Document O3kB8my0Yy8RorNYb4o8RX3Nv
MINIMUM REQUIREMENTS - SELF AUDIT SAFETY QUESTIONNAIRE AND
EMPLOYEE SAFETY SURVEY
MARCH 1991
LOUISIANA DIVISION CONSOLIDATED AUDIT PROGRAM
DOW U.S.A.
DO A 047478 CONFTDFNTTAL
TABLE OF CONTENTS
I. INTRODUCTION LETTER TO PLANT SUPERINTENDENT /DEPARTMENT HEAD
II. MINIMUM REQUIREMENTS - SELF AUDIT QUESTIONNAIRE A. PROGRAM FUNDAMENTALS B. EMPLOYEE RESPONSIBILITY FOR SAFETY C PROGRAM STRUCTURE - ORGANIZATION - PLANNING D. SAFETY TRAINING E OPERATING PROCEDURES F. EMERGENCY PLANS G ACCIDENT/INCIDENT INVESTIGATION AND REPORTING H. SAFETY STANDARDS, GUIDES, REQUIREMENTS I. HAZARD DETECTION PROGRAM J. SAFETY SUGGESTION SYSTEM K AWARD/RECOGNITION SYSTEMS L. CONTRACTOR SAFETY M. OFF THE JOB SAFETY N. COMMUNICATIONS
c Q PHYSICAL FACILITIES
III. EMPLOYEE SAFETY SURVEY
DO A 047479 CONFTDFNTTAI.
Louisiana Division March 6, 1991
Dow U.S.A
The Dow Chemical Company P.0 Box 150
Plaquemine. Louisiana 70765-0150
PLANT SUPERINTENDENT/DEPARTMENT HEAD
SAFETY AUDIT
The Safety Audit will be a part of the Louisiana Division's Consolidated Audit Program. The audit will be the responsibility of the Superintendent/Department Head.
The attached questionnaire has been prepared as a tool for each department to use as a self-evaluation in preparation for the audit. The questions are based on Dow Minimum Requirements Guidelines and Safety and Loss Prevention Standards and Principles. Please answer all questions that apply to your plant/department and make notes for discussion during the audit.
Also included is a copy of a Employee Safety Survey which should be copied and distributed to each of your employees for their input. This should be done at least one month prior to the audit to allow for collation of the responses.
Please send the Division Audit Facilitator a completed copy of this self-evaluation at least ten (10) days prior to your scheduled plant/department audit.
If you have any questions on this section of the assessment, please contact either your Safety Superintendent or me.
Don Jones Safety and Loss Prevention Building 3502W Ext 6097
mg
DO A 0A7480 CONFTDFNTTAl-
SAFETY
MINIMUM REQUIREMENTS - SELF AUDIT QUESTIONNAIRE
Division
L a. J).........................................................................................................._................ ..
Plant/Department
dp If
____________________________________________________
Plant/Department Safety Contact
_______________________________________
Person Completing this Reporttjf>Alk-rT______________________ __
Date
instructions: Answer in as brief a statement as possible. Where documentation or sample
examples exist, please reference, include and attach to final report. If area is nonapplicable, mark it so. Circle for yes or no. Check squares where applicable.
A. Program Fundamentals
(1) Do you have a plant/department safety policy statement? (If yes, please attach)
(JiD*
No
(2) Is the policy written?
No
(3)
How has the policy been communicated? /T /.?
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(4) Do you have safety mission statements for plant, site, safety committee, and/or natural work teams? Circle appropriate ones. '
If yes, how were they developed? (Please attach)
B. Employee Responsibility for Safety
(1) Is individual safety responsibility clearly defined in all job descriptions for all personnel? (Includes ail supervisory, technical, operating, salary, etc.)
If no, list exclusions:
Yes No
Revised: 8/7/91
00 A 042481 CONFTDFNTT Al
PROGRAM AUDIT QUESTIONNAIRE
Employee_BesPonsibilitv for Safety (cont'd.)
(2) Is individual safety performance reviewed personally on a one-to-one basis at least annually for all personnel mentioned in (1) above? If no, list exclusions:
PAGE 2 Yes No
Are annual personal safety goals required? Are they measurable?
C. Program Structure - Organization - Planning
Yes No Yes No
(1) Describe your safety organization. Please include organizational chart, if applicable. Indicate whether part-time or full-time.
(2) List any committees which exist to help promote/run the safety program such as on the job committee, off-the-job committee, etc.
-Committee
Duration of Freq. of Minutes Minutes Pre-pub. Pre-est.
Composition Membership Meetings Taken
Published Agenda Charter
Revised: 8/7/91
DO A 04048? OONFTDFNTTAI
PROGRAM AUDIT QUESTIONNAIRE
Program Structure - Organization Planning (cont'd.)
(3) Objectives, Goals, Plans, for Safety
a) Do they exist at a formal, written level for your Plant/Department?
b) Do they exist as a formal, written document at any level?
Explain:
PAGE 3
Yes No Yes No
c) Who sets objectives, goals, and plans?
d) Do objectives, goals, and plans other than just statistical goals exist?
Explain:
Yes No
e) Is the Safety Performance Improvement Process evaluation form used?
By whom? ___________ _____________
Yes No
Has it been used as a tool to help set safety goals and plans?
Yes
No
Describe the use of the SPIP evaluation form. ________________________________
(Attach appropriate documentation).
Revised: 8/7/91
DO A 042483 CONFTDFNTIAl
PROGRAM AUDIT QUESTIONNAIRE D. Safety Training
PAGE 4
(1) Do you have a new employee (new to location or new to Dow) safety indoctrination program?
If yes, please attach copy.
Yes No
a) Who conducts the indoctrination? ____________________________________________
b) How long an indoctrination?
(2) Do you conduct a safety indoctrination program for:
Supervisors as well as operating personnel?
Yes No
Management and technical personnel?
Yes No
Transferees from department to department?
Yes No
(3) Is there a formal checklist or sheet showing the kinds of training an employee should receive?
Yes No
Has received?
Yes No
(4) Describe your formal safety and loss prevention training programs subsequent to indoctrination for the following groups:
a) New supervisor
b) New chemical operator _ c) New craftsmen d) New technical personnel
Revised: 8/7/91
i
DO A 047484 OONFTOFNTTAl.
PROGRAM AUDIT QUESTIONNAIRE Safety Training (cont'd)
PAGE 5
(5) Check those topics below for which your Plant/Dept. Safety Programs cover via Plant/Dept., Division or other source (list others not covered)
Defensive driving
n
LJ Explosimeter & oxygen testing
EH Vessel entry EH OSHA - Familiarization EH OSHA - General industry EH DOT - Regulated materials
EH Proper labeling of chemicals EH Pipeline identification EH Emergency alarms EH Ladders EH Excavation for maintenance or const.
ED Checking of emergency equipment
Contractor safety
EH Audits
LH Safety meeting handling
EH Hearing conservation
EH Reactive chemicals EH Loading/unloading tank cars/tank trucks EH Static electricity
0 Compressed gas cylinders
EH Materials handling - Rigging EH Line opening EH Sampling EH Lockout and tagging EH Hot work EH Accident investigation EH Ventilation [H Radiation EH Heat stress
ED Eye and face protection EH Respiratory protection EH Personal protective equipment EH Emergency procedures EH Grounding and bonding ED Job safety analysis
Observation of unsafe acts/conditions
EH Intervention training
Revised: 8/7/91
00 A 042485 CONFTDFNTTAl
PROGRAM AUDIT QUESTIONNAIRE
(6) Other Units:
Motor Vehicle Training:
SBSPt Tmg.
Type Unit
Yes nq
Fork lift truck
Condor lift
Bucket trucks
Cherry pickers Cranes A-frames
Winch trucks
Bulldozers Road grader Front-end loader
PAGE 6
Licensina Proaram Yes NO
Firearms permitted in plant vehicles
Revised: 8/7/91
HO A 04P486 CONFIDFNTTAl.
PROGRAM AUDIT QUESTIONNAIRE
Safety Training (cont'd)
(7) Do you have different/more intensive safety training programs for any special group of employees? Yes If yes, explain:
PAGE 7 No
(8) Are safety meetings held with some degree of regularity?
Yes No
What frequency? _________________________________________________________ .
Describe how__________________________________________________________
-
Who is responsible for giving safety meetings___________________________________
If not, what is your method of communicating on safety matters? ________________
(9) Do you use any outside-the-company training programs? If yes, please list:
Yes No
(10) Who is responsible for developing safety training programs?
(11) Who is the trainer in your programs?
(12) Do you have a safety training manual? How is it used?
Yes No
Revised: 8/7/91
DO A 0424B7 CONFTDFNTTA1
PROGRAM AUDIT QUESTIONNAIRE
PAGE 8
Safety Training (cont'd)
(13) What safety training time schedule and criteria schedule do you have for each potential trainee? _______________________________________________________
(14) How do you use staff people and/or line people as Instructors?
(15) How do you review or follow up employee training?
(16) What safety-related material do you mail to the employees' homes?
(17) How are employees trained on the Division Safety Standards?
How often do you have refresher training?
(18) Does your department use the Division Personnel System (DPS) to document required
employee training?
Yes No
Revised: 8/7/91
n0 A 04?4B8 CONFTOFNTTAl
PROGRAM AUDIT QUESTIONNAIRE E. Operating Procedures
PAGE 9
(1) Describe your location's method for documenting, updating, and training, as it relates to standard operating procedures. Check all that apply.
Manual
IPT Modules
Job Safety Analysis
Other__________________________________________________________
Written?
Yes
No
Frequency of updating
Method of training and retraining
Verbal?
Yes No
How is training documentation done?___________________________________________
Who is responsible for writing and reviewing operating procedures? ____________ Updating them?
(2) Are IPT modules developed for the plants/department?
Yes No
Percent complete
Frequency of updating
Method of training and retraining______________________________________________
Who is responsible for writing IPT modules? ___________________________________
Updating them? How is training documentation done? __________________________________________
Revised: 8/7/91
DO A 042489 CONF T DFNT T Al
PROGRAM AUDIT QUESTIONNAIRE F. Emergency Plans
PAGE 10
References: Minimum Requirements
1. Are copies of your unit emergency plan available to all personnel? Yes No
2. Are copies up to date? Last update:
Yes No
3. Who updates the Dlan? Freauencv:
4. Does the plan include: (If not, be prepared to discuss why)
Emergency call list?
Yes No NA
Emergency equipment plant plan (such as SCBA, deluge, C02, fire monitors, hose
cabinets, etc.)
Yes No NA
Emergency equipment operating procedures for above equipment? Yes
Procedure for switching to alternate for each utility?
Yes
Procedure for total loss for each utility?
Yes
No NO No
Procedure for Power Failure?
Crash shutdown procedure? (time reauired:
)
Yes No Yes No
Severe Weather - Freeze, Hurricane, Flood? Procedures in case of neighbor plant problems? Procedure for loss of raw materials? Gas release procedure? 5. Does the plan include: (If not, be prepared to discuss why)
Yes No Yes No Yes No Yes No
NA NA NA
Spill procedure?
Yes No NA
Fire fighting plans for each type of fire?
Yes No NA
Emergency communications plan?
Yes No NA
Chain of command defined?
Yes No NA
6. Is there a documented emergency plan training and retraining program?
Yes No
Revised: 8/7/91
VO A 04?49Q OONFrDFNTTAI
PROGRAM AUDIT QUESTIONNAIRE
PAGE 11
7. Is training up to date and documented for all employees? 8. How often are hypothetical drills conducted?
Yes No
9. Do you meet with Emergency Services and discuss fire fighting plans and hazards for your
plan periodically
Yes No
10. Are vital records protected from loss (such as PC data, MOD V programs, training
programs, business information)?
Yes No
11. Do you have emergency drills involving neighboring plants?
Yes No
12. Are contractors adequately trained in what to do in an emergency? Yes No
13. Does plan provide for consideration of:
Check items that exist in current plan:
EH Line rupture EH Civil disorders EH Bomb threat EH Community EH Vendors EH Emergency power
0 Explosion
EH Evacuations EH Other EH Visitors
0 Head count of personnel
EH Emergency lighting
G. Accident/Incident Investigation and Reporting
References: "Dow Guidelines for Accident Investigation" and "Dow Guidelines for S/LP/S Reporting"
(1) Are ail accidents involving personal injury investigated?
Yes No
List exceptions _______ ______________________ ____________________________________
Revised: 8/7/91
no A 04749 CONF idf.nttai
PROGRAM AUDIT QUESTIONNAIRE
PAGE 12
) Check those accidents which require a report by supervisor and investigation at your plant/department:
ED All accidents ED OSHA recordables ED OSHA restricted workday cases ED OSHA lost workday cases ED Off-the-job injuries ED Motor vehicle accidents ED Near-miss (no injury)
(3 I Who initiates, submits, and signs accident investigation reports?
ED Safety person ED Supervisor of employee involved ED Other (list) _____________________________________________________________
(4 Does plant Superintendent/Department Head participate in disabling injury investigation?
Yes No
Days Away from Work Cases?
Yes No
(5 How are learning values of accidents publicized? _________________________________
(6 Who is involved in accident investigation?
(7 Are accident reports written in Safe Working Styles format? Revised: 8/7/91
Yes No
(y
DO A 042492 CONFIDENTIAL
PROGRAM AUDIT QUESTIONNAIRE
PAGE 13
Accident Investigation (cont'd)
(8) What method do you use to follow up on proposed corrective actions arising out of accident investigation?
Describe: ___________________________________________________________________
( 9) How do you encourage the reporting of minor injuries?
(10) Do you track your incidents, injuries and near-misses? (Provide the last 3 years' data).
Yes
(11) Do you have a copy of the latest guidelines in your plant/department? Yes
No No
H. Safety Standards, Guides. Requirements
(1) In what areas is the plant/department not in compliance with the Division Safety Standards? (List all variances)__________________________________
Is there a plan and schedule to come into compliance?
Yes
(2) Describe your method of informing your people of new or changes in OSHA or other regulations.
No
Revised: 8/7/91
A 04P493 ttONFTDFNT TAl'
PROGRAM AUDIT QUESTIONNAIRE (3) Check those for which you have a requirement:
PAGE 14
Required By
Written Safe Job Procedure
Not Written Left to
Judgement of Supervisor or
Operating Personnel
Lockout Vessel entry Smoking Hot Work Emergency planning Hard hat Contractor safety Tagging Defensive driving Fork truck operation Tank car loading/unloading
Revised: 8/7/91
DO A 042494 CONFIDENTIAL
PROGRAM AUDIT QUESTIONNAIRE Safety Standards, Guides. Requirements (corn'd) Check those for which you have a requirement: (confd)
Do You Have A Written Safe Job Procedure
B
Nothing Written But Left to
Judgement of Supervisor or
Operating Personnel
B
Ladders Scaffolding Egress Safety showers Eye bath Sampling Line/equipment opening Sight glasses Flammable storage Chemical refrigeration Hearing conservation Radiation Ventilation Asbestos Powered elevated work platforms Hot work - electrical Equipment handling hand rigging Heat stress
PAGE 15
Revised: 8/7/91
DO A 04?495 CONFTDFNTTAL
PROGRAM AUDIT QUESTIONNAIRE
Safety Standards. Guides. Requirements (corn'd)
Check those for which you have a requirement: (cont'd)
Required By
Written Safe Job Procedure
Not Written Left to
Judgement of Supervisor or Operating Personnel
Labeling of containers Pipeline identification Vessel identification Pressure vessel requirements Cylinder regulators Cylinder handling and storage Reactive chemicals Eye protection Foot protection Respiratory requirements Grounding and bonding Railroad - blue flag - derailer Static electricity Emergency lighting Emergency alarms Fire extinguishers Moving machinery Roll standard Guarding Ring and jewelry policy
Revised: 8/7/91
PAGE 16
HO A 040496 CONFTDFNTTAI
PROGRAM AUDIT QUESTIONNAIRE
PAGE 17
I. Hazard Detection Program
Check all that apply:
Inspections:
Superintendent makes inspection:
On regular basis
l_l On infrequent basis
U No plan
Internal units determine own policies on inspections and frequency thereof.
Entire plant/department committed to internal audit program with schedules and formal criteria.
Plant/department committed to audits - no schedules and no formal prepublished criteria.
No commitment to audit.
Audits (other) - Describe:
Job hazard analysis is used as a method of detection All identified hazards are tracked to completion.
Other - describe:________________________________
Revised: 8/7/91
PROGRAM AUDIT QUESTIONNAIRE
PAGE 18
J- Safety Suggestion System
Is there a written suggestion system in effect for safety suggestions and a process to follow up to completion?
Yes No
If yes, how are suggestions followed up? _____________________________________________
Response time?___________________________________________________ If no, how do you solicit safety improvements and method of follow-up?
K. Award/Recoonition Systems
Do you have a safety award/recognitionsystem?
Yes No
Is award/recognition built into achievement of some objective, goal, or plan?
Yes No
Is award/recognition system preplanned and communicated prior to start of any safety accountingperiod?
Yes No
Is award/recognition after the fact (i.e., decide to issue award/recognition after realizing that some milestone has been achieved)?
Yes No
What is the normal dollar value of a safety award? ___________________________________
Is it presented to everyone?
Revised: 8/7/91
DO A 042498 OONFTDFNTTAt.
PROGRAM AUDIT QUESTIONNAIRE L. Contractor Safety
PAGE 19
Check those that apply:
*e Nq
Contractor safety manual, other than purchasing specifications or contract in use.
Safety requirements spelled out in purchase order or written contract
and includes Dow, state, local, and federal requirements.
Contractor must submit his plan for safety of his personnel as part of bid
package.
Dow person responsible for safety of contract site is spelled out or
identified in job description
Pre-job safety meeting always held.
List exceptions:
Plant/department indoctrination program for contractor employees new to
Plant/department is in practice.
How accomplished? __
Accident reports of incidents by contractors on Dow sites are
required and filed.
Contractor must practice minimum Dow safety requirements at site
unless given variance by Dow in writing.
Contractor safety performance on Dow site is condition of employment and consideration for future contracts.
Contractor is allowed to use Dow equipment such as ladders,
scaffolds, tools, etc.
Revised: 8/7/91
CcOoNnPfriden4t;>i4a^l
PROGRAM AUDIT QUESTIONNAIRE
PAGE 20
Contractor Safety: (cont'd)
m NO
n Contract jobs are formally inspected on routine basis for safety and health.
Are you aware of and using, "Safety and Loss Prevention Manual for Contractors" - 1990? Contractor program is coordinated with local safety program. Do you have contract maintenance?
If yes, are they included in Dow safety programs? Contract laborers other than maintenance?
In absence of any formal manual or other Dow criteria to guide your safety program, please enclose or list safety criteria used on contract jobs:
Who attends contractor safety investigations? Describe any special features of your contractor safety program
Revised: 8/7/91
DO A Q4?S00 CONFIDENTIAL
PROGRAM AUDIT QUESTIONNAIRE
PAGE 21
M. Off-the-Job Safety
Yes fsb
EH There is a formal program for reporting of off-the-job injuries
to Dow personnel.
Results of Dow employee off-the-job injuries are collected and published for learning value.
EH Off-the-job accident statistics and learning situations are utilized in plant safety meetings or discussions.
List some of your most successful "off-the-job" oriented safety meeting topics:
N. Communications
Check those that apply:
EH Use slide-tape case histories from other locations in program EH Family Safety or other means used to convey safety to home
In-house closed circuit TV capability
EH Video-tape replay capability
Use National Safety Council resource material
EH Use Dow U.S.A. safety guidelines EH Other - list: _______________________________________________
Revised: 8/7/91
OO A 047501 CONFTDFNTTAl- ^
PROGRAM AUDIT QUESTIONNAIRE
PAGE 22
Q Physical Facilities
What provision do you have to maintain Housekeeping? How Accomplished?
Revised: 8/7/91
00 A 04750? CONFIDENT TAt
LOUISIANA DIVISION EMPLOYEE SAFETY SURVEY
circle one:
1 ) Employee - Less than one year
1 to 5 years
5 to 10 years
10 to 20 years
over 20 years
CFSCLEONB
2 ) Age -
20 tfl_3P yeats
30 to 50 years over 50 years
PLEASE ANSWER THE FOLLOWING QUESTIONS:
3 ) How would you describe your supervisor's views on safety?
4 ) In your formal Job Performance Review, did your supervisor discuss your safety performance?
Did you set a personal safety goal?
5 ) What does SAFETY actually mean to you personally?
6 ) How well are you trained on your job when you start something new?
7) On what part(s) of your job do you think you need more training?
8) Do you have written operating procedures covering your job in your department? (a) ______. How well are they kept up? (bj When did you last review them? (c) __________ .
9 ) What part of your job requires you to think the most about safety, or requires the most caution?
1 0) What do you do if you notice an employee performing work in an unsafe manner?
Revised: 8/7/91
DO A 042503 CONFIDENTIAL
11) a Do you attend meetings in which safety is discussed (at least monthly)? b. Who gives them?__________________________________________ c. Are they meaningful and helpful to you?.........................................-..........
12) Do you know the hazards of the chemicals to which you have potential exposure?
13) Do you know where the Material Safety Data Sheets and TIME' sheets are kept? . If so, are they readily available to you? _____________________ .
Have you used them outside of a training session?.
14) Do you wear personal protective equipment to avoid contact with chemicals?.
How is the protective equipment maintained?
15) a How are safety suggestions handled in your department?
b. Do you receive prompt feedback? 16) a Do you have written Emergency Procedures?
b. When and what was your last emergency drill?
17) In your opinion, what situation or problem do you think is going to cause the next serious accident on your job?
18) If actions are taken at the appropriate time, do you believe accidents to yourself and others can be prevented? OECKONE: All of the time; Most of the time: Some of the time: Why?
1 9) What one change would you suggest that would prevent injuries to the people at your location?
2 0) Is the Louisiana Division an OSHA Star Site? Yes
No
21) Do you know your rights under the OSHA VPP/Star Program? Yes No
2 2) Any other comments or areas of concern? ____________________________
Revised: 8/7/91
DO A 042504 C0NF7DFNTTA1