Reviewer: Date: Instructions:
This checklist identifies items that should be reviewed periodically to ensure that the Safety and Health Program is functioning as intended.
The Safety and Health Program Manager must perform this review of the Safety and Health Program at least Annually. When
the review has been completed and any deficiencies corrected, this checklist should be filed in the [Program Review] folder.
The [Accident Investigations] folder contains documentation
showing that all injuries and illnesses that have occurred since the last review were properly
investigated, recorded, and reported. Unsafe condition reports were investigated and
the conditions corrected when necessary.
Safety Meetings are Conducted
The [Safety Meetings] folder contains documentation
showing that the Safety meetings are being conducted in accordance with the frequency described in Section 4.1 (page 6).
Safety Inspections are Performed
The [Safety Inspections] folder contains documentation
showing that Safety Inspections are being performed as required in Section 6 (page 7). Issues identified during inspections were corrected in a timely manner.
Company Profile and Hazard Assessment
I have reviewed the Company Profile contained
in Appendix 6 and the personal protective equipment (PPE) hazard assessment in Appendix 5. If there have been any significant changes to the profile or hazard assessment, I have updated the program. Note: The program may be updated at http://www.mysafetyprogram.com.
General Program Effectiveness
Ihave considered the overall effectiveness of this Safety
and Health Program and discussed the program with others at Connected Fiber Inc. I have concluded this program is effectively achieving the goal of reducing occupational injuries
and illnesses at Connected Fiber Inc, or I have implemented changes in the program to make it more effective. I have discussed my findings with the General Manager.
This field is for validation purposes and should be left unchanged.