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PF^GRAN EVALUATION INFORHATIr,' 1 . Is your injury prevention program written? Yes _ No _ 2 . Do you have records of implementation and maintenance of your program? Yes _ No 3 . Do you have an individual (s ) name to implement on your program? Yes No 4 . Do you have a system other than periodic inspections for identifying and evaluating: A . Workplace hazards? Yes _ No _ B. Unsafe conditions? Yes _ No C. Unsafe work practices? Yes _ No _ 5 . Do you schedule periodic inspections? Yes _ No _ A. If yes , how often? 6 . Do you have methods for correcting in a timely manner: A. Unsafe or unhealthy conditions? Yes — No _ B. Unsafe or unhealthy work practices? Yes _ No 7 . Do you have an occupational health and safety training program that instructs employees in general safe and healthy work practices? Yes _ No _ 8. Do you provide specific instructions with respect to hazards specific to each employee's job assignment? Yes _ No _ 9 . Do you have a system for communicating with employees on occupational health and safety matters? Yes _ No _ A. If yes , does that system include a provision designed to encourage employees to report hazards without fear of reprisal? Yes No 10 . Do you have a system for ensuring that employees comply with safe and healthy work practices other than disciplinary action? Yes No 11 . Do you correct unsafe and unhealthy conditions in a timely manner? Yes No 12. Do you correct unsafe and unhealthy work practices in a timely manner? Yes No 13 . Did you train all employees when your program started? Yes No 14 . Do you train all new employees and employees given a new job assignment? Yes _ No _ 15. Do you train all employees whenever a new substance, process , procedure or equipment is introduced into the work- place that represents a new hazard or when a new or previously unrecognized hazard is discovered? Yes — No