WineSHIP - Safety and Health Program Assessment Worksheet

Employer

Consultant

Contact

Date

SIC/NAICS Code

Number of employees

Number of hours worked

Facility Incidence Rates:

DART

Recordable IR

Industry Incidence Rates:

DART

Recordable IR

Program ELEMENTS (Scores) Indicators (Enter most appropriate number) And Sub-elements

Program ELEMENTS (Scores) Indicators (Enter most appropriate number) And Sub-elements Comments: What evidence helped identify/verify adequacy? What improvement action is recommended?

A. Clear worksite safety and health policy

• (4) Workforce can explain, and fully embraces, S&H policy

• (3) Majority of personnel can explain policy

• (2) Some personnel can explain policy

• (1) Management can provide or state (where appropriate) a policy

• (0) There is no apparent policy

B. Management leadership health

• (4) All personnel can give examples of management's active commitment to safety and health

• (3) Majority of personnel can give examples of management's active commitment to safety and

• (2) Some personnel can give examples of management's active commitment to safety and health

• (1) Some evidence exists that management is committed to safety and health

• (0) Safety and health does not appear to be a management value or significant concern

C. Employee involvement

• (4) All personnel have ownership of safety and health and can describe their active roles

• (3) Majority of personnel feel they have a positive impact on identifying and resolving S&H issues

• (2) Some personnel feel they have a positive impact on identifying and resolving S&H issues

• (1) Employees frequently feel that their safety and health input will be considered by supervision

• (0) Employee involvement in safety and health issues is not encouraged or rewarded

D. Accountability

• (4) Personnel are held accountable and all performance is addressed with appropriate consequences

• (3) Accountability systems are in place; but consequences used tend to be for negative performance only

• (2) Personnel are generally held accountable, but consequences rarely follow performance

• (1) Accountability exists, but it appears to be generally hit or miss and prompted by serious negative events

• (0) There does not appear to be any effort at accountability

A. Hazard rare identification (Inspection)

• (4) Well trained employees at all levels conduct frequent and varied inspections, hazards of any kind

• (3) Inspections are conducted by trained personnel and all items are corrected, repeat hazards seldom found

• (2) Inspections are conducted by trained personnel, most items corrected; but some hazards still in evidence

• (1) An inspection program exists; but coverage and corrective action is not complete; hazards in evidence

• (0) There is no routine inspection program in place at this facility; many hazards can be found

B. Hazard reporting system

• (4) In addition, employees feel comfortable identifying and self-correcting hazards.

• (3) A comprehensive system for gathering hazard information exists; is positive, rewarding, and effective

• (2) A system exists for hazard reporting; employees feel they can use it; but it may be slow to respond

• (1) A system exists for hazard reporting; but employees may find it unresponsive or be unclear on its use

• (0) No formal hazard reporting system exists and/or employees do not appear comfortable reporting hazards

C. Accident/Incident

• (4) All loss-producing incidents and "near misses" are investigated for root cause with effective prevention investigation

• (3) All OSHA-reportable incidents are investigated and effective prevention is implemented

• (2) OSHA-reportable incidents generally investigated; cause identification/correction may be inadequate

• (1) Some investigation of incidents takes place, but root cause is seldom identified, correction is spotty

• (0) Injuries are either not investigated or investigation is limited to report writing required for compliance

A. Timely hazard engineering control

• (4) Hazard controls fully in place, known to and supported by workforce, with concentration on controls and reinforced/enforced safe work procedures

• (3) Hazard controls fully in place with priority to engineering controls, safe work procedures, administrative controls, and personal protective equipment (in that order)

• (2) Hazard controls fully in place; but order of priority variable

• (1) Hazard controls are generally in place; but priority and completeness varies

• (0) Hazard control is not considered complete, effective and appropriate in this facility 0

A. Employees lean

• (4) In addition, employees can demonstrate proficiency in, and support of, all areas covered by training hazards, how to

• (3) Facility committed to high quality employee hazard training, ensures all participate, regular updates protect themselves

• (2) Facility provides legally required training, makes effort to include all personnel and others

• (1) Training is provided when need is apparent, experienced personnel assumed to know material

• (0) Facility depends on experience and informal peer training to meet needs

B. Supervisors learn responsibilities and underlying reasons

• (4) All supervisors assist in worksite analysis, ensure physical protections, reinforce training, enforce discipline, and can explain work procedures, based on training provided to them

• (3) Most supervisors assist in worksite analysis, ensure physical protections, reinforce training, enforce discipline, and can explain work procedures, based on training provided to them

• (2) Supervisors have received basic training, appear to understand and demonstrate importance of worksite analysis, physical protections, training reinforcement, discipline, knowledge of procedures

• (1) Supervisors make reasonable effort to meet safety and health responsibilities; but have limited training

• (0) There is no formal effort to train supervisors in safety and health responsibilities

Total the scores for each sub-element (the circled choice) and list them below. The maximum possible score for each element is shown. To provide a graphic representation of the status of the facility, draw a vertical line for the score in the appropriate box on the chart and shade in the current level. The area remaining unshaded is the improvement opportunity.

Management Leadership (16)

Workplace Analysis (12)

Hazard Prevention and Control (4)

Safety and Health Training (8)

Total Score (40)