings, regulators, hoses, and apparatus keep free
of oily or greasy substances?
Is care taken not to drop or strike cylinders?
Unless secured on special trucks, are regulators removed and valve-protection caps put
in place before moving cylinders?
Do cylinders without fixed hand wheels have keys, handles, or non-adjustable wrenches
on stem valves when in service?
Are liquefied gases stored and shipped valve-end up with valve covers in place?
Are employees instructed to never crack a fuel-gas cylinder valve near sources of
Before a regulator is removed, is the valve closed and gas released form the
Is red used to identify the acetylene (and other fuel-gas) hose, green for oxygen
hose, and black for inert gas and air hose?
Are pressure-reducing regulators used only for the gas and pressures for which they
Is open circuit (No Load) voltage of arc welding and cutting machines as low as
possible and not in excess of the recommended limits?
Under wet conditions, are automatic controls for reducing no-load voltage used?
Is grounding of the machine frame and safety ground connections of portable machines
Are electrodes removed from the holders when not in use?
Is it required that electric power to the welder be shut off when no one is in
Is suitable fire extinguishing equipment available for immediate use?
Is the welder forbidden to coil or loop welding electrode cable around his body?
Are wet machines thoroughly dried and tested before being used?
Are work and electrode lead cables frequently inspected for wear and damage, and
replaced when needed?
Do means for connecting cables lengths have adequate insulation?
When the object to be welded cannot be moved and fire hazards cannot be removed, are
shields used to confine heat, sparks, and slag?
Are fire watchers assigned when welding or cutting is performed, in locations where a
serious fire might develop?
Are combustible floors kept wet, covered by damp sand, or protected by fire-resistant
When floors are wet down, are personnel protected from possible electrical shock?
When welding is done on metal walls, are precautions taken to protect combustibles on
the other side?
Before hot work is begun, are used drums, barrels, tanks, and other containers so
thoroughly cleaned that no substances remain that could explode, ignite, or produce toxic
Is it required that eye protection helmets, hand shields and goggles meet appropriate
Are employees exposed to the hazards created by welding, cutting, or bracing
operations protected with personal protective equipment and clothing?
Is a check made for adequate ventilation in and where welding or cutting is performed?
When working in confined places are environmental monitoring tests taken and means
provided for quick removal of welders in case of an emergency?
COMPRESSORS & COMPRESSED AIR
Are compressor air intakes installed and equipped to ensure that only clean
uncontaminated air enters the compressor?
Are air filters installed on the compressor intake?
Are compressors operated and lubricated in accordance with the manufacturer's
Are safety devices on compressed air systems checked frequently?
Before any repair work is done on the pressure system of a compressor, is the pressure
bled off and the system locked-out?
Are signs posted to warn of the automatic starting feature of the compressors?
Is the belt drive system totally enclosed to provide protection for the front, back,
top, and sides?
Is it strictly prohibited to direct compressed air towards a person?
Are employees prohibited from using highly compressed air for cleaning purposes?
If compressed air is used for cleaning off clothing, is the pressure reduced to less
than 10 psi?
When using compressed air for cleaning, do employees use personal protective
Are safety chains or other suitable locking devices used at couplings of high pressure
hose lines where a connection failure would create a hazard?
Before compressed air is used to empty containers of liquid, is the safe working
pressure of the container checked?
When compressed air is used with abrasive blast cleaning equipment, is the operating
valve a type that must be held open manually?
When compressed air is used to inflate auto tires, is a clip-on chuck and an inline
regulator preset to 40 psi required?
Is it prohibited to use compressed air to clean up or move combustible dust if such
action could cause the dust to be suspended in the air and cause a fire or explosion
COMPRESSED AIR RECEIVERS
Is every receiver equipped with a pressure gauge and with one or more automatic,
spring-loaded safety valves?
Is the total relieving capacity of the safety valve capable of preventing pressure in
the receiver from exceeding the maximum allowable working pressure of the receiver by more
than 10 percent?
Is every air receiver provided with a drainpipe and valve at the lowest point for the
removal of accumulated oil and water?
Are compressed air receivers periodically drained of moisture and oil?
Are all safety valves tested frequently and at regular intervals to determine whether
they are in good operating condition?
Is there a current operating permit issued by the Division of Occupational Safety and
Is the inlet of air receivers and piping systems kept free of accumulated oil and
COMPRESSED GAS & CYLINDERS
Are cylinders with a water weight capacity over 30 pounds equipped with means for
connecting a valve protector device, or with a collar or recess to protect the valve?
Are cylinders legibly marked to clearly identify the gas contained?
Are compressed gas cylinders stored in areas which are protected from external heat
sources such as flame impingement, intense radiant heat, electric arcs, or high
Are cylinders located or stored in areas where they will not be damaged by passing or
falling objects, or subject to tampering by unauthorized persons?
Are cylinders stored or transported in a manner to prevent them creating a hazard by
tipping, falling or rolling?
Are cylinders containing liquefied fuel gas, stored or transported in a position so
that the safety relief device is always in direct contact with the vapor space in the
Are valve protectors always placed on cylinders when the cylinders are not in use or
connected for use?
Are all valves closed off before a cylinder is moved, when the cylinder is empty, and
at the completion of each job?
Are low pressure fuel-gas cylinders checked periodically for corrosion, general
distortion, cracks, or any other defect that might indicate a weakness or render it unfit
Does the periodic check of low pressure fuel-gas cylinders include a close inspection
of the cylinders' bottom?
HOIST & AUXILIARY EQUIPMENT
Is each overhead electric hoist equipped with a limit device to stop the hook travel
at its highest and lowest point of safe travel?
Will each hoist automatically stop and hold any load up to 125 percent of its rated
load, if its actuating force is removed?
Is the rated load of each hoist legibly marked and visible to the operator?
Are stops provided at the safe limits of travel for trolley hoist?
Are the controls of hoists plainly marked to indicate the direction of travel or
Is each cage-controlled hoist equipped with an effective warning device?
Are close-fitting guards or other suitable devices installed on hoist to assure hoist
ropes will be maintained in the sheave groves?
Are all hoist chains or ropes of sufficient length to handle the full range of
movement for the application while still maintaining two full wraps on the drum at all
Are nip points or contact points between hoist ropes and sheaves which are permanently
located within 7 feet of the floor, ground or working platform, guarded?
Is it prohibited to use chains or rope slings that are kinked or twisted?
Is it prohibited to use the hoist rope or chain wrapped around the load as a
substitute, for a sling?
Is the operator instructed to avoid carrying loads over people?
Are only employees who have been trained in the proper use of hoists allowed to
INDUSTRIAL TRUCKS - FORKLIFTS
Are only trained personnel allowed to operate industrial trucks?
Is substantial overhead protective equipment provided on high lift rider equipment?
Are the required lift truck operating rules posted and enforced?
Is directional lighting provided on each industrial truck that operates in an area
with less than 2 foot candles per square foot of general lighting?
Does each industrial truck have a warning horn, whistle, gong or other device which
can be clearly heard above the normal noise in the areas where operated?
Are the brakes on each industrial truck capable of bringing the vehicle to a complete
and safe stop when fully loaded?
Will the industrial truck's parking brake effectively prevent the vehicle from moving
Are industrial trucks operating in areas where flammable gases or vapors, or
combustible dust or ignitable fibers may be present in the atmosphere, approved for such
Are motorized hand and hand/rider trucks so designed that the brakes are applied, and
power to the drive motor shuts off when the operator releases his/her grip on the device
that controls the travel?
Are industrial trucks with internal combustion engine operated in buildings or
enclosed areas, carefully checked to ensure such operations do not cause harmful
concentration of dangerous gases or fumes?
Is adequate ventilation assured before spray operations are started?
Is mechanical ventilation provided when spraying operation is done in enclosed areas?
When mechanical ventilation is provided during spraying operations, is it so arranged
that it will not circulate the contaminated air?
Is the spray area free of hot surfaces?
Is the spray area at least 20 feet from flames, sparks, operating electrical motors
and other ignition sources?
Are portable lamps used to illuminate spray areas suitable for use in a hazardous
Is approved respiratory equipment provided and used when appropriate during spraying
Do solvents used for cleaning have a flash point of 100° F or more?
Are fire control sprinkler heads kept clean?
Are "NO SMOKING" signs posted in spray areas, paint rooms, paint booths, and
paint storage areas?
Is the spray area kept clean of combustible residue?
Are spray booths constructed of metal, masonry, or other substantial noncombustible
Are spray booth floors and baffles noncombustible and easily cleaned?
Is infrared drying apparatus kept out of the spray area during spraying operations?
Is the spray booth completely ventilated before using the drying apparatus?
Is the electric drying apparatus properly grounded?
Are lighting fixtures for spray booths located outside of the booth and the interior
lighted through sealed clear panels?
Are the electric motors for exhaust fans placed outside booths or ducts?
Are belts and pulleys inside the booth fully enclosed?
Do ducts have access doors to allow cleaning?
Do all drying spaces have adequate ventilation?
ENTERING CONFINED SPACES
Are confined spaces thoroughly emptied of any corrosive or hazardous substances, such
as acids or caustics, before entry?
Before entry, are all lines to a confined space, containing inert, toxic, flammable,
or corrosive materials valved off and blanked or disconnected and separated?
Is it required that all impellers, agitators, or other moving equipment inside
confined spaces be locked-out if they present a hazard?
Is either natural or mechanical ventilation provided prior to confined space entry?
Before entry, are appropriate atmospheric tests performed to check for oxygen
deficiency, toxic substance and explosive concentrations in the confined space before
Is adequate illumination provided for the work to be performed in the confined space?
Is the atmosphere inside the confined space frequently tested or continuously monitor
during conduct of work?
Is there an assigned safety standby employee outside of the confined space, whose sole
responsibility is to watch the work in progress, sound an alarm if necessary, and render
Is the standby employee or other employees prohibited from entering the confined space
without lifelines and respiratory equipment if there is any questions as to the cause of
In addition to the standby employee, is there at least one other trained rescuer in
Are all rescuers appropriately trained and using approved, recently inspected
Does all rescue equipment allow for lifting employees vertically from a top opening?
Are there trained personnel in First Aid and CPR immediately available?
Is there an effective communication system in place whenever respiratory equipment is
used and the employee in the confined space is out of sight of the standby person?
Is approved respiratory equipment required if the atmosphere inside the confined space
cannot be made acceptable?
Is all portable electrical equipment used inside confined spaces either grounded and
insulated, or equipped with ground fault protection?
Before gas welding or burning is started in a confined space, are hoses checked for
leaks, compressed gas bottles forbidden inside of the confined space, torches lighted only
outside of the confined area and the confined area tested for an explosive atmosphere each
time before a lighted torch is to be taken into the confined space?
If employees will be using oxygen-consuming equipment--such as salamanders, torches,
furnaces,--in a confined space, is sufficient air provided to assure combustion without
reducing the oxygen concentration of the atmosphere below 19.5 percent by volume?
Whenever combustion-type equipment is used in confined space, are provisions made to
ensure the exhaust gases are vented outside of the enclosure?
Is each confined space checked for decaying vegetation or animal matter which may
Is the confined space checked for possible industrial waste which could contain toxic
If the confined space is below the ground and near areas where motor vehicles will be
operating, is it possible for vehicle exhaust or carbon monoxide to enter the space?
Are all work areas properly illuminated?
Are employees instructed in proper first aid and other emergency procedures?
Are hazardous substances identified which may cause harm by inhalation, ingestion,
skin absorption or contact?
Are employees aware of the hazards involved with the various chemicals they may be
exposed to in their work environment, such as ammonia, chlorine, epoxies, caustics?
Is employee exposure to chemicals in the workplace kept within acceptable levels?
Can a less harmful method or product be used?
Is the work area's ventilation system appropriate for the work being performed?
Are spray painting operations done in spray rooms or booths equipped with an
appropriate exhaust system?
Is employee exposure to welding fumes controlled by ventilation, use of respirators,
exposure time, or other means?
Are welders and other workers nearby provided with flash shields during welding
If forklifts and other vehicles are used in buildings or other enclosed areas, are the
carbon monoxide levels kept below maximum acceptable concentration?
Has there been a determination that noise levels in the facilities are within
Are steps being taken to use engineering controls to reduce excessive noise levels?
Are proper precautions being taken when handling asbestos and other fibrous materials?
Are caution labels and signs used to warn of asbestos?
Are wet methods used, when practicable, to prevent the emission of airborne asbestos
fibers, silica dust and similar hazardous materials?
Is vacuuming with appropriate equipment used whenever possible rather than blowing or
Are grinders, saws, and other machines that produce respirable dusts vented to an
industrial collector or central exhaust system?
Are all local exhaust ventilation systems designed and operating properly such as
airflow and volume necessary for the application? Are the ducts free of obstructions or
the belts slipping?
Are there written standard operating procedures for the selection and use of
respirators where needed?
Are restrooms and washrooms kept clean and sanitary?
Is all water provided for drinking, washing, and cooking potable?
Are all outlets for water not suitable for drinking clearly identified?
Are employees' physical capacities assessed before being assigned to jobs requiring
Are employees instructed in the proper manner of lifting heavy objects?
Where heat is a problem, have all fixed work areas been provided with spot cooling or
Are employees screened before assignment to areas of high heat to determine if their
health condition might make them more susceptible to having an adverse reaction?
Are employees working on streets and roadways where they are exposed to the hazards of
traffic, required to wear bright colored (traffic orange) warning vest?
Are exhaust stacks and air intakes located that contaminated air will not be
recirculated within a building or other enclosed area?
Is equipment producing ultra-violet radiation properly shielded?
FLAMMABLE & COMBUSTIBLE MATERIALS
Are combustible scrap, debris and waste materials (i.e. oily rags) stored in covered
metal receptacles and removed from the worksite promptly?
Is proper storage practiced to minimize the risk of fire including spontaneous
Are approved containers and tanks used for the storage and handling of flammable and
Are all connections on drums and combustible liquid piping, vapor and liquid tight?
Are all flammable liquids kept in closed containers when not in use (e.g. parts
cleaning tanks, pans)?
Are bulk drums of flammable liquids grounded and bonded to containers during
Do storage rooms for flammable and combustible liquids have explosion-proof lights?
Do storage rooms for flammable and combustible liquids have mechanical or gravity
Is liquefied petroleum gas stored, handled, and used in accordance with safe practices
Are liquefied petroleum storage tanks guarded to prevent damage from vehicles?
Are all solvent wastes, and flammable liquids kept in fire-resistant covered
containers until they are removed from the worksite?
Is vacuuming used whenever possible rather than blowing or sweeping combustible dust?
Are fire separators placed between containers of combustibles or flammables, when
stacked one upon another, to assure their support and stability?
Are fuel gas cylinders and oxygen cylinders separated by distance, fire resistant
barriers or other means while in storage?
Class B: Flammable liquid, gas or grease fires.
Class C: Energized-electrical equipment fires.
If a Halon 1301 fire extinguisher is used, can employees evacuate within the specified
time for that extinguisher?
Are appropriate fire extinguishers mounted within 75 feet of outside areas containing
flammable liquids, and within 10 feet of any inside storage area for such materials?
Is the transfer/withdrawal of flammable or combustible liquids performed by trained
Are fire extinguishers mounted so that employees do not have to travel more than 75
feet for a class "A" fire or 50 feet for a class "B"fire?
Are employees trained in the use of fire extinguishers?
Are extinguishers free from obstructions or blockage?
Are all extinguishers serviced, maintained and tagged at intervals not to exceed one
Are all extinguishers fully charged and in their designated places?
Is a record maintained of required monthly checks of extinguishers?
Where sprinkler systems are permanently installed, are the nozzle heads directed or
arranged so that water will not be sprayed into operating electrical switch boards and
Are "NO SMOKING" signs posted where appropriate in areas where flammable or
combustible materials are used or stored?
Are "NO SMOKING" signs posted on liquefied petroleum gas tanks?
Are "NO SMOKING" rules enforced in areas involving storage and use of
Are safety cans used for dispensing flammable or combustible liquids at a point of
Are all spills of flammable or combustible liquids cleaned up promptly?
Are storage tanks adequately vented to prevent the development of excessive vacuum or
pressure as a result of filling, emptying, or atmosphere temperature changes?
Are storage tanks equipped with emergency venting that will relieve excessive internal
pressure caused by fire exposure?
Are spare portable or butane tanks which are sued by industrial trucks stored in
accord with regulations?
Do you have a fire prevention plan?
Does your plan describe the type of fire protection equipment and/or systems?
Have you established practices and procedures to control potential fire hazards and
Are employees aware of the fire hazards of the material and processes to which they
Is your local fire department well acquainted with your facilities, location and
If you have a fire alarm system, is it tested at least annually?
If you have a fire alarm system, is it certified as required?
If you have interior stand pipes and valves, are they inspected regularly?
If you have outside private fire hydrants, are they flushed at least once a year and
on a routine preventive maintenance schedule?
Are fire doors and shutters in good operating condition?
Are fire doors and shutters unobstructed and protected against obstructions, including
Are fire door and shutter fusible links in place?
Are automatic sprinkler system water control valves, air and water pressures checked
weekly/periodically as required?
Is maintenance of automatic sprinkler system assigned to responsible persons or to a
Are sprinkler heads protected by metal guards, when exposed to physical damage?
Is proper clearance maintained below sprinkler heads?
Are portable fire extinguishers provided in adequate number and type?
Are fire extinguishers mounted in readily accessible locations?
Are fire extinguishers recharged regularly and noted on the inspection tag?
Are employees periodically instructed in the use of extinguishers and fire protection
HAZARDOUS CHEMICAL EXPOSURES
Are employees trained in the safe handling practices of hazardous chemicals such as
acids, caustics, and the like?
Are employees aware of the potential hazards involving various chemicals stored or
used in the workplace--such as acids, bases, caustics, epoxies, phenols?
Is employee exposure to chemicals kept within acceptable levels?
Are eye wash fountains and safety showers provided in areas where corrosive chemicals
Are all containers, such as vats and storage tanks labeled as to their contents--e.g.
Are all employees required to use personal protective clothing and equipment when
handling chemicals (i.e. gloves, eye protection, respirators)?
Are flammable or toxic chemicals kept in closed containers when not in use?
Are chemical piping systems clearly marked as to their content?
Where corrosive liquids are frequently handled in open containers or drawn from
storage vessels or pipe lines, is adequate means readily available for neutralizing or
disposing of spills or overflows properly and safely?
Have standard operating procedures been established and are they being followed when
cleaning up chemical spills?
Where needed for emergency use, are respirators stored in a convenient, clean and
Are respirators intended for emergency use adequate for the various uses for which
they may be needed?
Are employees prohibited from eating in areas where hazardous chemicals are present?
Is personal protective equipment provided, used and maintained whenever necessary?
Are there written standard operating procedures for the selection and use of
respirators where needed?
If you have a respirator protection program, are your employees instructed on the
correct usage and limitations of the respirators?
Are the respirators NIOSH approved for this particular application?
Are they regularly inspected and cleaned sanitized and maintained?
If hazardous substances are used in your processes, do you have a medical or
biological monitoring system in operation?
Are you familiar with the Threshold Limit Values or Permissible Exposure Limits of
airborne contaminants and physical agents used in your workplace?
Have control procedures been instituted for hazardous materials, where appropriate,
such as respirators, ventilation systems, handling practices, and the like?
Whenever possible, are hazardous substances handled in properly designed and exhausted
booths or similar locations?
Do you use general dilution or local exhaust ventilation systems to control dusts,
vapors, gases, fumes, smoke, solvents or mists which may be generated in your workplace?
Is ventilation equipment provided for removal of contaminants from such operations as
production grinding, buffing, spray painting, and/or vapor decreasing, and is it operating
Do employees complain about dizziness, headaches, nausea, irritation, or other factors
of discomfort when they use solvents or other chemicals?
Is there a dermatitis problem--do employees complain about skin dryness, irritation,
Have you considered the use of an industrial hygienist or environmental health
specialist to evaluate your operation?
If internal combustion engines are used, is carbon monoxide kept within acceptable
Is vacuuming used, rather than blowing or sweeping dusts whenever possible for
Are materials which give off toxic asphyxiant, suffocating or anesthetic fumes, stored
in remote or isolated locations when not in use?
HAZARDOUS SUBSTANCES COMMUNICATION
Is there a list of hazardous substances used in your workplace?
Is there a written hazard communication program dealing with Material Safety Data
Sheets (MSDS) labeling, and employee training?
Who is responsible for MSDSs, container labeling, employee training?
Is each container for a hazardous substance (i.e. vats, bottles, storage tanks,)
labeled with product identity and a hazard warning (communication of the specific health
hazards and physical hazards)?
Is there a Material Safety Data Sheet readily available for each hazardous substance
How will you inform other employers whose employees share the same work area where the
hazardous substances are used?
Is there an employee training program for hazardous substances? Does this program
An explanation of what an MSDS is and how to use and obtain one?
MSDS contents for each hazardous substance or class of substances?
Explanation of "Right to Know"?
Identification of where employees can see the employer's written hazard communication
program and where hazardous substances are present in their work area?
The physical and health hazards of substances in the work area, how to detect their
presence, and specific protective measures to be used?
Details of the hazard communication program, including how to use the labeling system
How employees will be informed of hazards of non-routine tasks, and hazards of
Are your workplace electricians familiar with the Cal/OSHA Electrical Safety Orders?
Do you specify compliance with Cal/OSHA for all contract electrical work?
Are all employees required to report as soon as practicable any obvious hazard to life
or property observed in connection with electrical equipment or lines?
Are employees instructed to make preliminary inspections and/or appropriate tests to
determine what conditions exist before starting work on electrical equipment or lines?
When electrical equipment or lines are to be serviced, maintained or adjusted, are
necessary switches opened, locked-out and tagged whenever possible?
Are portable electrical tools and equipment grounded or of the double insulated type?
Are electrical appliances such as vacuum cleaners, polishers, vending machines
Do extension cords being used have a grounding conductor?
Are multiple plug adapters prohibited?
Are ground-fault circuit interrupters installed on each temporary 15 or 20 ampere, 120
volt AC circuit at locations where construction, demolition, modifications, alterations or
excavations are being performed?
Are all temporary circuits protected by suitable disconnecting switches or plug
connectors at the junction with permanent wiring?
Is exposed wiring and cords with frayed or deteriorated insulation repaired or
Are flexible cords and cables free of splices or taps?
Are clamps or other securing means provided on flexible cords or cables at plugs,
receptacles, tools, equipment and is the cord jacket securely held in place?
Are all cord, cable and raceway connections intact and secure?
In wet or damp locations, are electrical tools and equipment appropriate for the use
or location or otherwise protected?
Is the location of electrical power lines and cables (overhead, underground,
underfloor, other side of walls) determined before digging, drilling or similar work is
Are metal measuring tapes, ropes, handlines or similar devices with metallic thread
woven into the fabric prohibited where they could come in contact with energized parts of
equipment or circuit conductors?
Is the use of metal ladders prohibited in area where the ladder or the person using
the ladder could come in contact with energized parts of equipment, fixtures or circuit
Are all disconnecting switches and circuit breakers labeled to indicate their use or
Are disconnecting means always opened before fuses are replaced?
Do all interior wiring systems include provisions for grounding metal parts of
electrical raceways, equipment and enclosures?
Are all electrical raceways and enclosures securely fastened in place?
Are all energized parts of electrical circuits and equipment guarded against
accidental contact by approved cabinets or enclosures?
Is sufficient access and working space provided and maintained about all electrical
equipment to permit ready and safe operations and maintenance?
Are all unused openings (including conduit knockouts) in electrical enclosures and
fittings closed with appropriate covers, plugs or plates?
Are electrical enclosures such as switches, receptacles, junction boxes, etc.,
provided with tight-fitting covers or plates?
Are disconnecting switches for electrical motors in excess of two horsepower, capable
of opening the circuit when the motor is in a stalled condition, without exploding?
(Switches must be horsepower rated equal to or in excess of the motor hp rating).
Is low voltage protection provided in the control device of motors driving machines or
equipment which could cause probably injury from inadvertent starting?
Is each motor disconnecting switch or circuit breaker located within sight of the
motor control device?
Is each motor located within sight of its controller or the controller disconnecting
means capable of being locked in the open position or is a separate disconnecting means
installed in the circuit within sight of the motor?
Is the controller for each motor in excess of two horsepower, rated in horsepower
equal to or in excess of the rating of the motor is serves?
Are employees who regularly work on or around energized electrical equipment or lines
instructed in the cardio-pulmonary resuscitation (CPR) methods?
Are employees prohibited from working alone on energized lines or equipment over 600
Are there areas in the workplace where continuous noise levels exceed 85 dBA? (To
determine maximum allowable levels for intermittent or impact noise, see Title 8, Section
Are noise levels being measured using a sound level meter or an octave band analyzer
and records being kept?
Have you tried isolating noisy machinery from the rest of your operation?
Have engineering controls been used to reduce excessive noise levels?
Where engineering controls are determined not feasible, are administrative controls
(i.e. worker rotation) being used to minimize individual employee exposure to noise?
Is there an ongoing preventive health program to educate employees in safe levels of
noise and exposure, effects of noise on their health, and use of personal protection?
Is the training repeated annually for employees exposed to continuous noise above 85
Have work areas where noise levels make voice communication between employees
difficult been identified and posted?
Is approved hearing protective equipment (noise attenuating devices) available to
every employee working in areas where continuous noise levels exceed 85 dBA?
If you use ear protectors, are employees properly fitted and instructed in their use
Are employees exposed to continuous noise above 85 dBA give periodic audiometric
testing to ensure that you have an effective hearing protection system?
Is it prohibited to fuel an internal combustion engine with a flammable liquid while
the engine is running?
Are fueling operations done in such a manner that likelihood of spillage will be
When spillage occurs during fueling operations, is the spilled fuel cleaned up
completely, evaporated, or other measures taken to control vapors before restarting the
Are fuel tank caps replaced and secured before starting the engine?
In fueling operations is there always metal contact between the container and fuel
Are fueling hoses of a type designed to handle the specific type of fuel?
Is it prohibited to handle or transfer gasoline in open containers?
Are open lights, open flames, or sparking or arcing equipment prohibited near fueling
or transfer of fuel operations?
Is smoking prohibited in the vicinity of fueling operations?
Are fueling operations prohibited in building or other enclosed areas that are not
specifically ventilated for this purpose?
Where fueling or transfer of fuel is done through a gravity flow system, are the
nozzles of the self-closing type?
IDENTIFICATION OF PIPING SYSTEMS
When nonpotable water is piped through a facility, are outlets or taps posted to alert
employees that it is unsafe and not to be used for drinking, washing or other personal
When hazardous substances are transported through above ground piping, is each
pipeline identified at points where confusion could introduce hazards to employees?
When pipelines are identified by color painting, are all visible parts of the line so
When pipelines are identified by color painted bands or tapes, are the bands or tapes
located at reasonable intervals and at each outlet, valve or connection?
When pipelines are identified by color, is the color code posted at all locations
where confusion could introduce hazards to employees?
When the contents of pipelines are identified by name or name abbreviation, is the
information readily visible on the pipe near each valve or outlet?
When pipelines carrying hazardous substances are identified by tags, are the tags
constructed of durable materials, the message carried clearly ad permanently
distinguishable and are tags installed at each valve or outlet?
When pipelines are heated by electricity, steam or other external source, are suitable
warning signs or tags placed at unions, valves, or other serviceable parts of the system?
Is there safe clearance for equipment through aisles and doorways?
Are aisleways designated, permanently marked, and kept clear to allow unhindered
Are motorized vehicles and mechanized equipment inspected daily or prior to use?
Are vehicles shut off and brakes set prior to loading or unloading?
Are containers or combustibles or flammables, when stacked while being moved, always
separated by dunnage sufficient to provide stability?
Are dock boards (bridge plates) used when loading or unloading operations are taking
place between vehicles and docks?
Are trucks and trailers secured from movement during loading and unloading operations?
Are dock plates and loading ramps constructed and maintained with sufficient strength
to support imposed loading?
Are hand trucks maintained in safe operating condition?
Are chutes equipped with sideboards of sufficient height to prevent the materials
being handled from falling off?
Are chutes and gravity roller sections firmly placed or secured to prevent
At the delivery end of rollers or chutes, are provisions made to brake the movement of
the handled materials.
Are pallets usually inspected before being loaded or moved?
Are hooks with safety latches or other arrangements used when hoisting materials so
that slings or load attachments won't accidentally slip off the hoist hooks?
Are securing chains, ropes, chockers or slings adequate for the job to be performed?
When hoisting material or equipment, are provisions made to assure no one will be
passing under the suspended loads?
Are Material Safety Data Sheets available to employees handling hazardous substances?
TRANSPORTING EMPLOYEES & MATERIALS
Do employees who operate vehicles on public thoroughfares have valid operator's
When seven or more employees are regularly transported in a van, bus or truck, is the
operator's license appropriate for the class of vehicle being driven?
Is each van, bus or truck used regularly to transport employees, equipped with an
adequate number of seats?
When employees are transported by truck, are provision provided to prevent their
falling from the vehicle?
Are vehicles used to transport employees, equipped with lamps, brakes, horns, mirrors,
windshields and turn signals in good repair?
Are transport vehicles provided with handrails, steps, stirrups or similar devices, so
placed and arranged that employees can safely mount or dismount?
Are employee transport vehicles equipped at all times with at least two reflective
Is a full charged fire extinguisher, in good condition, with at least 4 B:C rating
maintained in each employee transport vehicle?
When cutting tools with sharp edges are carried in passenger compartments of employee
transport vehicles, are they placed in closed boxes or containers which are secured in
Are employees prohibited from riding on top of any load which can shift, topple, or
otherwise become unstable?
CONTROL OF HARMFUL SUBSTANCES BY VENTILATION
Is the volume and velocity of air in each exhaust system sufficient to gather the
dusts, fumes, mists, vapors or gases to be controlled, and to convey them to a suitable
point of disposal?
Are exhaust inlets, ducts and plenums designed, constructed, and supported to prevent
collapse or failure of any part of the system?
Are clean-out ports or doors provided at intervals not to exceed 12 feet in all
horizontal runs of exhaust ducts?
Where two or more different type of operations are being controlled through the same
exhaust system, will the combination of substances being controlled, constitute a fire,
explosion or chemical reaction hazard in the duct?
Is adequate makeup air provided to areas where exhaust systems are operating?
Is the intake for makeup air located so that only clean, fresh air, which is free of
contaminates, will enter the work environment?
Where two or more ventilation systems are serving a work area, is their operation such
that one will not offset the functions of the other?
SANITIZING EQUIPMENT & CLOTHING
Is personal protective clothing or equipment, that employees are required to wear or
use, of a type capable of being easily cleaned and disinfected?
Are employees prohibited from interchanging personal protective clothing or equipment,
unless it has been properly cleaned?
Are machines and equipment, which processes, handle or apply materials that could be
injurious to employees, cleaned and/or decontaminated before being overhauled or placed in
Are employees prohibited from smoking or eating in any area where contaminates are
present that could be injurious if ingested?
When employees are required to change from street clothing into protective clothing,
is a clean changeroom with separate storage facility for street and protective clothing
Are employees required to shower and wash their hair as soon as possible after a known
contact has occurred with a carcinogen?
When equipment, materials, or other items are taken into or removed from a carcinogen
regulated area, is it done in a manner that will not contaminate non-regulated areas or
the external environment?
Where tires are mounted and/or inflated on drop center wheels, is a safe practice
procedure posted and enforced?
Where tires are mounted and/or inflated on wheels with split rims and/or retainer
rings, is a safe practice procedure posted and enforced?
Does each tire inflation hose have a clip-on chuck with at least 24 inches of hose
between the chuck and an in-line hand valve and gauge?
Does the tire inflation control valve automatically shut off the air flow when the
valve is released?
Is a tire restraining device such as a cage, rack or other effective means used while
inflating tires mounted on split rims, or rims using retainer rings?
Are employees strictly forbidden from taking a position directly over or in front of a
tire while it's being inflated?
EMERGENCY ACTION PLAN
Are you required to have an emergency action plan?
Does the emergency action plan comply with requirements of T8CCR 3220(a)?
Have emergency escape procedures and routes been developed and communicated to all
Do employees, who remain to operate critical plant operations before they evacuate,
know the proper procedures?
Is the employee alarm system that provides a warning for emergency action recognizable
and perceptible above ambient conditions?
Are alarm systems properly maintained and tested regularly?
Is the emergency action plan reviewed and revised periodically? Do employees now their
For reporting emergencies?
During an emergency?
For conducting rescue and medical duties?
Are employees potentially exposed to infectious agents in body fluids?
Have occasions of potential occupational exposure been identified and documented?
Has a training and information program been provided for employees exposed to or
potentially exposed to blood and/or body fluids?
Have infection control procedures been instituted where appropriate, such as
ventilation, universal precautions, workplace practices, personal protective equipment?
Are employees aware of specific workplace practices to follow when appropriate? (Hand
washing, handling sharp instruments, handling of laundry, disposal of contaminated
materials, reusable equipment.)
Is personal protective equipment provided to employees, and in all appropriate
Is the necessary equipment (i.e. mouth-pieces, resuscitation bags, other ventilation
devices) provided for administering mouth-to-mouth resuscitation on potentially infected
Are facilities/equipment to comply with workplace practices available, such as
hand-washing sinks, biohazard tags and labels, needle containers, detergents/disinfectants
to clean up spills?
Are all equipment and environmental and working surfaces cleaned and disinfected after
contact with blood or potentially infectious materials?
Is infectious waste placed in closable, leak proof containers, bags or
puncture-resistant holders with proper labels?
Has medical surveillance including HBV evaluation, antibody testing and vaccination
been made available to potentially exposed employees?
Training on universal precautions?
Training on personal protective equipment?
Training on workplace practices which should include blood drawing, room cleaning,
laundry handling, clean-up of blood spills?
Training on needlestick exposure/management?
Hepatitis B vaccinations?
Can the work be performed without eye strain or glare to the employees?
Does the task require prolonged raising of the arms?
Do the neck and shoulders have to be stooped to view the task?
Are there pressure points on any parts of the body (wrists, forearms, back of thighs)?
Can the work be done using the larger muscles of the body?
Can the work be done without twisting or overly bending the lower back?
Are there sufficient rest breaks, in addition to the regular rest breaks, to relieve
stress from repetitive-motion tasks?
Are tools, instruments and machinery shaped, positioned and handled so that tasks can
be performed comfortably?
Are all pieces of furniture adjusted, positioned and arranged to minimize strain on
all parts of the body?
VENTILATION FOR INDOOR AIR QUALITY
Does your HVAC system provide at least the quantity of outdoor air required by the
State Building Standards Code, Title 24, Part 2 at the time the building was constructed?
Is the HVAC system inspected at least annually, and problems corrected?
Are inspection records retained for at least 5 years?
Are the cranes visually inspected for defective components prior to the beginning of
any work shift?
Are all electrically operated cranes effectively grounded?
Is a crane preventive maintenance program established?
Is the load chart clearly visible to the operator?
Are operating controls clearly identified?
Is a fire extinguisher provided at the operator's station?
Is the rated capacity visibly marked on each crane?
Is an audible warning device mounted on each crane?
Is sufficient illumination provided for the operator to perform the work safely?
Are cranes of such design, that the boom could fall over backward, equipped with
Does each crane have a certificate indicating that required testing and examinations
have been performed?
Are crane inspection and maintenance records maintained and available for inspection?
HAZARD ASSESSMENT AND CORRECTION RECORD
Unsafe Condition or Work Practice:
Corrective Action Taken:
Unsafe Condition or Work Practice:
Corrective Action Taken:
Unsafe Condition or Work Practice:
Corrective Action Taken:
ACCIDENT/EXPOSURE INVESTIGATION REPORT
Date & Time of Accident:
Preventive Action Recommendations:
Corrective Actions Taken:
WORKER TRAINING AND INSTRUCTION RECORD
Type of Training
This model program has been prepared for use by employers in industries which have been determined by Cal/OSHA to be high hazard. You are not required to use this program. This model program was written for a broad spectrum of employers and it may not match your establishment's exact needs. However, it does provide the essential framework required for an Injury and Illness
Proper use of this model program requires the IIP Program administrator for your establishment to carefully review the requirements for each of the eight IIP Program elements found in this model program, fill in the appropriate blank spaces and check those items that are applicable to your workplace. The recordkeeping section requires that the IIP Program administrator select and implement the category appropriate for your establishment. Sample forms for hazard assessment and correction, accident/exposure investigation, and employee training and instruction are provided with this model program.
This model program must be maintained by the employer in order to be effective.
The Injury and Illness Prevention Program (IIP Program) administrator,
has the authority and responsibility for implementing the provisions of this program
All managers and supervisors are responsible for implementing and maintaining the IIP Program in their work areas and for answering worker questions about the IIP Program. A copy of this IIP Program is available from each manager and supervisor.
Management is responsible for ensuring that all safety and health policies and procedures are clearly communicated and understood by all employees. Managers and supervisors are expected to enforce the rules fairly and uniformly.
All employees are responsible for using safe work practices, for following all directives, policies and procedures, and for assisting in maintaining a safe work environment.
Our system of ensuring that all employees comply with the rules and maintain a safe work environment include:
1. Informing employees of the provisions of our IIP Program;
2. Evaluating the safety performance of all employees;
3. Recognizing employees who perform safe and healthful work practices;
4. Providing training to employees whose safety performance is deficient;
5. Disciplining employees for failure to comply with safe and healthful work practices; and
6. The following practices: ________________________________________________________
We recognize that open, two-way communication between management and staff on health and safety issues is essential to an injury-free, productive workplace. The following system of communication is designed to facilitate a continuous flow of safety and health information between management and staff in a form that is readily understandable and consists of one or more of the following checked items:
Periodic inspections to identify and evaluate workplace hazards shall be performed by the following competent observer(s) in the following areas of our workplace:
Periodic inspections are performed according to the following schedule:
Periodic inspections consist of identification and evaluation of workplace hazards utilizing applicable sections of the attached Hazard Assessment Checklist and any other effective methods to identify and evaluate workplace hazards.
Procedures for investigating workplace accidents and hazardous substance exposures include:
Unsafe or unhealthy work conditions, practices or procedures shall be corrected in a timely manner based on the severity of the hazards. Hazards shall be corrected according to the following procedures:
TRAINING AND INSTRUCTION
All employees, including managers and supervisors, shall have training and instruction on general and job-specific safety and health practices. Training and instruction shall be provided as follows:
Workplace safety and health training practices for all industries include, but are not limited to, the following:
In addition, we provide specific instructions to all employees regarding hazards unique to their job assignment, to the extent that such information was not already covered in other training.
We have checked one of the following categories as our recordkeeping policy.
1. Records of hazard assessment inspections, including the person(s) conducting the inspection, the unsafe conditions and work practices that have been identified and the action taken to correct the identified unsafe conditions and work practices, are recorded on a hazard assessment and correction form; and
2. Documentation of safety and health training for each employee, including the employee's name or other identifier, training dates, type(s) of training, and training providers. are recorded on an employee training and instruction form. We also include the records relating to employee training provided by a construction industry occupational safety and health training program approved by Cal/OSHA.
Inspection records and training documentation will be maintained according to the following checked schedule:
We train our workers about the following checked training subjects:
PERSONAL PROTECTIVE EQUIPMENT & CLOTHING
Are fire extinguishers selected and provided for the types of
materials in areas where they are to be used? Class A: Ordinary combustible material