ISAWWA WATER PLANT SYSTEMS SAFETY AUDIT/SURVEY TOOL

Prevention of workplace injuries in Water collection and treatment plants

Water plant operations involve extensive monitoring of both interior and exterior facilities, use of potentially hazardous chemicals, and mechanical repairs which can involve heavy and out of position lifting. Outside winter-time monitoring operations present significant slip/fall hazards. Key activities include proper use of hand and power tools, proper lifting techniques and practices, proper use of personal protective equipment and slip/fall protection, and proper training and operation systems use for chemical operations.

Instructions: This is a pro-active safety auditing tool designed for periodic use to reduce high risk behaviors and increase safe behaviors.

·  “Yes” answers should be scored at (1)

·  “No” answers should be scored at (0)

In the corrective action column, either a time frame for completing the correction or the actual date corrective action was completed should be noted. Check the “NA” column if this item is not applicable. Total and track audit scores over time to track up or down trends along with tracking the number of incidents, accidents and injuries sustained. Use the last page to list and describe each corrective action that is needed as well as any additional safety hazards identified during the inspection.

Take pictures of any identified safety hazard and store with completed checklist. Once the correction has been made, take picture of corrected item and keep in file. Set a timeline of no more than 7 days to correct high safety hazards and 15 days for low-moderate safety hazards.

System Information
System Name
City, State
Date of Completion
Type of Work Being Completed
Task/Job Part 1– Safety Training / Yes / No / Corrective action date / NA
Training completed with passing scores in a timely
manner
Training properly recorded
Training and new employee safety orientation completed (Including Seasonal)
Training and new employee safety orientation
completed for seasonal workers (including part time)
Task/Job Part 2 – Monitoring & Communication / Yes / No / Corrective action date / NA
Hazardous atmospheric monitoring devices and alarms in working order
All other gas and or chemical monitoring devices and alarms in working order
Work completed in a timely manner with proper use of
PPE and safe lifting practices
Slip/fall protection used as needed (outside,
winter- time conditions) (ie salt)
Procedure and Policy in place for corrective action
Procedure and Policy in place for incident reporting
Task/Job Part 3 – Water Plant Operations - Proper
Work Practices / Yes / No / Corrective action date / NA
Have a procedure for proper position and lifting techniques
Proper use of hand and power tools during maintenance operations
·  Employees provided all tools and equipment needed
·  Employees provided training for tools and equipment
·  Employees are not allowed to use personal tools and equipment on the job
Proper use of heavy boots, gloves, eye protection, and other PPED during maintenance operations
Proper communication, safety equipment and back up personnel during hazardous chemical and other
higher risk operations
Task/Job Part 4 – Use of Personal Protective
Equipment (PPE) / Yes / No / Corrective action date / NA
PPE is provided that fits the hazard, if needed and training provided. List out
-  _
-  _
-  _
-  _
-  _
PPE is good and usable condition
PPE accessible to personnel
PPE for Fall protection provided – list out
-  _
-  __
- 
PPE provided for chemical handling – list out
-  Non permeable gloves
-  Splash type safety glasses
-  Reviewed hazard labels for recommended PPE
-  _
Task/Job Part 5– Proper use of incident reporting forms logs with proper recording / Yes / No / Corrective action date / NA
All worker injuries reported to supervisor and recorded
All worker accidents involving property, chemicals reported and recorded using OSHA 300A form if needed.
All “near misses” reported to supervisors and recorded
If a reporting program was in place, all hazards and potential hazards reported and recorded
All incidents or accidents involving customers reported and recorded
·  At the time of an accident or incident, there is no admission of liability on the part of the municipality
All appropriate public safety and EMS agencies were notified
Task/Job Part 6 – Safety Meetings and Records / Yes / No / Corrective action date / NA
Periodic safety meetings attended with training and or incident investigations and corrective action taken
All records associated with safety meetings properly maintained
OSHA 300A completed
OSHA Logs are completed and posted in a common area from Feb 1st to April 30th of the following year.
Records retained for 5 years
Task/Job Part 7 – Illness Prevention and Environmental
Safety / Yes / No / Corrective action date / NA
Proper work practices around water inlets, reservoirs to prevent drowning
Task/Job Part 8 – Confined Space Entry Lockout Tag out / Yes / No / Corrective action date / NA
Confined spaces and Permit Confined Spaces have been identified
Confined Spaces ID Chart posted
Training staff on how to identify a confined space
Proper air quality and gas monitoring before entry, if employees will be entering.
Proper fall protection and rescue staff and equipment used
Proper Lockout/Tag out procedures and communications used
Task/Job Part 9– Site Safety Equipment in Place and Properly Maintained / Yes / No / Corrective action date / NA
Fire extinguishers – checked every year by third party and clearly marked.
Eyewashes and/or Safety Showers= exercised every week (and recorded) and accessible
First Aid Kit available
Handrails – checked for proper height and security
Utility name w/ 24 hour telephone contact number “Authorized Personnel Only” or similar sign at entrance gates
Federal No Tampering Sign
Chemical Hazards / Yes / No / Corrective action date / NA
MSDS on site and up to date
Containers labeled with HMIS label and chemicals stored properly
CERCLA form posted
Electrical / Yes / No / Corrective action date / NA
Power line is free of tree limbs
Ground fault circuit interrupters part of new construction
Wall outlets and light switches in good condition
Wall outlets properly grounded
All circuit breakers are labeled
No gaps in breaker panel
All control s are labeled
Total Score
Use this box to describe and comment on all corrective actions needed and any additional safety items identified during the inspection. Be sure to identify location and corrective action to be taken.
ALWAYS record the date the correction was made to ensure complete records.

Signature

Print Name

Date

Safety Audit Survey v 1.1 DATE