1.
Does your company operate aerial lifts?
2.
Does your company perform work on anything electrical?
3.
Does your company work in any areas containing asbestos?
4.
Does your company work in any areas containing the carcinogen benzene?
5.
Will any of your employees be exposed to blood or any other potentially infectious materials (OPIM)? (For example: a designated first aid responder may reasonably anticipate exposure to blood or OPIM)
6.
Does your company use or store any compressed gas cylinders?
7.
Does your company perform work in any confined spaces? (1. Must have limited openings for entry and exit. 2. The space is not designed for continuous human occupancy. 3. The space is large enough for you to enter and conduct work.)
8.
Does your company allow cell phones on premises? (Employees or managers)
9.
Does your company perform any work around crystalline silica dust?
10.
Does your company have any emergency eyewash stations or showers for employee use?
11.
Are any employees exposed to potential fall hazards/Do any employees work from heights above 4 feet?
12.
Does your company have any fire extinguishers and are any employees allowed to use them in case of an emergency?
13.
Does your company handle any food that is intended for consumers?
14.
Does your company operate powered industrial trucks PITs? (Forklifts, scissor lifts, golf carts, etc…)
15.
Do any of your employees use/operate hand & power tools? (Axes, wrenches, knives, drills, electric tools, hydraulic tools etc..)
16.
Has anyone in your company ever sustained a hand injury?
17.
Does your company have any chemicals on-site that are accompanied by a Safety Data Sheet (SDS)? (Oils, Grease, bleach, cleaning products etc…)
18.
Are there areas in the workplace where continuous noise levels exceed 85 decibels?
19.
Does your company perform any hot work? (Welding, cutting, brazing, or other devices that create sparks)
20.
Are there any areas in the workplace that contain hydrogen sulfide gases?
21.
Does your company use any portable ladders?
22.
Does your company have any machinery or equipment that requires de-energization when performing maintenance or servicing? (Lockout/Tagout)
23.
Does your company use any machines that require guarding? (Portable power tools, power saws, shears, milling machines etc…)
24.
Do your employees perform any material handling?
25.
Do any of your employees work in an office setting?
26.
Do any work functions at your company require the use of personal protective equipment (PPE)? (eye, face, head, hand, foot, etc…)
27.
Does your company have work environments with insufficient oxygen or toxic substances in the air that are unable to be eliminated?
28.
Is your company in the restaurant industry?
29.
Does your company work with scaffolding?
30.
Does your company operate scissor lifts?
31.
Do any of your company locations have stairs or stairways?
32.
Does your company do any welding, cutting or brazing?
33.
Are any employees exposed to lead?
34.
Are any company employees under the age of 18?
