**Facility
Name/Type:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date:**

**Facility
Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_State:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Facility POC \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Phone:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

+---------------------------+-----------------------+---+---+---+-----+
| **Topic**                 | # Applicability       | * | * | * | *   |
|                           |                       | * | * | * | *Un |
|                           |                       | Y | N | N | sur |
|                           |                       | e | o | / | e** |
|                           |                       | s | * | A |     |
|                           |                       | * | * | * |     |
|                           |                       | * |   | * |     |
+===========================+=======================+===+===+===+=====+
| **INSPECTIONS CONDUCTED** |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are any internal          | LIST TYPES OF         |   |   |   |     |
| inspections conducted?    | INSPECTIONS           |   |   |   |     |
| (i.e. general work areas, |                       |   |   |   |     |
| equipment, fire           |                       |   |   |   |     |
| extinguishers, etc.)      |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **INSPECTIONS, CITATIONS, |                       |   |   |   |     |
| AND PROPOSED PENALTIES:   |                       |   |   |   |     |
| (29 CFR 1903)**           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Has the facility received |                       |   |   |   |     |
| any regulatory            |                       |   |   |   |     |
| inspections, citations,   |                       |   |   |   |     |
| or proposed penalties?    |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **OSHA 300 LOG/MEDICAL    |                       |   |   |   |     |
| RECORDS: (29 CFR 1904)**  |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are occupational injuries | -   Incident that     |   |   |   |     |
| and illnesses recorded on |     results in a      |   |   |   |     |
| a log?                    |     fatality or the   |   |   |   |     |
|                           |     hospitalization   |   |   |   |     |
|                           |     of three or more  |   |   |   |     |
|                           |     employees.        |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Facilities that   |   |   |   |     |
|                           |     are not exempt    |   |   |   |     |
|                           |     **(see            |   |   |   |     |
|                           |                       |   |   |   |     |
|                           |   attachment/appendix |   |   |   |     |
|                           |     XX for            |   |   |   |     |
|                           |     exemptions)**     |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are employees medical and | -   General industry, |   |   |   |     |
| exposure records          |     maritime, and     |   |   |   |     |
| maintained or managed?    |     construction      |   |   |   |     |
|                           |     employers         |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| ## WALKING/W              |                       |   |   |   |     |
| ORKING SURFACES AND GUARD |                       |   |   |   |     |
| ING: (29 CFR 1922 AND 23) |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are walking/working       | -   All permanent     |   |   |   |     |
| surfaces adequately       |     places of         |   |   |   |     |
| managed. *(i.e. floor     |     employment.       |   |   |   |     |
| loading marked, open      |                       |   |   |   |     |
| pits, tanks, vats, and    |                       |   |   |   |     |
| ditches provided with     |                       |   |   |   |     |
| covers, safe clearances   |                       |   |   |   |     |
| allowed where mechanical  |                       |   |   |   |     |
| handling equipment is     |                       |   |   |   |     |
| used, etc,.)?*            |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are all floor and wall    | -   All permanent     |   |   |   |     |
| openings guarded?         |     places of         |   |   |   |     |
|                           |     employment.       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **LADDERS/ELEVATED        |                       |   |   |   |     |
| PLATFORMS: (29 CFR        |                       |   |   |   |     |
| 1910.24-28)**             |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any fixed       | -   Includes interior |   |   |   |     |
| industrial stairs in the  |     and exterior      |   |   |   |     |
| facility?                 |     stairs around     |   |   |   |     |
|                           |     machinery, tanks, |   |   |   |     |
|                           |     and other         |   |   |   |     |
|                           |     equipment, and    |   |   |   |     |
|                           |     stairs leading to |   |   |   |     |
|                           |     or from floors,   |   |   |   |     |
|                           |     platforms, or     |   |   |   |     |
|                           |     pits. This        |   |   |   |     |
|                           |     section does not  |   |   |   |     |
|                           |     apply to stairs   |   |   |   |     |
|                           |     used for fire     |   |   |   |     |
|                           |     exit purposes, to |   |   |   |     |
|                           |     construction      |   |   |   |     |
|                           |     operations to     |   |   |   |     |
|                           |     private           |   |   |   |     |
|                           |     residences, or to |   |   |   |     |
|                           |     articulated       |   |   |   |     |
|                           |     stairs, such as   |   |   |   |     |
|                           |     may be installed  |   |   |   |     |
|                           |     on floating roof  |   |   |   |     |
|                           |     tanks or on dock  |   |   |   |     |
|                           |     facilities, the   |   |   |   |     |
|                           |     angle of which    |   |   |   |     |
|                           |     changes with the  |   |   |   |     |
|                           |     rise and fall of  |   |   |   |     |
|                           |     the base support  |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -                     |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any portable    | -   Applies to common |   |   |   |     |
| wood ladders used at the  |     types of portable |   |   |   |     |
| facility?                 |     wood ladders.     |   |   |   |     |
|                           |     Fruitpicker\'s    |   |   |   |     |
|                           |     ladders,          |   |   |   |     |
|                           |     combination step  |   |   |   |     |
|                           |     and extension     |   |   |   |     |
|                           |     ladders,          |   |   |   |     |
|                           |     stockroom step    |   |   |   |     |
|                           |     ladders,          |   |   |   |     |
|                           |     aisle-way step    |   |   |   |     |
|                           |     ladders, shelf    |   |   |   |     |
|                           |     ladders, and      |   |   |   |     |
|                           |     library ladders   |   |   |   |     |
|                           |     are not           |   |   |   |     |
|                           |     specifically      |   |   |   |     |
|                           |     covered by        |   |   |   |     |
|                           |     regulation.       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any portable    | -                     |   |   |   |     |
| metal ladders used at the |                       |   |   |   |     |
| facility?                 |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any fixed       | -   \"Fixed ladder.\" |   |   |   |     |
| ladders in the facility?  |     A fixed ladder is |   |   |   |     |
|                           |     a ladder          |   |   |   |     |
|                           |     permanently       |   |   |   |     |
|                           |     attached to a     |   |   |   |     |
|                           |     structure,        |   |   |   |     |
|                           |     building, or      |   |   |   |     |
|                           |     equipment. . This |   |   |   |     |
|                           |     does not apply to |   |   |   |     |
|                           |     stairs used for   |   |   |   |     |
|                           |     fire exit         |   |   |   |     |
|                           |     purposes, to      |   |   |   |     |
|                           |     construction      |   |   |   |     |
|                           |     operations to     |   |   |   |     |
|                           |     private           |   |   |   |     |
|                           |     residences, or to |   |   |   |     |
|                           |     articulated       |   |   |   |     |
|                           |     stairs, such as   |   |   |   |     |
|                           |     may be installed  |   |   |   |     |
|                           |     on floating roof  |   |   |   |     |
|                           |     tanks or on dock  |   |   |   |     |
|                           |     facilities, the   |   |   |   |     |
|                           |     angle of which    |   |   |   |     |
|                           |     changes with the  |   |   |   |     |
|                           |     rise and fall of  |   |   |   |     |
|                           |     the base support  |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is scaffolding used at    |                       |   |   |   |     |
| the facility?             |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **MANUALLY PROPELLED      |                       |   |   |   |     |
| MOBILE LADDERS AND        |                       |   |   |   |     |
| SCAFFOLDS (TOWERS): (29   |                       |   |   |   |     |
| CFR 1910.29)**            |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are manually propelled    | -   Mobile work       |   |   |   |     |
| mobile ladder stands or   |     platforms         |   |   |   |     |
| scaffolds used at the     |     (including ladder |   |   |   |     |
| facility?                 |     stands but not    |   |   |   |     |
|                           |     including aerial  |   |   |   |     |
|                           |     ladders) and      |   |   |   |     |
|                           |     rolling (mobile)  |   |   |   |     |
|                           |     scaffolds         |   |   |   |     |
|                           |     (towers)          |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Manually          |   |   |   |     |
|                           |     propelled mobile  |   |   |   |     |
|                           |     scaffold - A      |   |   |   |     |
|                           |     portable rolling  |   |   |   |     |
|                           |     scaffold          |   |   |   |     |
|                           |     supported by      |   |   |   |     |
|                           |     casters           |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are other working         | -   Portable and      |   |   |   |     |
| surfaces located in or    |     powered dock      |   |   |   |     |
| used at the facility?     |     boards (bridge    |   |   |   |     |
|                           |     plates), forging  |   |   |   |     |
|                           |     machines, aisles  |   |   |   |     |
|                           |     used by employees |   |   |   |     |
|                           |     for bringing and  |   |   |   |     |
|                           |     removing          |   |   |   |     |
|                           |     materials, steam  |   |   |   |     |
|                           |     vats.             |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **MEANS OF                |                       |   |   |   |     |
| EGRESS/EMERGENCY PLANS:   |                       |   |   |   |     |
| (29 CFR 1910.36-38)**     |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Have exits been           | -   Applicable to all |   |   |   |     |
| designated as "emergency  |     facilities        |   |   |   |     |
| exits"?                   |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are all designated        |                       |   |   |   |     |
| emergency exits labeled   |                       |   |   |   |     |
| and accessible?           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are employee emergency    |                       |   |   |   |     |
| and fire prevention plans |                       |   |   |   |     |
| in place?                 |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **VEHICLE-MOUNTED WORK    |                       |   |   |   |     |
| PLATFORMS (AERIALS): (29  |                       |   |   |   |     |
| CFR 1910.67)**            |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are vehicle-mounted       | -   "Aerial device.\" |   |   |   |     |
| elevating and rotating    |     Any               |   |   |   |     |
| work platforms used at    |     vehicle-mounted   |   |   |   |     |
| the facility? *(i.e.      |     device,           |   |   |   |     |
| aerial lifts)*            |     telescoping or    |   |   |   |     |
|                           |     articulating, or  |   |   |   |     |
|                           |     both, which is    |   |   |   |     |
|                           |     used to position  |   |   |   |     |
|                           |     personnel.        |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **NOISE EXPOSURE: (29 CFR |                       |   |   |   |     |
| 1910.95)**                |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any areas in    | -                     |   |   |   |     |
| the facility that         |                       |   |   |   |     |
| elevated speech is        |                       |   |   |   |     |
| required for              |                       |   |   |   |     |
| communication?            |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is an occupational noise  | -   Whenever employee |   |   |   |     |
| exposure program in       |     noise exposures   |   |   |   |     |
| place? *A common area     |     equal or exceed   |   |   |   |     |
| that triggers this        |     an 8-hour         |   |   |   |     |
| requirement is a          |     time-weighted     |   |   |   |     |
| generator and/or          |     average sound     |   |   |   |     |
| compressor room.*         |     level (TWA) of 85 |   |   |   |     |
|                           |     decibels          |   |   |   |     |
|                           |     measured.         |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Has noise monitoring been | -                     |   |   |   |     |
| conducted anywhere in the |                       |   |   |   |     |
| facility?                 |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any areas in    | -                     |   |   |   |     |
| the facility where        |                       |   |   |   |     |
| personnel need to raise   |                       |   |   |   |     |
| their voices to talk over |                       |   |   |   |     |
| noise in the area?        |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Do employees voluntarily  | -                     |   |   |   |     |
| wear hearing protection,  |                       |   |   |   |     |
| or is hearing protection  |                       |   |   |   |     |
| required for any areas in |                       |   |   |   |     |
| the facility?             |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **COMPRESSED              |                       |   |   |   |     |
| GAS/FLAMMABLE             |                       |   |   |   |     |
| LIQUIDS/HIGHLY HAZARDOUS  |                       |   |   |   |     |
| CHEMICALS: (29 CFR        |                       |   |   |   |     |
| 1910.101, 106, 107,       |                       |   |   |   |     |
| 119)**                    |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are compressed gases      | -                     |   |   |   |     |
| used/stored at the        |                       |   |   |   |     |
| facility?                 |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are flammable/combustible | -   See checklist for |   |   |   |     |
| liquids stored/used at    |     applicability.    |   |   |   |     |
| the facility?             |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are spray finishing       | -   See checklist for |   |   |   |     |
| operations that use       |     applicability     |   |   |   |     |
| flammable/combustible     |                       |   |   |   |     |
| materials conducted at    |                       |   |   |   |     |
| the facility? (i.e. paint |                       |   |   |   |     |
| booths)                   |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are highly hazardous      | -   List of highly    |   |   |   |     |
| chemicals used at the     |     hazardous         |   |   |   |     |
| facility?                 |     chemicals is      |   |   |   |     |
|                           |     extensive. See    |   |   |   |     |
|                           |     checklist.        |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **HAZARDOUS               |                       |   |   |   |     |
| WASTE/EMERGENCY RESPONSE  |                       |   |   |   |     |
| (HAZWOPR): (29 CFR        |                       |   |   |   |     |
| 1910.120)**               |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are employees involved in | > Employees who       |   |   |   |     |
| hazardous waste           | > engage in any of    |   |   |   |     |
| operations?               | > the following:      |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Hazardous waste   |   |   |   |     |
|                           |     operations under  |   |   |   |     |
|                           |     the Comprehensive |   |   |   |     |
|                           |     Environmental     |   |   |   |     |
|                           |     Response          |   |   |   |     |
|                           |     Compensation and  |   |   |   |     |
|                           |     Liability Act,    |   |   |   |     |
|                           |     including any     |   |   |   |     |
|                           |     initial           |   |   |   |     |
|                           |     investigations of |   |   |   |     |
|                           |     the site prior to |   |   |   |     |
|                           |     identification of |   |   |   |     |
|                           |     exposures.        |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Corrective        |   |   |   |     |
|                           |     actions involving |   |   |   |     |
|                           |     cleanup conducted |   |   |   |     |
|                           |     under Resource    |   |   |   |     |
|                           |     Conservation and  |   |   |   |     |
|                           |     Recovery Act.     |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Operations at     |   |   |   |     |
|                           |     State or local    |   |   |   |     |
|                           |     government        |   |   |   |     |
|                           |     designated        |   |   |   |     |
|                           |     hazardous waste   |   |   |   |     |
|                           |     sites             |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Operations        |   |   |   |     |
|                           |     involving         |   |   |   |     |
|                           |     hazardous waste   |   |   |   |     |
|                           |     storage,          |   |   |   |     |
|                           |     treatment, and    |   |   |   |     |
|                           |     disposal          |   |   |   |     |
|                           |     facilities        |   |   |   |     |
|                           |     regulated by 40   |   |   |   |     |
|                           |     CFR 264 and 265   |   |   |   |     |
|                           |     pursuant to the   |   |   |   |     |
|                           |     Resource          |   |   |   |     |
|                           |     Conservation and  |   |   |   |     |
|                           |     Recovery Act.     |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Emergency         |   |   |   |     |
|                           |     response          |   |   |   |     |
|                           |     operations at any |   |   |   |     |
|                           |     workplace when    |   |   |   |     |
|                           |     there has been a  |   |   |   |     |
|                           |     release or a      |   |   |   |     |
|                           |     substantial       |   |   |   |     |
|                           |     threat of a       |   |   |   |     |
|                           |     release of        |   |   |   |     |
|                           |     hazardous         |   |   |   |     |
|                           |     substances        |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **PERSONAL PROTECTIVE     |                       |   |   |   |     |
| EQUIPMENT (PPE): (29 CFR  |                       |   |   |   |     |
| 1910.132-134)**           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is PPE worn by employees? | -   Protective        |   |   |   |     |
|                           |     equipment,        |   |   |   |     |
|                           |     including         |   |   |   |     |
|                           |     personal          |   |   |   |     |
|                           |     protective        |   |   |   |     |
|                           |     equipment for     |   |   |   |     |
|                           |     eyes, face, head, |   |   |   |     |
|                           |     and extremities,  |   |   |   |     |
|                           |     protective        |   |   |   |     |
|                           |     clothing,         |   |   |   |     |
|                           |     respiratory       |   |   |   |     |
|                           |     devices, and      |   |   |   |     |
|                           |     protective        |   |   |   |     |
|                           |     shields and       |   |   |   |     |
|                           |     barriers          |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is respiratory protection | -                     |   |   |   |     |
| worn by employees, either |                       |   |   |   |     |
| by policy or voluntarily? |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is head protection (i.e.  | -   Employees that    |   |   |   |     |
| hard hats) used by        |     works in areas    |   |   |   |     |
| employees?                |     where there is a  |   |   |   |     |
|                           |     potential for     |   |   |   |     |
|                           |     injury to the     |   |   |   |     |
|                           |     head from falling |   |   |   |     |
|                           |     objects or        |   |   |   |     |
|                           |     electrical        |   |   |   |     |
|                           |     contact.          |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Do employees wear         |                       |   |   |   |     |
| protective footwear (i.e. |                       |   |   |   |     |
| safety shoes/boots)?      |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **SANITATION: (29         |                       |   |   |   |     |
| 1910.141)**               |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are efforts taken to      | -   Permanent places  |   |   |   |     |
| ensure the workplace is   |     of employment     |   |   |   |     |
| well-kept and good        |                       |   |   |   |     |
| housekeeping is           | -   All places of     |   |   |   |     |
| maintained? (i.e. trash   |     employment shall  |   |   |   |     |
| emptied regularly,        |     be kept clean to  |   |   |   |     |
| storage rooms kept        |     the extent that   |   |   |   |     |
| orderly, offices and      |     the nature of the |   |   |   |     |
| workplaces free of        |     work allows       |   |   |   |     |
| clutter, etc.)            |                       |   |   |   |     |
|                           | -   To facilitate     |   |   |   |     |
|                           |     cleaning, every   |   |   |   |     |
|                           |     floor, working    |   |   |   |     |
|                           |     place, and        |   |   |   |     |
|                           |     passageway shall  |   |   |   |     |
|                           |     be kept free from |   |   |   |     |
|                           |     protruding nails, |   |   |   |     |
|                           |     splinters, loose  |   |   |   |     |
|                           |     boards, and       |   |   |   |     |
|                           |     unnecessary holes |   |   |   |     |
|                           |     and openings      |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **PHYSICAL HAZARD         |                       |   |   |   |     |
| WARNINGS/SIGNS: (29 CFR   |                       |   |   |   |     |
| 1910.144, 145)**          |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are physical hazards      | -   Physical hazards  |   |   |   |     |
| color coded?              |     include flammable |   |   |   |     |
|                           |     storage cans,     |   |   |   |     |
|                           |     stop bars,        |   |   |   |     |
|                           |     buttons,          |   |   |   |     |
|                           |     switches, and     |   |   |   |     |
|                           |     tripping,         |   |   |   |     |
|                           |     slipping, and     |   |   |   |     |
|                           |     falling hazards.  |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are accident prevention   | -                     |   |   |   |     |
| signs and tags utilized   |                       |   |   |   |     |
| in the facility where     |                       |   |   |   |     |
| there are hazards or      |                       |   |   |   |     |
| potential hazards to      |                       |   |   |   |     |
| employees?                |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **CONFINED SPACES: (29    |                       |   |   |   |     |
| CFR 1910.146)**           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any confined    | "Confined space\"     |   |   |   |     |
| spaces in the facility?   | means a space that:   |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Is large enough   |   |   |   |     |
|                           |     and so configured |   |   |   |     |
|                           |     that an employee  |   |   |   |     |
|                           |     can bodily enter  |   |   |   |     |
|                           |     and perform       |   |   |   |     |
|                           |     assigned work;    |   |   |   |     |
|                           |     and               |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Has limited or    |   |   |   |     |
|                           |     restricted means  |   |   |   |     |
|                           |     for entry or exit |   |   |   |     |
|                           |     (for example,     |   |   |   |     |
|                           |     tanks, vessels,   |   |   |   |     |
|                           |     silos, storage    |   |   |   |     |
|                           |     bins, hoppers,    |   |   |   |     |
|                           |     vaults, and pits  |   |   |   |     |
|                           |     are spaces that   |   |   |   |     |
|                           |     may have limited  |   |   |   |     |
|                           |     means of entry.); |   |   |   |     |
|                           |     and               |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Is not designed   |   |   |   |     |
|                           |     for continuous    |   |   |   |     |
|                           |     employee          |   |   |   |     |
|                           |     occupancy         |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any             | > Permit-required     |   |   |   |     |
| permit-required confined  | > confined space      |   |   |   |     |
| spaces in the facility?   | > (permit space)\":A  |   |   |   |     |
|                           | > confined space that |   |   |   |     |
|                           | > has one or more of  |   |   |   |     |
|                           | > the following       |   |   |   |     |
|                           | > characteristics     |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Contains or has a |   |   |   |     |
|                           |     potential to      |   |   |   |     |
|                           |     contain a         |   |   |   |     |
|                           |     hazardous         |   |   |   |     |
|                           |     atmosphere        |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Contains a        |   |   |   |     |
|                           |     material that has |   |   |   |     |
|                           |     the potential for |   |   |   |     |
|                           |     engulfing an      |   |   |   |     |
|                           |     entrant           |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Has an internal   |   |   |   |     |
|                           |     configuration     |   |   |   |     |
|                           |     such that an      |   |   |   |     |
|                           |     entrant could be  |   |   |   |     |
|                           |     trapped or        |   |   |   |     |
|                           |     asphyxiated by    |   |   |   |     |
|                           |     inwardly          |   |   |   |     |
|                           |     converging walls  |   |   |   |     |
|                           |     or by a floor     |   |   |   |     |
|                           |     which slopes      |   |   |   |     |
|                           |     downward and      |   |   |   |     |
|                           |     tapers to a       |   |   |   |     |
|                           |     smaller           |   |   |   |     |
|                           |     cross-section; or |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Contains any      |   |   |   |     |
|                           |     other recognized  |   |   |   |     |
|                           |     serious safety or |   |   |   |     |
|                           |     health hazard     |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| LOCKOUT/TAGOUT: (29 CFR   |                       |   |   |   |     |
| 1910.147)                 |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is there a program for    | -   Servicing and     |   |   |   |     |
| the control of hazardous  |     maintenance of    |   |   |   |     |
| energy?                   |     machines and      |   |   |   |     |
|                           |     equipment in      |   |   |   |     |
|                           |     which the         |   |   |   |     |
|                           |     **unexpected**    |   |   |   |     |
|                           |     energization or   |   |   |   |     |
|                           |     start up of the   |   |   |   |     |
|                           |     machines or       |   |   |   |     |
|                           |     equipment, or     |   |   |   |     |
|                           |     release of stored |   |   |   |     |
|                           |     energy could      |   |   |   |     |
|                           |     cause injury to   |   |   |   |     |
|                           |     employees         |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   (**Energy         |   |   |   |     |
|                           |     source.** Any     |   |   |   |     |
|                           |     source of         |   |   |   |     |
|                           |     electrical,       |   |   |   |     |
|                           |     mechanical,       |   |   |   |     |
|                           |     hydraulic,        |   |   |   |     |
|                           |     pneumatic,        |   |   |   |     |
|                           |     chemical,         |   |   |   |     |
|                           |     thermal, or other |   |   |   |     |
|                           |     energy)           |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **FIRST AID/EMERGENCY     |                       |   |   |   |     |
| RESPONSE (includes        |                       |   |   |   |     |
| emergency shower/eyewash  |                       |   |   |   |     |
| requirements): (29        |                       |   |   |   |     |
| 1910.151)**               |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is there first aid        | -   In the absence of |   |   |   |     |
| available for employees   |     an infirmary,     |   |   |   |     |
| either in-house, or by    |     clinic, or        |   |   |   |     |
| outside emergency medical |     hospital in near  |   |   |   |     |
| responders?               |     proximity to the  |   |   |   |     |
|                           |     workplace which   |   |   |   |     |
|                           |     is used for the   |   |   |   |     |
|                           |     treatment of all  |   |   |   |     |
|                           |     injured           |   |   |   |     |
|                           |     employees, a      |   |   |   |     |
|                           |     person or persons |   |   |   |     |
|                           |     shall be          |   |   |   |     |
|                           |     adequately        |   |   |   |     |
|                           |     trained to render |   |   |   |     |
|                           |     first aid.        |   |   |   |     |
|                           |     Adequate first    |   |   |   |     |
|                           |     aid supplies      |   |   |   |     |
|                           |     shall be readily  |   |   |   |     |
|                           |     available.        |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Where the eyes or |   |   |   |     |
|                           |     body of any       |   |   |   |     |
|                           |     person may be     |   |   |   |     |
|                           |     exposed to        |   |   |   |     |
|                           |     injurious         |   |   |   |     |
|                           |     corrosive         |   |   |   |     |
|                           |     materials,        |   |   |   |     |
|                           |     suitable          |   |   |   |     |
|                           |     facilities for    |   |   |   |     |
|                           |     quick drenching   |   |   |   |     |
|                           |     or flushing of    |   |   |   |     |
|                           |     the eyes and body |   |   |   |     |
|                           |     shall be provided |   |   |   |     |
|                           |     within the work   |   |   |   |     |
|                           |     area for          |   |   |   |     |
|                           |     immediate         |   |   |   |     |
|                           |     emergency use.    |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **FIRE                    |                       |   |   |   |     |
| PROTECTION/EMPLOYEE ALARM |                       |   |   |   |     |
| SYSTEM: (29 CFR           |                       |   |   |   |     |
| 1910.157-159, 164, 165)** |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are portable fire         |                       |   |   |   |     |
| extinguishers available   |                       |   |   |   |     |
| in the workplace?         |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are employees             | -   Exemption: Where  |   |   |   |     |
| tr                        |     the employer has  |   |   |   |     |
| ained/designated/expected |     established and   |   |   |   |     |
| to use fire extinguishers |     implemented a     |   |   |   |     |
| during a fire?            |     written fire      |   |   |   |     |
|                           |     safety policy     |   |   |   |     |
|                           |     which requires    |   |   |   |     |
|                           |     the immediate and |   |   |   |     |
|                           |     total evacuation  |   |   |   |     |
|                           |     of employees from |   |   |   |     |
|                           |     the workplace     |   |   |   |     |
|                           |     upon the sounding |   |   |   |     |
|                           |     of a fire alarm   |   |   |   |     |
|                           |     signal and which  |   |   |   |     |
|                           |     includes an       |   |   |   |     |
|                           |     emergency action  |   |   |   |     |
|                           |     plan and a fire   |   |   |   |     |
|                           |     prevention plan   |   |   |   |     |
|                           |     which meet the    |   |   |   |     |
|                           |     requirements of   |   |   |   |     |
|                           |     29 CFR 1910.38    |   |   |   |     |
|                           |     and 29 CFR        |   |   |   |     |
|                           |     1910.39           |   |   |   |     |
|                           |     respectively, and |   |   |   |     |
|                           |     when              |   |   |   |     |
|                           |     extinguishers are |   |   |   |     |
|                           |     not available in  |   |   |   |     |
|                           |     the workplace     |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is the facility equipped  | -   Applies to all    |   |   |   |     |
| with standpipe and hose   |     small hose, Class |   |   |   |     |
| systems?                  |     II, and Class III |   |   |   |     |
|                           |     standpipe systems |   |   |   |     |
|                           |     installed to meet |   |   |   |     |
|                           |     the requirements  |   |   |   |     |
|                           |     of a particular   |   |   |   |     |
|                           |     OSHA standard.    |   |   |   |     |
|                           |     Exception. This   |   |   |   |     |
|                           |     section does not  |   |   |   |     |
|                           |     apply to Class I  |   |   |   |     |
|                           |     standpipe systems |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is the facility equipped  | -   All automatic     |   |   |   |     |
| with an automatic         |     sprinkler systems |   |   |   |     |
| sprinkler system?         |     installed to meet |   |   |   |     |
|                           |     a particular OSHA |   |   |   |     |
|                           |     standard.         |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is the facility equipped  | -   All fire          |   |   |   |     |
| with a fire detection     |     detection systems |   |   |   |     |
| system?                   |     installed to meet |   |   |   |     |
|                           |     a particular OSHA |   |   |   |     |
|                           |     standard          |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is the facility equipped  | -   Applies to all    |   |   |   |     |
| with an employee alarm    |     emergency         |   |   |   |     |
| system (if no, review     |     employee alarms   |   |   |   |     |
| checklist for             |     installed to meet |   |   |   |     |
| applicability             |     a particular OSHA |   |   |   |     |
| determination)            |     standard. This    |   |   |   |     |
|                           |     requirement does  |   |   |   |     |
|                           |     not apply to      |   |   |   |     |
|                           |     those discharge   |   |   |   |     |
|                           |     or supervisory    |   |   |   |     |
|                           |     alarms required   |   |   |   |     |
|                           |     on various fixed  |   |   |   |     |
|                           |     extinguishing     |   |   |   |     |
|                           |     systems or to     |   |   |   |     |
|                           |     supervisory       |   |   |   |     |
|                           |     alarms on fire    |   |   |   |     |
|                           |     suppression,      |   |   |   |     |
|                           |     alarm or          |   |   |   |     |
|                           |     detection systems |   |   |   |     |
|                           |     unless they are   |   |   |   |     |
|                           |     intended to be    |   |   |   |     |
|                           |     employee alarm    |   |   |   |     |
|                           |     systems           |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **COMPRESSED AIR: (29 CFR |                       |   |   |   |     |
| 1910.169)**               |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is compressed air used in |                       |   |   |   |     |
| the facility?             |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **MATERIALS HANDLING: (29 |                       |   |   |   |     |
| CFR 1910.176)**           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Materials handling and    | -   Where mechanical  |   |   |   |     |
| storage                   |     handling          |   |   |   |     |
|                           |     equipment is used |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -   Material storage  |   |   |   |     |
|                           |     and storage areas |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **FORKTRUCKS/CRANES: (29  |                       |   |   |   |     |
| CFR 1910.178, 179, 184)** |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are powered industrial    | -                     |   |   |   |     |
| trucks (forklifts) used   |                       |   |   |   |     |
| at the facility?          |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are employees trained on  | -                     |   |   |   |     |
| forktruck operations?     |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any overhead or | -                     |   |   |   |     |
| gantry cranes at the      |                       |   |   |   |     |
| facility?                 |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are slings used at the    | -   Applies to slings |   |   |   |     |
| facility?                 |     used in           |   |   |   |     |
|                           |     conjunction with  |   |   |   |     |
|                           |     other material    |   |   |   |     |
|                           |     handling          |   |   |   |     |
|                           |     equipment for the |   |   |   |     |
|                           |     movement of       |   |   |   |     |
|                           |     material by       |   |   |   |     |
|                           |     hoisting          |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
|                           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **MACHINE GUARDING: (29   |                       |   |   |   |     |
| CFR 1910.212, 215, 217,   |                       |   |   |   |     |
| 219, 242, 243, 244)**     |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are any machines used at  | -   All machinery     |   |   |   |     |
| the facility that pose    |     that poses a      |   |   |   |     |
| hazards to employees such |     hazard to         |   |   |   |     |
| as those created by point |     employees.        |   |   |   |     |
| of operation, nip points, |                       |   |   |   |     |
| rotating parts, and       |                       |   |   |   |     |
| flying chips and sparks?  |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is any of the following   | -   See applicable    |   |   |   |     |
| equipment used at the     |     checklist         |   |   |   |     |
| facility?                 |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Abrasive wheel        |                       |   |   |   |     |
|     machinery             |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Mechanical power      |                       |   |   |   |     |
|     presses               |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Mechanical power      |                       |   |   |   |     |
|     transmissions         |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Hand or portable      |                       |   |   |   |     |
|     powered tools and     |                       |   |   |   |     |
|     equipment             |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Abrasive blast        |                       |   |   |   |     |
|     cleaning nozzles      |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **WELDING: (29 CFR        |                       |   |   |   |     |
| 1910.252, 253)**          |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are welding (including    | -   See applicable    |   |   |   |     |
| oxygen-gas, arc and       |     checklist         |   |   |   |     |
| resistance), cutting, or  |                       |   |   |   |     |
| other hot work operations |                       |   |   |   |     |
| conducted at the          |                       |   |   |   |     |
| facility?                 |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **ELECTRICAL: (29 CFR     |                       |   |   |   |     |
| 1910.303, 304, 305, 307,  |                       |   |   |   |     |
| 332, 334)**               |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is any of the following   | -   See applicable    |   |   |   |     |
| electrical equipment or   |     checklist         |   |   |   |     |
| locations used or present |                       |   |   |   |     |
| at the facility?          |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   spliced wiring        |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   electrical equipment  |                       |   |   |   |     |
|     that ordinarily       |                       |   |   |   |     |
|     produces arcs,        |                       |   |   |   |     |
|     sparks, flames, or    |                       |   |   |   |     |
|     molten metal          |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Any areas where       |                       |   |   |   |     |
|     electrical equipment  |                       |   |   |   |     |
|     that operates at 50   |                       |   |   |   |     |
|     volts or greater      |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Overcurrent devices   |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Circuit breakers      |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Electrical pull boxes |                       |   |   |   |     |
|     and junction boxes    |                       |   |   |   |     |
|                           |                       |   |   |   |     |
| -   Extension/temporary   |                       |   |   |   |     |
|     electrical cords or   |                       |   |   |   |     |
|     cables                |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Do employees conduct      | -   The training      |   |   |   |     |
| electrical work (i.e.     |     requirements      |   |   |   |     |
| repairs, wiring, etc)?    |     apply to          |   |   |   |     |
|                           |     employees who     |   |   |   |     |
|                           |     face a risk of    |   |   |   |     |
|                           |     electric shock    |   |   |   |     |
|                           |     that is not       |   |   |   |     |
|                           |     reduced to a safe |   |   |   |     |
|                           |     level by          |   |   |   |     |
|                           |     electrical        |   |   |   |     |
|                           |     installation      |   |   |   |     |
|                           |     requirements.     |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **AIR                     |                       |   |   |   |     |
| CONTAMINANTS/ASBESTOS:    |                       |   |   |   |     |
| (29 CFR 1910.1000,        |                       |   |   |   |     |
| 1001)**                   |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Have hazardous air        | -                     |   |   |   |     |
| contaminants been         |                       |   |   |   |     |
| monitored for in the      |                       |   |   |   |     |
| workplace?                |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Does the facility contain | -                     |   |   |   |     |
| asbestos-containing       |                       |   |   |   |     |
| materials?                |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **BLOODBORNE PATHOGENS:   |                       |   |   |   |     |
| (29 CFR 1910.1030)**      |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are any employees exposed | -   **Occupational    |   |   |   |     |
| (occupational exposure)   |     Exposure** means  |   |   |   |     |
| to blood or other         |     reasonably        |   |   |   |     |
| potentially infectious    |     anticipated skin, |   |   |   |     |
| materials?                |     eye, mucous       |   |   |   |     |
|                           |     membrane, or      |   |   |   |     |
|                           |     parenteral        |   |   |   |     |
|                           |     contact with      |   |   |   |     |
|                           |     blood or other    |   |   |   |     |
|                           |     potentially       |   |   |   |     |
|                           |     infectious        |   |   |   |     |
|                           |     materials that    |   |   |   |     |
|                           |     may result from   |   |   |   |     |
|                           |     the performance   |   |   |   |     |
|                           |     of an employee\'s |   |   |   |     |
|                           |     duties            |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are any employees         | -                     |   |   |   |     |
| designated as first aid   |                       |   |   |   |     |
| responders within the     |                       |   |   |   |     |
| facility?                 |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are Material Safety Data  | -                     |   |   |   |     |
| Sheets (MSDSs) maintained |                       |   |   |   |     |
| for all hazardous         |                       |   |   |   |     |
| chemicals?                |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is there a written Hazard | -                     |   |   |   |     |
| Communication Program     |                       |   |   |   |     |
| (HAZCOM) at the facility? |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **HAZARD                  |                       |   |   |   |     |
| COMMUNICATION/RIGHT TO    |                       |   |   |   |     |
| KNOW: (29 CFR             |                       |   |   |   |     |
| 1910.1200)**              |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are hazardous chemicals   | -   Applies to any    |   |   |   |     |
| used in the workplace?    |     chemical which is |   |   |   |     |
|                           |     known to be       |   |   |   |     |
|                           |     present in the    |   |   |   |     |
|                           |     workplace in such |   |   |   |     |
|                           |     a manner that     |   |   |   |     |
|                           |     employees may be  |   |   |   |     |
|                           |     exposed under     |   |   |   |     |
|                           |     normal conditions |   |   |   |     |
|                           |     of use or in a    |   |   |   |     |
|                           |     foreseeable       |   |   |   |     |
|                           |     emergency         |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **RADIATION: IONIZING (10 |                       |   |   |   |     |
| CFR 20); NONIONIZING (29  |                       |   |   |   |     |
| CFR 1910.97)**            |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are sources of ionizing   | -   See applicable    |   |   |   |     |
| or non-ionizing radiation |     checklist         |   |   |   |     |
| located in the facility?  |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **ABRASIVE BLAST          |                       |   |   |   |     |
| OPERATIONS AND            |                       |   |   |   |     |
| VENTILATION: (29 CFR      |                       |   |   |   |     |
| 1910.94)**                |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is abrasive-blast         | -   See applicable    |   |   |   |     |
| operation conducted at    |     checklist         |   |   |   |     |
| the facility which are    |                       |   |   |   |     |
| equipped with ventilation |                       |   |   |   |     |
| systems?                  |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **DIP TANKS: (29 CFR      |                       |   |   |   |     |
| 1910.108)**               |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are dip tanks used at the | -   Examples of       |   |   |   |     |
| facility?                 |     covered           |   |   |   |     |
|                           |     operations are    |   |   |   |     |
|                           |     paint dipping,    |   |   |   |     |
|                           |     electroplating,   |   |   |   |     |
|                           |     pickling,         |   |   |   |     |
|                           |     quenching,        |   |   |   |     |
|                           |     tanning,          |   |   |   |     |
|                           |     degreasing,       |   |   |   |     |
|                           |     stripping,        |   |   |   |     |
|                           |     cleaning, roll    |   |   |   |     |
|                           |     coating, flow     |   |   |   |     |
|                           |     coating, and      |   |   |   |     |
|                           |     curtain coating.  |   |   |   |     |
|                           |                       |   |   |   |     |
|                           | -                     |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **TOXIC AND HAZARDOUS     |                       |   |   |   |     |
| SUBSTANCES:**             |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Are there any sources of  | -   Not applicable to |   |   |   |     |
| lead, cadmium, or benzene |     fuels             |   |   |   |     |
| in the facility?          |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
|                           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
|                           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **FALL PROTECTION: (29    |                       |   |   |   |     |
| CFR 1926.502)**           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Do employees work in or   | -   See applicable    |   |   |   |     |
| required to climb to      |     checklist         |   |   |   |     |
| elevated areas?           |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is there a fall           |                       |   |   |   |     |
| protection program in     |                       |   |   |   |     |
| place?                    |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| **TRAINING:**             |                       |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+
| Is training conducted for | > *LIST TYPES OF      |   |   |   |     |
| employees?                | > TRAINING*:          |   |   |   |     |
+---------------------------+-----------------------+---+---+---+-----+