Occupational Health Survey

Health Hazard Identification and Requirements

Does your company have any of the following occupational health hazards? These are the five major categories with some examples given for each one. Check the boxes that apply.

Chemical Hazards (Fibers, Dusts, Metals, Acids, Solvents, Gases, and Vapors) Physical Hazards (Noise, Thermal (Heat/Cold Stress), Ionizing Radiation, Non-ionizing Radiation, Vibration, and Illumination)Biological Hazards (Bloodborne Pathogens, Indoor Air Quality, Communicable Diseases (COVID, Influenza), Flora and Fauna (plants, animal/bird droppings), Food-borne and Water-borne Bacteria)Ergonomic Hazards (Manual Lifting, Awkward Postures, and Office Workstations)Psychosocial Hazards (Stress, Shift Work, Fatigue, Living and Working Away from Home)

Does your company have a written Occupational Health Program documenting how to characterize and manage occupational health hazards? *

YesNoUnsure

Has your company done risk assessments for the selected health hazards and their respective tasks that are performed to determine what controls (i.e., engineering, administrative, or personal protective equipment) are needed to reduce the risk of exposure? *

YesSome of themNone of themUnsure

Does your company have written programs and/or procedures for the selected health hazards per their specific regulations? *

YesSome of themNone of themUnsure

Has your company done the required sampling or monitoring (e.g., air sampling for chemicals or sound surveys for noise) for the selected health hazards?

YesSome of themNone of themUnsure

Has your company done the required health surveillance (e.g., audiograms, respiratory function tests, blood tests, biological monitoring, or allergy tests) for the selected health hazards? *

YesSome of themNone of themUnsure

__________________________________________

Specific Occupational Health Programs

Personal Protective Equipment (PPE) Standard (OSHA 29 CFR 1910.132) - Check all the ones your company has in place. *

There is a written PPE program in place identifying the PPE program elements.Workplace assessments are done to determine what hazards are present and what PPE is needed to protect the employees from harm which should also include breakthrough times for chemical clothing and chemical gloves.There is a variety of PPE and sizes available to accommodate different employee statures.PPE is inspected, cleaned, maintained, and stored properly.All employees are trained on the use and storage of PPE.Your company doesn't need a PPE Program.

Respiratory Protection (RP) Standard (OSHA 29 CFR 1910.134) - Check all the ones your company has in place. *

There is a written Respiratory Program in place identifying the respiratory program elements.Respiratory protection is assigned based on risk assessments and a respiratory cartridge change out schedule is incorporated based on objective information or data of known chemical concentrations.All employees are annually trained, medically fit (had a physical) to wear a respirator and fit tested documenting respirator model and size.All respiratory protection is cleaned, maintained, and stored in a bag with employee's name and work ID number.All training and fit testing records are recorded and maintained until next training/fit testing date.Your company doesn't need a RP Program.

Hazard Communication (HAZCOM) Standard (OSHA 29 CFR 1910.1200) - Check all the ones your company has in place. *

There is a written Hazard Communication Program with the Globally Harmonized System (GHS) requirements in place.There is a Safety Data Sheet (SDS) for each chemical with a revision date less than 5 years.The SDSs are available either by hard copy or electronic access.All employees have been trained on the GHS requirements on the use, handling, and storage of chemicals.All the primary and secondary containers have GHS labels.Your company doesn't need a HAZCOM Program.

Access to Employee Exposure and Medical Records Standard (OSHA 29 CFR 1910.1020) - Check all the ones your company has in place. *

There is a section in the Occupational Health Program specifying the employee exposure and medical recordkeeping requirements for employees that may be exposed to health hazards.Employee exposure records (i.e., workplace monitoring or surveys, biological monitoring, and SDS with chemical or substance name) for each employee are being preserved and maintained for at least the duration of employment plus thirty (30) years.Employee medical records (i.e., medical and employment questionnaires or histories, medical examinations) for each employee are being preserved and maintained for at least the duration of employment plus thirty (30) years.Whenever an employee or designated representative requests access to exposure or medical records, your company is assuring access free of charge within fifteen (15) working days.Whenever access is requested to an analysis which reports the contents of employee medical records by either direct identifier or by information that could indirectly identify specific employees, your company is removing that information before access is provided. Your company doesn't need an Exposure and Medical Program.

__________________________________________