Safety Compliance Checklist Template - Free Download | Page 3
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EVALUATION
STANDARD
Indoor Environment
Score:
Other Factors:
Notes:
Evidence of mold
Thermal comfort
Excessive dust
Continuing or multiple IAQ complaints
Objectionable odor
Others
Injury & Illness Prevention
Score:
Other Factors:
Notes:
Stay at Work Program implemented
Suspected fraud cases reported
Accident repeaters counseled
OSHA 300 Log
Disciplinary action for safety violation
3 LAUSD required posters
Machine guarding
Lead Management
Notes:
Score:
Other Factors:
Staff Awareness
Others
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OEHS School Safety Compliance Checklist
SSCC Worksheet v, 2 September 2007
-
Threshold Questions
YES
NO
Is the site free of evidence of potentially toxic or odorous emissions, such as mold, affecting the indoor environment [Evaluation
should be based on staff interviews, field observations, and review of Contact Log.]
Are indoor areas adequately lighted
Are ventilation systems adequate & properly maintained [Evaluation should be based on visual observations and interview of Plant
Manager.
Are classrooms free of excessive noise [Evaluation should be based on staff interviews, field observations, and review of Contact
Log.]
Threshold Questions
YES
NO
Is a current IIPP available and is the summary page posted listing the responsible individual
Has a Safety Committee been established and are meetings held at least quarterly and documented
Are safety inspections conducted at least two times per year, documented and identified deficiencies corrected and/or reported to
M&O
Are all accidents investigated by the supervisor and a completed ''Injury/Accident Investigation Report'' sent to OEHS & ORMIS
within 24 hours
Are IIPP and Blood-borne Pathogens trainings conducted within 30 days of job assignment and annually thereafter & documented
Is the Claims Rate less than 120% of the District average
Threshold Questions
YES
NO
Are buildings constructed prior to 1993 free of peeling or chalking paint
Has a trouble call been placed for areas of peeling or chalking paint
Are drinking fountains flushed daily {Per REF-858]
source: achieve.lausd.net
