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GAP Analysis

GAP Analysis

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General Information

Your Work Email *

Site Name *

Site address (actual address and mailing address if different) *

Key contact personnel, with titles and contact information (phone and email) *

Union contact information with titles, phone, and email *

Number of employees; Number of applicable contractors (those at the site over 1000 hours in a calendar quarter) *

Type of work performed/products produced *

North American Industrial Classification System number (NAICS) 6-digits or Standard Industrial Classification number (SIC) 4-digits *

Year Injury and Illness Rates for the last 3 years

Year *

TCIR *

DART *

Year *

TCIR *

DART *

Year *

TCIR *

DART *

What do you hope to accomplish? *

What is the timeline? *

6 Months
6 Months to 1 Year
1 Year or More
Other

If Other, please Specify:

Is the following in place at the workplace?

Management Commitment

Adequate expenditures for PPE, S/H training and maintaining safety procedures

Comments

Safety / health goals established / achieved / revisited on a periodic basis

Comments

EHS policies have been communicated to all affected Employees

Comments

Planning

Budget for employee participation in Safety & Health Program

Comments

Budget for safety & health training, correction of deficiencies, PPE and

Comments

Written Safety and Health Program

All Employees and applicable Contractors are educated on S/H program

Comments

Enforcement Policy of S/H program is in place

Comments

All elements addressed in the S/H program

Comments

or Specialists and

Top Management Leadership

All levels of Management supportive of S/H program

Comments

Open door policy for Employees to Management

Comments

Signed Safety Commitment Statement/letter posted

Comments

Management participates in hazard identification

Comments

Correction of unsafe conditions in a timely manner

Comments

Communicates corrective actions to affected parties, including contractors

Comments

Authority and Resources

Safety work procedures readily available

Comments

Safety manual accessible

Comments

Employees have authority and responsibility to enforce S/H program

Comments

Are S/H resources readily available

Comments

Line Accountability

All employees held accountable for safety

Comments

Management responsible for Employees' safety

Comments

Employees are supported in stopping work to correct unsafe conditions or actions

Comments

Contractors

Contractor's safety program equal to site's program

Comments

Pre-qualification process in use

Comments

Safety training for Contractors

Comments

Monitoring of Contractor performance

Comments

Resident Contractor list where applicable

Comments

Contractor participation in site’s S/H program

Comments

Joint Site and Contractor safety meetings occur

Comments

Evaluation of contractor performed on a periodic basis

Comments

Employee Involvement

At least 3 Meaningful ways of employee involvement in S/H program

Comments

Part of VPP committee/prep

Comments

Participate in inspections/investigations

Comments

Provided computer access if needed to access S/H information

Comments

Understands employee OSHA rights

Comments

Can provide Input to the S/H Procedures

Comments

Employee Suggestion System in place

Comments

Training development program for employees

Comments

Safety and Health Program Evaluation

Are periodic S/H program evaluations performed

Comments

Who is on Team for preparing evaluation

Comments

Findings tracked to completion

Comments

Pre-use Analysis

Employee involvement

Comments

Sampling / Air monitoring (lead, noise, metals, silica, heat stress – if any applies to site)

Comments

Sampling results provided to all affected employees

Comments

Ventilation system provided if applicable

Comments

Adequate training on pre-use analysis results

Comments

Communication analysis before putting into service

Comments

Pre-use & non-routine activities analyses conducted

Comments

Regulatory lighting requirements met for work areas

Comments

Hazard Analysis

Analysis of routine task (i.e. SOPs, JHA work instruction)

Comments

Eating areas are separate from work areas

Comments

JHAs/JSAs – performed and employees trained on them

Comments

Employee involvement in hazard analysis processes

Comments

Written IH monitoring In place

Comments

Monitoring strategy developed

Comments

Baseline monitoring complete including contractors

Comments

Ergonomic concerns identified where applicable

Comments

Trend Analysis

Trends identified and used as leading indicators

Comments

Leading indicators have been established

Comments

Information being trended is relevant to S/H program performance

Comments

Routine Inspections

Monthly inspections of site to cover entire site quarterly

Comments

Housekeeping program in place

Comments

Inspection findings documented, tracked to completion & shared with all affected personnel

Comments

Management and Labor inspections performed

Comments

Employee lead inspections

Comments

Routine inspections of required equipment (i.e. Ladders, fork trucks, fire extinguishers, etc.)

Comments

First use inspections of required equipment (i.e. vehicles, Fork trucks scaffold, PPE, etc.)

Comments

Work areas inspected for proper utility connections and use (i.e. air, water, steam, etc.)

Comments

Employee Hazard Reporting System

Anonymous way to report hazard or emergency

Comments

System in place to provide feedback anonymous concerns reported

Comments

Contractor hazard reporting system in place

Comments

Documented reporting system

Comments

Employees and Contractors know how to report to a safety issue

Comments

Accident/Incident Investigations

Are all accidents/incidents/near misses reported and documented

Comments

Accurate reporting of all accident/incidents and tracked to completion

Comments

All employees participate in reporting

Comments

Employees who participate in investigations trained root cause methods employed

Comments

Incident/Accident databases accessible by all affected employees

Comments

Certified Professional Resources

Certified Industrial Hygienist/Certified Safety Professional or Health Professionals onsite or readily available as appropriate for workplace

Comments

Hazard Elimination or Control

Engineering Controls

Engineering analysis of potential workplace hazards and implemented controls (i.e. machine guards, ventilation systems, or safety interlocks)

Comments

Engineering review process for capital projects or new equipment to improve S/H issues

Comments

Administrative Controls

Work rotation or rescheduling process in place (i.e. job rotation, weather related work, etc.)

Comments

Safety procedures in place

Comments

Training – safety procedures, PPE, computer, inspections, emergencies, electrical, etc.

Comments

Applicable warning signs in place

Comments

Work practices adequate

Comments

Safety and Health Rules

Rules/standards established, followed and enforced

Comments

Site safety manual available to all employees, including contractors

Comments

Personal Protective Equipment

Required PPE provided to all employees as applicable for tasks performed

Comments

Employees trained on proper use of PPE

Comments

Employee use PPE when job requires

Comments

Employees are medically qualified for PPE as needed (i.e. respiratory protection program).

Comments

Hazard Control Programs

Written Hazard Communication Program

Comments

MSDS available to all employees, including Contractors

Comments

Contractor MSDS available to affected employees

Comments

Containers labeled, including secondary containers

Comments

Warning signs, Noise, Asbestos, Radiation, or regulated areas

Comments

IH monitoring data reported to individuals and areas

Comments

Safe Work Practices

Examples of Safe Work Practices include

Confined space entry locations identified & labeled

Comments

Lock out / Tag out program and log

Comments

Confined space entry permit and log

Comments

Equipment opening (i.e. Line breaking) procedure

Comments

High voltage program

Comments

Hot work permits

Comments

S/H concerns, suggestions, recommendations, findings tracked to completions

Comments

Site specific Safe work practices in place

Comments

Preventative Maintenance (PM)

PM inspections, findings tracked to completion (fork trucks, shops, tools, manlifts, cranes, etc.)

Comments

Fire equipment inspections

Comments

Emergency Alarms systems tested

Comments

Safety devices are inspected, tested, and controlled (i.e. relief valves, interlocks, etc.)

Comments

PM documentation completed and maintained

Comments

Documented PM inspection schedule established per manufacturer recommendations or industry standards

Comments

Have required studies been completed (i.e. Arc flash, Infrared, seismic, etc.)

Comments

Hazard Correction Tracking

Safety concerns tracked to completion, root cause identified and communicated

Comments

Safety concerns are tracked and readily available to all employees to see tracking.

Comments

Safety concerns/suggestions process is in place

Comments

Safety concerns/suggestions corrections are made in a timely manner

Comments

Safety concerns/suggestions are documented

Comments

Occupational Healthcare Program

Record keeping

Comments

Medical surveillance for Hearing, Respirator, Chemical Specific, HazWoper is conducted as applicable

Comments

First aid supplies or assistance available as needed

Comments

CPR & AED qualified personnel on-site if needed

Comments

Disciplinary System

Written progressive disciplinary procedure

Comments

All employees (managers, supervisors and employees) are treated the same

Comments

Contractor disciplinary system in place

Comments

Procedure knowledgeable to all Employees and Contractors

Comments

Emergency System

Emergency drills include all Employees and Contractors including all Shift Workers and performed annually

Comments

Visitor orientation addresses what to do in case of emergency

Comments

Site Employees and Contractors are trained on emergency scenarios

Comments

Natural and External hazards addressed in emergency program

Comments

Contracted Outside Rescue Services available

Comments

Supervisors / Specialists

Training matrix for all Employees of regulatory & Company required training

Comments

Designated Trainers where required (i.e. forklift, etc.)

Comments

Documented frequency of training requirements

Comments

Employees

Specialized training for certain trades/jobs/competent employees where applicable (i.e. trenching, scaffolding, scaffold inspection, Lead, Asbestos)

Comments

Designated where needed (i.e. hazard recognition)

Comments

Are Employee computer literate that are required to take computer-based training (CBT)

Comments

Frequency of training documented

Comments

Employees involved in critiquing refresher training needs

Comments

Emergencies

Hands on training and/or book training including Blood borne Pathogen, CPR, AED, Confined Space Rescue

Comments

Contractor emergency response/evacuation training

Comments

Documented frequency of training and drills

Comments

Drills and events critiqued and documented

Comments

Personal Protective Equipment (PPE)

Employees trained on PPE they use

Comments

Frequency of training documented

Comments

Employees can readily access PPE

Comments

PPE inspection and maintenance procedures communicated

Comments

Employees use PPE properly and know limitations

Comments

Managers

Specialized training for Management – consistent and regular

Comments

Frequency of training documented

Comments

Process Safety Management

Appropriate PSM areas identified

Comments

Reduction of Haz Chems considered or Inventories Controlled

Comments

Employee participation in PSM program evident

Comments

All Process Safety Information Available

Comments

P&ID Drawings Accurate

Comments

PHA's scheduled & performed

Comments

Facility siting studies current

Comments

PHA Recommendations completed in timely manner

Comments

Communication is provided to affected employees

Comments

Operator Training & Refresher Training Provided

Comments

Investigation History Available (5 years)

Comments

Safe work practices in place and in use

Comments

Pre-Startup Safety Reviews Appropriate

Comments

Mechanical Programs exist to maintain integrity of covered processes including Maintenance Training

Comments

Inspections cover regulatory required equipment (i.e. Tankage, Piping, Relief systems, Rotating Equipment, Electrical, Interlock/Alarm systems)

Comments

Emergency Response Plan capable of mitigating hazards

Comments

Management of Change (MOC) system is in place & effective (i.e. MOC complete before startup)

Comments

MOC training documented and complete for all affected personnel

Comments

MOC drawing changes complete or redlines available

Comments

PSM Compliance is audited on a least 3 yr cycle

Comments

Operating procedures meet regulatory requirements for all scenarios listed

Comments

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