r Ivimnmentafl Health Center *1: EHCJM924 December 1991 PUBL NAW MEDICAL DEPARTMENT HEALTHCARE FACILITIES’ SAFETY AND HEALTH GUIDE NAW ENVIRONMENTAL HEALTH CENTER us. DEPOSITOR‘I MAR ] 1 1982 BUREAU OF MEDICINE AND SURGERY NAW MEDICAL DEPARTMENT HEALTHCARE FACILITIES’ SAFETY AND HEALTH GUIDE Publlshed By NAW ENVIRONMENTAL HEALTH CENTER 2510 WALMER AVENUE NORFOLK, VIRGINIA 23513-2617 DECEMBER 1991 Reviewed and up: roved In accordance with SECNR VINST 5600.16A XML, CAPTAIN J.J. EDWARDS, MC, USN Commanding Officer PREFACE The purpose of this manual is to provide a standardized safety program within all Bureau of Medicine and Surgery (BUMED) activities. This will help achieve the goals of providing a safe working environment for each employee, and ensuring patient and visitor safety as required by the precepts of the Joint Commission on the Accreditation of Healthcare Organizations and Navy Department directives. This manual provides standardized guidelines for the conduct and reporting of Occupational Safety and Health Management Evaluations at Navy medical and dental treatment facilities. At the time of publication this manual referenced current Navy directives and Joint Commission on Accreditation of Healthcare Organizations requirements. As policies and requirements change, this manual will be updated to reflect those changes. This manual will also be continually improved and expanded in scope to meet "customer" needs based upon feedback from Bureau of Medicine and Surgery safety professionals at all echelon levels. This manual is not a substitute for the Accreditation Manual for Hospitals, published by the Joint Commission on Accreditation of Healthcare Organizations. The standards listed herein are intended to serve as a reference to the Manual and, therefore, must be used in conjunction with Volume I: Standards, and Volume II: Scoring Guidelines. The complete Manual may be purchased from the Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Boulevard, Oakbrook Terrace, IL 60181. \ Pg. App. 1 :11 G) '11 L11 D O 03 9 TABLE OF CONTENTS Introduction Scope and Responsibilities Using the Manual Conducting the Evaluation Appendices Regional Manager Facility Responsibilities General Information Work Sheet Safety Office Staffing Work Sheet Disclosure Statement Executive Summary Format Format for Program Findings and Recommendations Format for Workplace Findings and Recommendations Safety and Health Evaluation Guides for BUMED Activities H-1 NAVOSH Program Elements H-2 Accreditation Elements References INTRODUCTION In addition to implementing NAVOSH programs, MTF and DTF commanding officers must ensure patient and visitor safety and maintain control of hazards unique to medical facilities, such as infectious agents, potentially infectious medical and biological wastes, antineoplastic drugs, and radiological hazards and wastes. The MTF commanding officer must also successfully meet the requirements of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). These accreditation elements include such programs as the prevention of nosocomial diseases (Infection Control), Disaster Preparedness, and Quality Assurance and Risk Management. BUMED regional safety managers, attached to Navy Environmental Preventive Medicine Units (NAVENPVNTMEDUs) and the Navy Environmental Health Center Detachment (NAVENVIRHLTHCEN DET) Portsmouth, NH are qualified and have experience in the unique aspects of safety and health programs at medical and dental treatment facilities. It follows, therefore, that these BUMED safety managers can effectively and efficiently conduct thorough safety and health evaluations at MTFs and DTFs, encompassing all issues relevant to occupational safety and health and the provision of healthcare services. The purpose of this technical manual is to provide a standardized source of NAVOSH Program evaluation elements, Joint Commission for the Accreditation of Healthcare Organizations safety-related accreditation elements, and to promulgate other guidance, including a standardized format for reports resulting from Occupational Safety and Health Management Evaluations. SCOPE AND RESPONSIBILITIES Regional BUMED safety managers will generally schedule and conduct OSHMEs at MTFs, DTFs, and Navy Environmental Health Center Echelon 4 activities listed in Appendix A, Regional Manager Facility Responsibilities. Officers- -in— —charge may vary these assignments at their discretion to respond to special needs or workload situations. BUMED Echelon 3 commands and National Naval Medical and Dental Centers, Bethesda, Maryland will be inspected by the BUMED Safety Manager (BUMED-09C). These are also listed in Appendix A. The BUMED Safety Manager may also be requested to evaluate NAVENVIRHLTHCEN Echelon 4 activities. Regional Managers should propose a schedule early enough to ensure consideration for budget requirements and allow promulgation of a firm schedule concurrent to the beginning of each fiscal year. The frequency of evaluation will be governed by current BUMED directives. Managers should also conduct assist visits at the request of the RLC. It is anticipated that funding constraints will be persistent. Therefore, managers should take full advantage of government transportation and quarters and should use motor pool vehicles at the evaluated facility. These economies can only be realized if long range planning is pursued diligently. OSHMEs should also be scheduled well in advance of NAVINSGEN NAVOSH oversight inspections or JCAHO surveys, when anticipated. This will avoid last-minute evaluations and assist visits accomplished to "get ready" for the inspection and will allow ample time for correction of identified program and workplace deficiencies. USING THE MANUAL Appendices B - H are provided to standardize the minimum depth of the evaluation and to provide a standardized report format. Appendices B and C provide work sheets to gather relevant information about the command. Appendix B, General Information Work Sheet, provides a form on which to record the names of the commanding officer, executive officer, safety manager, responsible line commander, and other important information, such as addresses and phone numbers. Appendix C provides a work sheet on which to record command population data and safety office staffing information. Appendices D through G provide a standardized format for the resultant report. The report must be comprehensive, fully documenting and supporting the findings and recommendations. The report will be transmitted as a single enclosure. The evaluator will prepare the report in the standardized format and submit it to the Navy Environmental Health Center (NAVENVIRHLTHCEN) for review and distribution. The copy must be clearly marked "DRAFT" and submitted to NAVENVIRHLTHCEN accompanied by a 5 1/4 inch floppy disk and a completed copy of the General Information Work Sheet. WordPerfect Release 5.1 is the preferred word processing format for submission to NAVENVIRHLTHCEN. Preliminary distribution of the report by the Echelon 4 command is NOT AUTHORIZED. The NAVENVIRHLTHCEN Deputy Director for NAVOSH (NEHC- 02C) will prepare a cover letter for the signature of the Commanding Officer of the Environmental Health Center. Appendix D shall be the first page of all reports. This disclosure statement prohibits distribution of the report outside of the concerned chain—of-command without prior written approval from the Commanding Officer of NAVENVIRHLTHCEN. All pages subsequent to the Disclosure Statement will have a header and a footer stating "FOR OFFICIAL USE ONLY". Appendix E describes the contents of the Executive Summary. The Executive Summary is a one—page or less synopsis of the evaluation and should include the inclusive dates of the evaluation; the name(s) of the personnel conducting the evaluation; a statement of the overall status of the NAVOSH Program; a statement of the status of CNO special interest programs; - significant adverse findings related to either the NAVOSH Program or to JCAHO accreditation. The executive summary may also contain comment on notable positive findings. Use of the bullet format in the Executive Summary is strongly recommended. The Report of the Evaluation, a more detailed narrative of the results, will follow the Executive Summary. The report should summarize the status of all inspected NAVOSH Program areas, particularly special interest areas such as Hazardous Materials, Industrial Hygiene, or Workplace Monitoring. The narrative although more detailed than the summary, should not belabor specifics. Reserve specific findings and recommendations for the pages that follow. Findings and recommendations are itemized in the format presented in Appendices F and G. Program findings and recommendations are to be itemized in the format shown in Appendix F. Provide the following information: Subject — The subject will be the exact title of the program area exhibiting the deficiency... e.g. NAVOSH MISHAP REDUCTION PROGRAM. References - List as (a), (b), (c), etc, the appropriate directives, publications, or other sources of the requirement. Finding - Describe the deficiency in the verbiage contained in the directive. This paragraph should also substantiate and clarify the extent of the deficiency. Recommendations - All formal recommendations will be serialized for reporting and tracking purposes. Begin numbering with 001. The serial number will be followed by a hyphen and the last two digits of the calendar year in which the evaluation was conducted. Serial numbers will be preceded by an alpha code signifying the facility. — Immediately following the serial number, describe the action required to correct the deficiency. If it will add clarity to the recommendation, cite the specific paragraph, subparagraph, etc. from the appropriate reference. - Recommendations must be CLEAR, PRECISE, ACHIEVABLE, and MEASURABLE. Appendix G provides a format for documenting workplace findings noted during the walk through portion of the evaluation. Workplace findings require serialization. The purpose of the walk through is to gauge the effectiveness of the command's OSH inspection program. If there are an excessive number of workplace hazards that have not been previously identified, a deficiency exists in the OSH Inspection program. The following information should be included in the Workplace Findings and Recommendations: Subject - Give a general description of the deficiency, for example, Machine Guarding. Reference - Cite the governing directive(s) or regulation(s) including the section and paragraph, e.g. 29 CFR 1910.212(a)(3). Finding - Describe the deficiency and state where it, was observed. Specify the shop, room number, or other identifying location and the equipment, machine, or system, as appropriate, that exhibited the deficiency. List all incidences of the same deficiency under one finding. Assign each instance a unique serial number continuing in sequence from the program recommendations. Recommendation - State the recommended corrective action, for example, install machine guards as required by reference Serialization of the recommendation is not required since the individual finding is serialized. Appendices H- 1 and H- 2 provide checklists to ensure that minimum standardized safety and health elements are reviewed for NAVOSH programs and JCAHO accreditation. Appendix H— 1, NAVOSH Program Elements, is built around the program evaluation guide for shore activities used by the NAVOSH Oversight Inspection Unit (NOIU). The appendix also contains a section for the evaluation of the hospital's compliance with the ethylene oxide (EtO) standard, should the facility have EtO sterilization capabilities. This checklist is to be used by Regional Safety Managers during OSHMEs, and may be used by hospital safety managers to conduct self-evaluations. However, a word of caution; these are minimum standards and, therefore, should not be considered to be a comprehensive document or used to define NAVOSH program compliance goals. Activity NAVOSH program effectiveness will be evaluated as outstanding, excellent, satisfactory or unsatisfactory. Grading a program outstanding or excellent is left to the discretion of the evaluator, but should be assigned only to programs truly deserving of increased credit. In accordance with command inspection policies set forth in OPNAVINST 5040.7K, there is no "marginally satisfactory score". Appendix H- 2, JCAHO Accreditation elements, is a compilation of safety- -related standards taken from the Accreditation Manual for Hospitals (AMH). These standards are to be used by the Regional Safety Manager during the OSHME in order to gauge the hospital's 5 compliance with the accreditation standards. Hospital safety managers may use the checklists for self-evaluation. The sections are organized in outline form to enhance readability and to facilitate the use of the manual as a self—evaluation guide. A two-letter prefix to each standard signifies the service or department to which it applies. The "Plant, Technology, and Safety Management (PL)" section of the AMH is included in its entirety. In other service areas, such as Nursing Care (NC) and Dietetic Services (DT), only those elements related to safety have been included. The rating scale used by JCAHO surveyors to assess and report degrees of compliance with standards contains five rankings - numbers 1 through 5. This scale should also be used by Regional Safety Managers and hospital safety managers during OSHMEs and self—evaluations. An explanation of the scale follows: 1 — Substantial compliance, indicates that the hospital consistently meets all major provisions of the standard. 2 - Significant compliance, indicates that the hospital meets most provisions of the standard. 3 - Partial compliance, indicates that the hospital meets some of the provisions of the standard. 4 — Minimal compliance, indicates that the hospital meets few provisions of the standard. 5 - Noncompliance, indicates that the hospital fails to meet the provisions of the standard. Any standard that does not apply to the hospital may be marked "NA", Not applicable. Generic guidelines for arriving at a compliance score for JCAHO elements follows in Table 1. The 1992 Accreditation Manual for Hospitals, Volume II: Scoring Guidelines contains all existing scoring guidelines for hospital standards. The Introduction to Volume II should be read and thoroughly understood before assigning scores to hospital program elements. JCAHO expects hospitals to be in compliance for the entire three-year accreditation period. Survey time constraints dictate sampling within this time frame. Compliance scores should reflect a thorough review of at least the most recent 12 months; more extensive review is an option left to the evaluator. GENERIC MATRIX: SCORING DEFINITIONS BY CATEGORY Compliance Score (A) Quantitative Concurrent (B) Quantitative Retrospective (C) Qualitative Concurrent (D) Qualitative Retrospective* Duration varies Compliance varies 1 = smstantial 911-1001 of required items are present at time of survey In past 12 months fmction has been performed 911-1001 as often as recpired Document/subject fully meets intent of the standard, with very minor exceptions Performance fully meets intent of standard and this level of coupliance has been maintained for the last 12 months Performance fully meets intent of standard and this level of conpliance has been maintained for the last 12 months 2 = Significant 761-901 of the required items are present at the time of the survey In the past 12 months function has been performed 761-901 as often as required Docunent/slbject meets all major requirements, but several less critical ones are only minimally addressed Performance fully meets the intent of the standard, but the level of coupliance has been mintained only for the last nine months Performance over the last 12 months meets all major requirements but only partially addresses some minor expectations 04 I1 Partial 511-751 of the required items are present at the time of the survey In the past 12 months fmction has been performed 511-751 as often as required Docunent/subject marginally meets all major recpirements; addresses some major requirements Hell and omits others Performance fully meets the intent of the standard, but the level of coupliance has been mintained only for the last six months Performance over last 12 months marginally addresses all major requirements, or covers some major requirements well and omits others 6 = Minimal 261-501 of the required items are present at the time of the survey In the past 12 months function has been perfon 261-501 as often as required Document/subject meets some minor expectations but fails to address the basic intent of the standard Performance fully meets the intent of the standard, but this level of coupliance has been maintained for only three months Performance over the last 12 months meets some minor expectations but fails to address the basic intent of the standard U‘ II Nonconpl i ance 01-251 of the required item are present at the time of the survey In the past 12 months fmction has been performed 01-251 as often as required Document/subject Has not present; or if present is not at all relevant to the requirements of the standard performance of this fmction has been conpletely lacking Performance over the last 12 months has been mresponsive to the intent of the standard NA = Not Applicable NA NA NA NA NA Table 1. CONDUCTING THE EVALUATION The evaluation will consist of two phases: administrative and walk through. The administrative phase will provide a means to evaluate the completeness of documentation relating to the occupational safety and health program, JCAHO safety management elements, and the requirements of non-occupational safety programs such as motor vehicle safety and the Navy's off duty, home, recreational, and athletic safety program. Documentation that should be reviewed during the evaluation includes, but need not be limited to: — written policy and procedures required by JCAHO; - written SOPs required to implement NAVOSH programs such as respiratory protection; - training records, lesson plans and other training-related support elements such as schedules; - records and reports of workplace inspections, life safety inspections, and documentation that appropriate corrective actions or hazard abatement plans have been implemented; - records and results of equipment performance tests; - records and critiques of emergency drills; - radiation exposure records, radiation health physical examinations, and radioactive materials control records; - agendas and minutes of safety council and committee meetings held in accordance with NAVOSH or JCAHO requirements. - copies of mishap reports and occupational injury and illness reports submitted to NAVSAFECEN as required by OPNAVINST 5102.1C. The walk through portion of the evaluation is an opportunity to judge the effectiveness of the command's OSH inspection program and evaluate certain elements of the JCAHO Standard. An excessive number of previously unidentified hazards could signify that inspections aren't being conducted, aren't sufficiently thorough, that employee hazard reporting is not being adequately encouraged, or that supervisors aren't executing their OSH responsibilities. Examples of observations that should be noted during the walk through are use, maintenance, and storage of respirators and other personal protective equipment; hazardous materials use, labeling, storage, and disposal; posting of notices and other forms of hazard warning; machine guarding, electrical safety, and all safety elements related to JCAHO accreditation. Evaluators should not limit their observations to those listed herein. Endeavor to evaluate all work places and address all pertinent hazards. >_u_umzo_x > REGIONAL MANAGER FACILITY RESPONSIBILITIES BUREAU OF MEDICINE AND SURGERY SAFETY MANAGER (BUMED-09C) NAVY National Naval Medical Center Bethesda, MD National Naval Dental Center Bethesda, MD Naval Medical Research and Development Command, Bethesda, MD Navy Environmental Health Center, Norfolk, VA Naval Ophthalmic Support and Training Activity, Yorktown, VA Navy Medical Data Services Center, Bethesda, MD Navy Health Sciences Education and Training Command, Bethesda, MD Naval Medical Materiel Support Command, Frederick, MD Naval Aerospace Medical Institute, Pensacola, FL ENVIRONMENTAL PREVENTIVE MEDICINE UNIT TWO Naval Hospital Portsmouth, VA Naval Hospital Cherry Point, NC Naval Hospital Camp Lejeune, NC Naval Hospital Patuxent River, MD U. S. Naval Hospital Guantanamo Bay, Cuba U. S. Naval Hospital Roosevelt Roads, Puerto Rico U. S. Naval Hospital Keflavik, Iceland Naval Medical Clinic Annapolis, MD Naval Medical Clinic Quantico, VA Naval Dental Center Roosevelt Roads, Puerto Rico Naval Dental Center Norfolk, VA Appendix A NAVY ENVIRONMENTAL PREVENTIVE MEDICINE UNIT TWO, Cont. Naval Dental Center Camp Lejeune, NC Navy Drug Screening Laboratory Norfolk, VA Manager located at: NAVY DISEASE VECTOR ECOLOGY AND CONTROL CENTER JACKSONVILLE, FL Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Hospital Hospital Hospital Hospital Hospital Hospital Hospital Jacksonville, FL Orlando, FL Pensacola, FL Beaufort, SC Charleston, SC Millington, TN Corpus Christi, TX Medical Clinic Key West, FL Medical Clinic New Orleans, LA Dental Center Jacksonville, FL Dental Center Orlando, FL Dental Center Pensacola, FL Dental Center Parris Island, SC Dental Center Charleston, SC Navy Drug Screening Laboratory Jacksonville, FL NAVY ENVIRONMENTAL PREVENTIVE MEDICINE UNIT FIVE NAVY Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Naval Hospital Camp Hospital Hospital Long Hospital Hospital Hospital Hospital Hospital Pendleton, CA Twentynine Palms, CA Beach, CA Lemoore, CA Oakland, CA San Diego, CA Bremerton, WA Oak Harbor, WA Medical Clinic Port Hueneme, CA Medical Clinic Seattle, WA Dental Dental Dental Dental Dental Center Center Center Center Center Navy Drug Screening Navy Drug Screening Camp Pendleton, CA San Francisco, CA San Diego, CA Long Beach, CA Bremerton, WA Laboratory San Diego, CA Laboratory Oakland, CA ENVIRONMENTAL PREVENTIVE MEDICINE UNIT SIX U. S. U. S. U. S. U. S. U. S. Naval Hospital Okinawa, Japan Naval Hospital Yokosuka, Japan Naval Hospital Subic Bay, Republic of the Philippines Naval Hospital Guam, Mariana Islands Naval Dental Center Guam, Mariana Islands NAVY ENVIRONMENTAL PREVENTIVE MEDICINE UNIT SIX (Con't) U. S. Naval Dental Center Yokosuka, Japan U. S. Naval Dental Center Okinawa, Japan Naval Medical Clinic Pearl Harbor, HI Naval Dental Center Subic Bay, Republic of the Philippines Naval Dental Center Pearl Harbor, HI NAVY ENVIRONMENTAL HEALTH CENTER DETACHMENT PORTSMOUTH, NH Naval Hospital Groton, CT Naval Naval Naval Naval Naval Naval Naval Hospital Great Lakes, IL Hospital Newport, RI Hospital Philadelphia, PA Medical Clinic Portsmouth, NH Dental Center Great Lakes, IL Dental Center Philadelphia, PA Dental Center Newport, RI Navy Drug Screening Laboratory Great Lakes, IL NAVAL ENVIRONMENTAL PREVENTIVE MEDICINE UNIT SEVEN U. S. U. S. U. S. U. S. U. S. Naval Naval Naval Naval Naval Hospital Naples, Italy Hospital Rota, Spain Medical Clinic London, England Dental Center Naples, Italy Hospital Sigonella, Italy POINTS OF CONTACT BUMED SAFETY MANAGER CHIEF, BUREAU OF MEDICINE AND SURGERY (BUMED—09C) Navy Department WASHINGTON, D. C. 20173-5000 Mr. Rod Hawley AUTOVON: 294-0243/1309 COMMERCIAL: (202) 653—0243/1309 REGIONAL SAFETY MANAGERS NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT No. Naval Station Bldg. X-336 Norfolk, VA 23511-6288 Mr. Errol Gillette AUTOVON: 564-7671 COMMERCIAL: (804) 444-7671 Manager located at: NAVY DISEASE VECTOR ECOLOGY AND CONTROL CENTER JACKSONVILLE, FL BOX 43 Naval Air Station Jacksonville, FL 32212-0043 Mr. Ed Sheaffer AUTOVON: 942-2424 COMMERCIAL: (904) 772-2424 NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT NO. BOX 143 Naval Station San Diego, CA 92136-5143 Mr. Vernon Cozart AUTOVON: 526—8562 COMMERCIAL: (619) 556-8562 NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT No. 6 Box 112 Pearl Harbor, HI 96860-5040 Mr. Bill Johnson AUTOVON: 471-9505 COMMERCIAL: (808) 471-9505 U. S. NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT No. 7 BOX 41 FPO New York 09521-4200 Mr. Richard Markvart AUTOVON: 625-1110 (Ext. 4468) COMMERCIAL: 11-39-81-724-4468 NAVY ENVIRONMENTAL HEALTH CENTER DETACHMENT, PORTSMOUTH, NH Portsmouth Naval Shipyard, Building H-1 Portsmouth, NH 03804-5000 Mr. Jim Lark AUTOVON: 684-1807 COMMERCIAL: (207) 438-1998 >t_umz_u_x w FOR OFFICIAL USE ONLY GENERAL INFORMATION Activity Name: UIC Message address (PLAD): Address: Phone Numbers: ADMIN: AV: COMM: FAX: AV: COMM: Commanding Officer/OIC: Executive Officer: Responsible Line Commander: Unit: Address: Safety Manager: Location of office: OSHME coordinator: Industrial Hygiene Information Servicing hospital/clinic: Point of contact: Date of last IH survey: Notes: Appendix B FOR OFFICIAL USE ONLY >1vm22x O FOR OFFICIAL USE ONLY SAFETY OFFICE STAFFING WORK SHEET COMMAND: EVALUATOR: DATE: *REC Total personnel assigned to command/activity: Military Civilian Total personnel assigned to supported/tennant activities: (with ISSA/MOU for safety) Military Civilian Total personnel assigned to other area BUMED activities without a full time safety manager: Safety office staff **** Manager Technicians: Military: Civilian: Clerical: * Recommended by OPNAVINST 5100.23B **AUTH ***ON BOARD ** Manpower Authorizations OPNAVFORM 1000/2 (Officer/Enlisted/Civilian) *** Civilians by monthly BUMED SAG Report/Military By Count **** List classification and grade (civilian) or rank Appendix C FOR OFFICIAL USE ONLY >1vmzn=X U OCCUPATIONAL SAFETY AND HEALTH MANAGEMENT EVALUATION OF (ACTIVITY) (DATE) DISCLOSURE POLICY The information contained herein relates to internal practices of the Department of the Navy and is an internal communication within the inapecting command. This Navy' Environmental Health Center (NAVENVIRHLTHCEN) report is not releasable, nor may its contents be diaclcaed outside the original distribution, nor may it be reproduced in_ whole or in part, without prior written approval of NAVENVIRKLTBCEN. Under OPNAVINST 5100.233 requests for this report, portions thereof, or correspondence related thereto, from a source external to the Department of the Navy shall be promptly referred to the NAVENVIRHLTHCEN. Holders of this report shall strictly observe this caveat. APPENDIX D >_u_umz_u_x m FOR OFFICIAL USE ONLY EXECUTIVE SUMMARY FORMAT 1. During the period Dates , an Occupational Safety and Health Management Evaluation (OSHME) was conducted at Command by Name , BUMED Regional Safety Manager, Echelon 4 Activity . 2. Construct a brief narrative description of the findings. Include - an overall evaluation of the status of the activity's NAVOSH Program, - significant positive and negative findings, — mention the status of CNO special interest items, and - any findings that might have a negative impact on JCAHO accreditation. 3. The use of bullets is strongly recommended. Appendix E FOR OFFICIAL USE ONLY >11ngx m FOR OFFICIAL USE ONLY FORMAT FOR PROGRAM FINDINGS AND RECOMMENDATIONS SUBJ: Use exact title as shown in the specific section (e.g. NAVOSH MISHAP REDUCTION PROGRAM). REF: (a) List governing directives, letters, publications, including date. (b) . . . FINDING(S): 1. Describe the deficiency based on the verbage of the directive. This paragraph should substantiate the finding and clarify the extent of the deficient area. RECOMMENDATION(S): 1. (Alpha code)001...n - CY. The alpha code is a short abreviation denoting the medical treatment facility, e.g., NHSD for NAVHOSP San Diego. Number all recommendations sequentially throughout the report beginning with 001 - CY, where "CY" represents the last two digits of the calendar year in which the OSHME is accomplished. List required corrective actions here. If it will add clarity to the recommendation, cite the specific paragraph, subparagraph etc., from the appropriate reference. Recommendations must be CLEAR, PRECISE, ACHIEVABLE, AND MEASURABLE! Appendix F FOR OFFICIAL USE ONLY >1vngx Q. N FOR OFFICIAL USE ONLY FORMAT FOR WORKPLACE FINDINGS AND RECOMMENDATIONS SUBJ: General descripton of the deficiency, e.g. Machine guarding. REF: (a) Cite the governing directive(s) or regulation(s) including the section and paragraph, e.g. 29 CFR 1910.212(a)(3) FINDING: 1. State where the deficiency was observed. Specify the shop or other identifying location and the machinery, equipment or system, as appropriate, that exhibits the deficiency. 2. List as many occurances as is necessary on one sheet. 3. Assign each occurance a serial number continuing in sequence from the program recommendations. RECOMMENDATION: 1. State the required corrective action. Serialization of recommedations is not required. Appendix G FOR OFFICIAL USE ONLY >vvm22x I SAFETY AND HEALTH EVALUATION GUIDES FOR BUMED ACTIVITIES November 1991 APPENDIX H SECTION NO. 1 1A 1B 2A 10 11 12 l3 14 15 16 17 18 APPENDIX H - 1 NAVOSH PROGRAM ELEMENTS PROGRAM ELEMENT Safety Office Organization, Staffing and NAVOSH Functional Requirements OSH Management Evaluation OSH Performance Evaluation Procedures for Civilian Supervisors OSH Inspection Program Federal OSHA Inspections of Navy Workplaces NAVOSH Deficiency Abatement Program OSH Training Program Employee Reports of Unsafe/Unhealthful Working Conditions Mishap Investigation and Reporting Practices OSH Policy Council Project, Operating, Purchasing, and Contracting Procedures Review Program Federal Employees' Compensation Act (FECA) Program Back Injury Prevention and Control Program Navy Awards Program for Achievement in Safety Ashore Gas Free Engineering Program Sight Conservation Program Hazardous Material Control and Management Program Industrial Hygiene Survey Program Workplace Monitoring Program Medical Surveillance Asbestos Control Program ii SECTION NO. 19 20 21 22 23 24 25 PROGRAM ELEMENT Hearing Conservation Program Respiratory Protection Program Ionizing Radiation Protection Program (BUMED Only) Radiofrequency Radiation Control Program Laser Hazard Control Program Lead Control Program Ethylene Oxide (EtO) Control Program iii SECTION 1 - OSH OFFICE ORGANIZATION, NAVOSH FUNCTIONAL REQUIREMENTS STAFFING AND 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS OPNAVINST Is the OSH Office organizationally placed on the 5100.238, immediate staff of the commander, commanding par. 3005.a. officer, or the officer in charge? OPNAVINST Based on functional responsibilities (direct and 5100.238, indirect) is the OSH office adequately staffed? par. 3005.b. c. and d. an OSH professional as head safety and health professionals clerical support - activity workforce population Category A Category B Category C ____ Total tenant activities serviced - tenant activities workforce population Category A Category B Category C Total OPNAVINST Is the OSH professional assigned collateral 5100.238, duties unrelated to the functions listed in par. par. 3005.c. 3005.b.? OPNAVINST Are written agreements established between the 5100.238, activity furnishing the OSH services and the par. 3006.a. users of that service? If so, do the agreements specify specific services to be provided? OPNAVINST Have DD Forms 2272, "Department of Defense Occupa— 5100.238, tional Safety and Health Protection Program" been par. 2011.e. posted in prominent locations such as official bulletin boards in all required areas? OPNAVINST Has the CO established annual OSH goals and objec- 5100.23B, tives that are publicized and included in the com- par. 2009.0. mand goals and objectives? SECTION 1 - OSH OFFICE ORGANIZATION, STAFFING AND 10/91 NAVOSH FUNCTIONAL REQUIREMENTS - (Cont'd) REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Has the CO issued an OSH policy statement adopting 5100.238, and enhancing/expanding the Navy's OSH policy par. 2009.a. established in par. 1004. of the reference? and 2011. OPNAVINST Has the CO established positive procedures to pro— 5100.23B, tect all Navy personnel from coercion, discrimina- par. 2009.i. tion or reprisals for participation in the NAVOSH program? OPNAVINST Are all command publications, instructions, 5100.238, manuals, specifications, technical orders, etc., par. 16007.c. which contain OSH provisions, reviewed and updated to conform to NAVOSH standards? CHANGE 6 STAFFING SUMMARY Primary Factors: Minimum Core Requirements - All OSH offices Direct: Indirect: 1.a. OSH Program Manage- 2.a. Supervision ment b. Admin/Clerical b. OSH Reviews c. Travel c. OSH Inspections d. Meetings d. Def. Abatement e. Cleanup e. Consultation f. Investigation, Reporting & Recording of Mishaps 9. Hazard Reports h. Analysis of Prog. Effectiveness i. Attend & Conduct Meetings j. Training, Promoting and Education k. PPE l. HMC&M m. Occ. Health Most activities including bases and activities with industrial operations n. GFE o. Asbestos p. Respiratory Protection q. Radiation Safety (ion., nonion., RFR) lasers, SECTION 1 - OSH OFFICE ORGANIZATION, STAFFING AND NAVOSH FUNCTIONAL REQUIREMENTS - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS Additions: Determined locally or by Workload Analysis 1. Motor Vehicle 5. Diving 2. ans & Explosives 6. Mercury 3. Fire Protection 7. Contractor Oversight 4. Rec. & Home Safety 8. Industrial Hygiene other Considerations: - Geography - # of Locations - Sub units and tenants .0033 x first 1200 persons in CAT.A = + .0025 x next 800 persons in CAT.A = + .0020 x remaining persons in CAT.A = + .0020 x total number of persons in CAT.B = + .0016 x total number of persons in CAT.C = Total professionals required A = High 8 = High c = H OW Activity population exceeding 600 need full time clerical support, with additional clerical support of one person per five professional staff. SECTION 1A - OSH MANAGEMENT EVALUATION 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OSH Management Evaluations — (ECH 2 or Appropriate ECH 3) OPNAVINST Has an OSH Management Evaluation of the activity 5100.233, been conducted either separately or in conjunction par. 9006. with ISIC command inspection? OPNAVINST Does the OSH Management Evaluation written report 5100.233, forwarded to the CO contain: par. 9006. An overall evaluation of the activity OSH c. program; NAVOSH Program deficiencies observed; and Recommended corrective actions? OPNAVINST Are OSH Management Evaluation reports retained on 5100.238, file until the deficiencies have been corrected par. 9006. and for at least 5 years following the end of the calendar year to which they relate? OPNAVINST Are procedures established by echelon 2 or 3 5100.238, commands to follow-up on the correction of defi— par. 9006. ciencies identified during OSH Management Evaluations? 1A-1 SECTION 13 - OSH PERFORMANCE PROCEDURES FOR CIVILIAN SUPERVISORS 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS Supervisory Performance OPNAVINST Has the command developed procedures to measure 5100.238, and recognize superior or deficient OSH perfor— par. 2009.k. mances for civilian supervisors? OPNAVINST Do evaluations for civilian supervisors reflect 5100.238, OSH performance and personal accountability that par. 2009.k. are consistent with the duties of the position? lB-l SECTION 2 - OSH INSPECTION PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Are all workplaces inspected at least annually? 5100.238, par. 9005.a. OPNAVINST Have guidelines been established for the 5100.238, increased frequency of high hazard areas? par. 9005.b. OPNAVINST Are high hazard areas inspected more frequently 5100.238, than annually as established by the major command, par. 9005.a. installation or local activity? OPNAVINST Are inspectors provided appropriate technical 5100.238, test equipment? par. 9005.c. (i.e., ground impedance tester, tic tracer, etc.) OPNAVINST Are written reports of workplace inspections pro— 5100.238, vided to the official in charge of the operation par. 9005.h. inspected NLT 15 working days after the inspection? OPNAVINST Are OPNAV Forms 5100/12 or a computer generated 5100.238, form containing the same information used to docu- par. 9005.h. ment activity level inspection reports and did the OSH office provide all required information in Section A of this form? OPNAVINST Are follow-up workplace inspections conducted to 5100.238, verify corrections have been made or to focus on par. 9005.j. specific problem areas? Is Section C of OPNAV Form 5100/12 or the computerized form used to document follow-up inspections? SECTION 2A - FEDERAL OSHA INSPECTIONS OF NAVY CIVILIAN WORKPLACES 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST 5100.238, par. 11006.c. OPNAVINST 5100.238, par. 11006.1. OPNAVINST 5100.233, par. 11006.j. Has the activity designated by letter to the appropriate OSHA Regional Office, a coordinator with whom Federal OSHA officials may interface for inspection purposes? If so, Has a copy of the letter been provided to: CNO (OP—45) and Chain of Command? Reference/date of letter: Have Federal OSHA officials issued reports or notices of unsafe or unhealthful working condi- tions discovered during their inspections? If so, Case/file number/date of inspection: Has a summary report, with a copy of such notices, been forwarded immediately to CNO (OP-45)? Reference/date report forwarded: Were information copies provided to the Chain of Command? Reference/date information provided: Were deficiencies discovered during such inspec- tions entered into the activity's NAVOSH Defici- ency Abatement Plan? Date deficiencies entered in abatement plan: If a response is required, has the command pro- vided an official response to such inspections? If so, Reference/date responses forwarded: Were information copies provided to CNO (OP-45)? Reference/date copy forwarded: Chain of Command? Reference/date copy forwarded: 2A-1 SECTION 3 - NAVOSH DEFICIENCY ABATEMENT PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Have copies of OPNAV Form 5100/12 for RACs 1, 2 5100.233, and 3 deficiencies been posted in the area of the par. 12004. deficiency until the hazard was abated? b. OPNAVINST Does the official in charge of the operation take 5100.238, prompt action to correct the deficiency within 30 par. 12004. days of the date of the notice, complete Section B b. of OPNAV Form 5100/12 and return a copy to the activity OSH Office? Does Section B of OPNAV Form 5100/12 indicate the status of the deficiency as follows: - the deficiency has been corrected, or - an abatement project has been initiated OPNAVINST Are deficiencies assigned RACs 1, 2 and 3 requiring 5100.238, more than 30 days for correction, recorded in a par. 12004. formal installation hazard abatement plan? c. AND OPNAVINST Does the formal installation hazard abatement 5100.233, plan include the following standard data for par. 12004. each deficiency? c. (1) Dates of hazard identification. (2) Location of the hazard(s). (3) Description of the hazard(s) including reference to applicable standards. (4) Estimated RAC (with hazard severity, probability of single occurrence, and annual personnel exposure cited separately) or calculated RAC. (5) Interim control measures in effect. (6) Description of the abatement action, including estimated cost and completion date. (7) Abatement priority (see 12007—locally funded projects should be prioritized). (8) Close out statement, indicating: com- pleted abatement action and actual cost, with date of completed action; or process discon- tinued or worksite vacated. SECTION 3 - NAVOSH DEFICIENCY ABATEMENT PROGRAM (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Are OSH deficiencies reported by higher echelons 5100.23B, (including NOIU Oversight Inspections and OSH par. 12004. Management Evaluations) transcribed to OPNAV Form b. 5100/12 and processed by the OSH office? OPNAVINST Are interim controls documented on the NAVOSH 5100.238, Deficiency Notice and measures in effect for par. 12005. more than 60 days approved by the activity OSH office? OPNAVINST Are all funds (local) expended for correction of 5100.238, NAVOSH deficiencies reported to CNO (OP-O4), via par. 12008. the chain of command, through use of existing reporting systems? OPNAVINST At a minimum, does the C0 review semiannually the 5100.238, activity hazard abatement program plan? par. 2009. h. SECTION 4 - OSH TRAINING PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS OPNAVINST Has the activity established and implemented a 5100.233, local, written training plan for OSH and HAZCOM par. 6009. consistent with activity needs? e.(2) OPNAVINST Management personnel (Recommended minimum require— 5100.233, ments) par. 6004. Management personnel shall receive 053 training a. & App. to enable them to actively and effectively support 6-A OSH programs in their specific areas of responsi- bility. OPNAVINST Supervisors and Employee Representatives 5100.233, (Recommended minimum requirements) par. 6004. b. & App. 6-A OPNAVINST Is 083 refresher/update training conducted annually 5100.238, for supervisors? par. 6004.b. OPNAVINST Do newly appointed supervisors receive 053 training 5100.233, within 120 days of their appointment? par. 6004.b. OPNAVINST Nonsupervisory Personnel (Recommended minimum 5100.233, requirements) par. 6004.c. & App. 6-A OPNAVINST New Employees 5100.233, par. 6004.c. Are all new (military and civilian) personnel provided initial 083 training close to the time of assuming their duties and does it include: __(1) local policy on occupational safety and health? __(2) Work unit policy on occupational safety and health? __(3) Individual responsibility for safety and health? SECTION 4 - OSH TRAINING PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS __(4) Employee reporting procedures for hazardous operations/conditions? and __(5) Awareness of hazards common to the individual's worksite, trade, occupation or task? __(6) Specific hazards of chemicals/materials used in the workplace and the activity's hazard communication plan? OPNAVINST Safety and Health Personnel 5100.238, (Recommended minimum requirements) par. 6004.d. 8 CEUs, or equivalent training, or one & App. 6—A college level course. 4 hours course time equals 0.5 CEU. 1 college course = 8 CEUs. OPNAVINST Is an individual development plan established for 5100.238, each OSH professional? par. 6004.d. Head, 088 Office technical staff members OPNAVINST Have collateral duty personnel received training 5100.238, (4 CEUs/yr) that assures they are technically par. 6004.e. qualified for the performance of OSH duties specified by Navy programs? OPNAVINST Does the activity maintain training records for 5100.238, five years? par. 6007. OPNAVINST Does the OSH office maintain files of OSH training 5100.238, records? par. 6007. OPNAVINST Does the minimum required recordkeeping data for 5100.238, individuals include? par. 6007.a. __ Name __ Org. Code/Shop __ Job Title Signature (or valid elec. media equivalent) Gs/GM/WG series, rank/rate/grade SECTION 4 - OSH TRAINING PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST For each training session or course an individual 5100.23B, completes, is the following data maintained? par. 6007.b. __ Course date(s) __ Instructor's Name __ Description __ Course Title __ Course Length (Hrs.) OPNAVINST Does the OSH office maintain copies of lesson 5100.233, plans for local training courses? par. 6007.c. OPNAVINST Has the OSH Manager identified those specific 5100.238, individuals requiring first aid and/or CPR par. 6004. training? f.(2) OPNAVINST Is first aid and/or CPR training provided to per- 5100.23B, sonnel who require it? par. 6004. f.(l) OPNAVINST Are appropriate records, or documentation, main— 5100.23B, tained? par. 6004.f. (1)(C) OPNAVINST Is refresher training in first aid and/or CPR 5100.238, conducted as necessary to maintain qualifications par. 6004. of trained personnel? f.(4) SECTION 5 - EMPLOYEE REPORTS OF UNSAFE/UNHEALTHFUL WORKING CONDITIONS 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Does the activity publicize the existence of the 5100.23B, employee hazard reporting program and notify per— par. 10007. sonnel regarding their rights and obligations in a. reporting hazardous situations? OPNAVINST Are blank copies of forms (such as OPNAV 5100/11) 5100.238, and procedures for employees to report unsafe/ par. 10004. unhealthful working conditions located in areas b. convenient to all workplaces, e.g., bulletin boards, time clocks, etc. OPNAVINST Does the OSH Office advise the cognizant 5100.238, Supervisor that a hazard has been reported? par. 10004. c. OPNAVINST Does the OSH Office investigate all reports 5100.233, brought to its attention? par. 10004. - Imminent danger — 24 hours d. - Serious - 3 days - Health — cognizant medical authority OPNAVINST Does the OSH Office provide an interim or 5100.238, complete response in writing to the originator of par. 10004. the report within 10 working days of receipt? e. OPNAVINST Does the response include: 5100.233, __ Interim - expected date of complete response? par. 10004. e. & f. __ Complete - summary of action taken for abate- ment and the basis for negative determination when no hazard exists? - encourage the originator to informally con— tact the OSH Office if he/she desires addi- tional information or is dissatisfied with the response? - state or provide the reference for procedures for making appeals and appeal levels? OPNAVINST Does the activity commander respond to the origi- 5100.23B, nator of an appeal within 10 working days? par. 10005. b. SECTION 6 - MISHAP INVESTIGATION AND REPORTING PRACTICES 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST 5100.233 CH-14 refers to OPNAVINST 5102.10 MISHAP INVESTIGATION AND REPORTING OPNAVINST Are military and civilian personnel reportable 5102.1C, (military on-duty or off-duty, civilians occupa- ch. 3, tionally related mishaps) injury/fatality acci- par. 301.a. dents involving: a fatality; lost workday case; and 302.b.(2) OPNAVINST 5102.10, ch. 3, par. 301.a. and 302.b.(2) OPNAVINST 5102.1C, ch. 2, par. 205.a. OPNAVINST 5102.1C, ch. 3, par. 302.b. (3) OPNAVINST 5102.1C, ch. 7, par. 70l.a., 701.b. and 7.a. OPNAVINST 5102.10, ch. 7, par. 70l.a. OPNAVINST 5102.1C, ch. 7, par. 701.c. man overboard; electric shock; chemical or toxic exposure or oxygen deficiency investigated? Are they reported to COMNAVSAFECEN within 20 calendar days by message format (Appendix A) or a speedletter, NAVGRAM, or letter? Has the activity established guidelines to deter— mine who, such as the OSH office, the supervisor or the leading petty officer, etc., will conduct the safety investigation of every mishap? Are priority message/telephone reports sent to CNO (OP-45) and NAVSAFECEN within 24 hrs when any of the following occupationally related events occurs: 1) fatality, 2) hospitalization of 5 or more Navy and non-Navy personnel? Does the activity maintain Local Form 5102/7 or equivalent "Log of Navy Injuries and Occupa- tional Illnesses" accurately and properly? Are all occupational injuries or illnesses that are reported on Form CA-l, CA-2 or CA-6 to OWCP recorded on the log within 6 working days after receiving information on a recordable occupational injury or illness? Does the activity accurately complete and forward OPNAV 5102/8 "Quarterly Report of Navy Civilian Occupational Injuries and Illnesses" to COMNAV— SAFECEN, NAS, Code 50, Norfolk, VA 23511-5796 within 20 days following the close of each quarter? SECTION 6 - MISHAP INVESTIGATION AND REPORTING PRACTICES - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Does the activity accurately compile and post 5102.1C, an annual summary report of occupational injuries ch. 7, and illnesses for civilian personnel in a par. 701.d. conspicuous space not later than 45 days after the close of the fiscal year and leave in place for at least 30 days? OPNAVINST Is the CO reviewing all lost time mishaps with 5100.233, 3 or more lost workdays with cognizant first line par. 16007.d. supervision and/or the next level of management involved? OPNAVINST If the activity has military personnel attached, 5102.1C, is a log maintained similar to the one described ch. 7, in par. 701.a. for military personnel, with on- par. 702. duty and off-duty mishaps recorded separately? OPNAVINST Is OPNAV 5100/9, Dispensary Permit prepared and 5102.1C, utilized by the injured employee's immediate ch. 9, supervisor? par. 901. and 903. SECTION 7 - OSH POLICY COUNCIL 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Has the activity established an OSH policy council 5100.233, to consider pertinent OSH matters and does it meet par. 4004.f. OPNAVINST 5100.238, par. 4004.f. OPNAVINST 5100.233, par. 4004.f. (2) OPNAVINST 5100.233, par. 4004.f. (1) OPNAVINST 5100.233, par. OPNAVINST 5100.238, par. 4004.f. 4004.f. quarterly? Is this council chaired by the CO or X0? Does the OSH office develop proposed agendas and presentations for the council, and assure meetings are scheduled? Are minutes maintained by the activity OSH Office? Are members appointed by local directive and include key civilian and military personnel representing key organizational codes as well as safety and health professionals? Are civilian employees represented on the council when they constitute a significant portion of the work force? SECTION 8 — PROJECT, OPERATING, PURCHASING, AND CONTRACTING PROCEDURES REVIEW PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS Project Reviews: OPNAVINST Do safety professionals participate in the review 5100.238, of plans and specifications for projects and are par. 5005.b. recommendations submitted in writing? OPNAVINST DO cognizant industrial hygienists participate in 5100.238, the review of plans and specifications for projects par. 5005.b. and are recommendations submitted in writing? Operating Procedures: OPNAVINST Are SOPs or similar directives that direct the 5100.238, manner in which work is performed coordinated with par. 5005.c. cognizant safety and health personnel prior to issuance and are recommendations for changes/addi- tions to the directive for safety/health purposes submitted in writing to the originator? Purchasing Procedures: OPNAVINST Are personnel responsible for developing specifi- 5100.233, cations for equipment/material purchases coor— par. 5005.d. dinating with cognizant OSH personnel to ensure that NAVOSH requirements are considered? Contracts: OPNAVINST Are contracts that require work to be performed 5100.238, by contract personnel at Navy facilities par. 5005.d. coordinated with cognizant OSH personnel? SECTION 9 — FEDERAL EMPLOYEES' COMPENSATION ACT (FECA) PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS FECA Program OPNAVINST Has the Civilian Personnel Director (CPD) 12810.1, appointed a professional specialist as Injury par. 5.d.(1) Compensation Program Administrator (ICPA)? OPNAVINST 12810.1 , Has the CO established a light duty program for par. 5.c.(4) injured workers to permit them if possible, to and remain on the job during medical treatment and OPNAVINST rehabilitation? Is it administered by the CPD? 12810.1, par. 5.d.(3) OPNAVINST Has the CO established a Return—to-Work (RTW) 12810.1, program geared to rehiring eligible rehabilitated par. 5.c.(5) injured workers into necessary and meaningful jobs and and removing them from OWCP compensation rolls? OPNAVINST Is it administered by the CPD? 12810.1, par. 5.d.(4) OPNAVINST Does CPD assure accuracy of the Naval Civilian 12810.1, Personnel Data System on Unit Identification par. 5.d.(6) Codes (UIC) and activity names used for charge— back reports? OPNAVINST Does the CPD provide reports and statistics to 12810.1, the CO on costs and trends? par. 5.d.(9) OPNAVINST Have supervisors, managers and FECA program 12810.1, operating officials been trained on current par. 4.i. injury compensation laws, regulations, and local injury compensation program policy? OPNAVINST Has an Injury Compensation Cost Reduction Commit— 12810.1, tee been established to recommend local policy par. 5.c.(2) and operational improvements for managing and reducing FECA costs, if the annual FECA bill exceeds $1 million? Does it consist of at least the C0, CPD, ICPA, and OSH manager and does it meet quarterly? SECTION 10 - NAVY BACK INJURY PREVENTION AND CONTROL PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Has the echelon two command provided supplemental 5100.238, guidance and assistance to the activity in imple- par. 5104.b. OPNAVINST 5100.238, par. 5104.a. (1) OPNAVINST 5100.238, par. 5104.a. (2) OPNAVINST 5100.238, par. 5104.a. (3) OPNAVINST 5100.238, par. 5104.a. (4) OPNAVINST 5100.238, par. 5104.a. (5) OPNAVINST 5100.238, par. 5104.c. menting a back injury prevention and control program? Has the activity analyzed mishap data for the last 5 years to identify the numbers, frequency, type, location and cost of back pain complaints and injuries? Has the activity: (1) Established and published goals to prevent and reduce back pain complaints and injuries using available statistical data? (2) Used key elements from paragraph 5102 as applicable in the development and maintenance of the program? (3) Provided appropriate training of employees: (4) Coordinated the medical aspects of the program with the cognizant local BUMED representative? Has the local BUMED representative provided required support? 10-1 SECTION 11 - NAVY AWARDS PROGRAM FOR ACHIEVEMENT IN SAFETY ASHORE 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS SECNAVINST NOTE: Activities with fewer than 400 personnel 5100.15, are exempt from these requirements but heads par. 4. of such activities are encouraged to use the individual and group awards to the maximum extent practicable. Supervisors: SECNAVINST Has the activity implemented "The Navy Accident 5100.15, Prevention Award (Supervisors)" for military and encl. (3) civilian supervisors who complete specified periods of time without a disabling work/duty injury to themselves or to personnel under their supervision? Group: SECNAVINST Has the activity implemented "The Navy Accident 5100.15, Prevention Award (Group)" for work groups such as encl. (4) shops, section crews, and similar components which are engaged in sufficiently hazardous work and which have completed a calendar year without a disabling work/duty injury? Driving: SECNAVINST Has the activity implemented "The Navy Safe 5100.15, Driving Awards" for drivers of Navy motor vehicles encl. (5) who have completed 12 consecutive months of safe driving? MH-CE: SECNAVINST Has the activity implemented "The Navy Materials 5100.15, Handling and Construction Equipment (MR-CE) encl. (6) Operator's Safety Award" for military and civilian personnel for 12 consecutive months of safe operation of materials handling and construction equipment? 11-1 SECTION 12 - GAS FREE ENGINEERING PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS NAVSEA Has the activity issued an instruction, direc- S6470-AA- tive, manual or other implementing document SAF—Olo, establishing a gas free engineering program? par. 2—2 NAVSEA Does the activity have one person trained, S6470-AA- qualified and certified by the C0 as a gas free SAF-OlO, engineer? par. 2—3a NAVSEA Are the assistant GFE and GFE technician(s) S6470-AA- qualified? sap-010, par. 2—4.1 NAVSEA Are all gas free engineering personnel recer- $6470-AA— tified annually by the CO? SAP-010, par. 2-6.1 NAVSEA Is the gas free engineer directly responsible to $6470-AA- the CO or 083 Director for all aspects of the gas SAP-010, free engineering program? par. 2-7.3 NAVSEA Is an evaluation of the gas free engineering $6470-AA- program made annually? SAP-010, par. 2-6.1 NAVSEA Is entry into confined, closed, or enclosed spaces $6470-AA- prohibited until the space has been tested and SAP-010, found to be safe? par. 3-6 NAVSEA Is a gas free engineering log or equivalent S6470-AA- maintained for all tests and inspections of con- SAF-Olo, fined or enclosed spaces? par. 2-9.1 NAVSEA Is the following information documented by the GFE 86470-AA- or GFET for each certificate issued? sap—010, par. 3—8.2 12-1 12-2 SECTION 12 - GAS FREE ENGINEERING PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS a. Date and time of test. b. Date and time of certificate expiration. c. Date and time of retesting and update of certificate. d. Signature of gas-free engineering personnel performing tests or retests as applicable. 9. Name of unit/activity. f. Location/identification of space. g. Type of operation for which the certificate is requested such as hot work, spray painting, etc. h. Category of conditions found to exist (e.g., "Safe for Personnel - Not Safe for Hot Work). i. Requirements for conditions or operations within the space. j. Special conditions shall be noted under remarks. NAVSEA Are records maintained of all equipment calibra- S6470-AA- tion checks? SAF-Olo, par. 3—10.3 NAVSEA Are emergency and rescue procedures established? $6470—AA- SAF-Olo, par. 3-9 NAVSEA Does the command prohibit the gas free engineer S6470-AA- from testing confined spaces for contractor opera- SAF-OlO, tions or personnel except where failure to do so par. 2-8c. would create an extreme emergency and would endanger personnel and property? NAVSEA Are supervisors trained/familiar with the S6470—AA- provisions of the manual as they relate to SAF—Olo, personnel or operations under their supervisory par. 1—8.3 control? NAVSEA Do supervisors train/explain to all employees $6470-AA— under their supervision the nature of the hazards SAF-OlO, associated with the operations and the pre- par. 1-8. cautions necessary to control such hazards? 3a. SECTION 13 - SIGHT CONSERVATION 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Are employees provided adequate eye protection 5100.23B, equipment at government expense? par. 19003.a. OPNAVINST Does the activity OSH Manager maintain a list 5100.238, of all areas, processes, and occupations that par. 19004.a. require eye protection? OPNAVINST Are all personnel exposed to eye—hazardous pro- 5100.23B, cesses or operations scheduled for sight screening par. 19005. examinations by the cognizant regional medical command or the individual in charge of the activity safety program? OPNAVINST Is a comprehensive education program on the need 5100.233, for, and the use of, protective eyewear par. 19009. conducted? 13—1 SECTION 14 - HAZARDOUS MATERIAL CONTROL AND MANAGEMENT PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Does the activity have a written Hazardous Mate— 4110.2, rial Control and Management (HMCEM) Program? par. 8.1.(1) OPNAVINST Has the OSH office developed a written Hazard 5100.233, Communication plan that addresses the key elements par. 7004.9. contained in Enclosure (3) of OPNAVINST 4110.2? (2) Key elements are: OPNAVINST — list of hazardous chemicals. 4110.2, - Material Safety Data Sheets (MSDS) encl. (3) - labels and other forms of warning - training and - hazards of non-routine tasks 29 CFR 1910. 1200(e) OPNAVINST 4110.2, par. 7004.e. (2) OPNAVINST 4110.2, par. 8.i.(4) 29 CFR 1910. 1200(e)(l)(i) OPNAVINST 5100.233, par. 7004.b. (3) OPNAVINST 5100.238, par. 7004.b. (5) - contractor operations - host/tenant command relationships — location of program information Are procedures established and implemented to con- trol, track, and reduce the variety and quantities of hazardous material (BM) in use, in storage or stock, or disposed as hazardous waste (HW)? Has the activity developed an "authorized HM use list" using an inventory that identifies and quan— tifies HM? Does the "authorized HM use list" use an identity that is referenced on the appropriate MSDS? Has the Occupational Safety and Health (05H) office ensured all routine and non-routine uses of HM are evaluated and assessed using industrial hygiene guidelines and risk assessment to establish autho— rized HM use? and Has the OSH office provided reports and recommenda- tions resulting from evaluations of routine and non-routine uses to line supervisors, managers and the activity Hazardous Material Control Committee? 14-1 SECTION 14 - HAZARDOUS MATERIAL CONTROL AND MANAGEMENT PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Does the OSH office perform random, periodic spot 5100.238, checks to verify that HM is approved for use; and par. 7004.j. the conditions of use are appropriate and included (3) in OSH surveillance, industrial hygiene baseline 29 CFR 1910. 1200(g)(1) OPNAVINST 5100.238, par. 7004.e. (5) 29 CPR 1910. 1200(f)(5) OPNAVINST 5100.238, par. 7004.e. (7) and APP- 6—8 29 CFR 1910. 1200(h) surveys, and the workplace monitoring plan? Does the activity have an MSDS for each hazardous chemical which is used? Has the OSH office developed a program to assure MSDSs for all HM in local use are readily access— ible to employees during each work shift? Are containers of hazardous chemicals in the work— place labeled, tagged or marked with the following information: a. identity of the hazardous chemical(s). b. appropriate hazard warnings. Has the OSH office developed and implemented a program to ensure employees receive required HAZCOM training? Does the program include: a. requirements of the hazard communication standard? b. any hazardous operations in their work area where hazardous chemicals are present? c. location and availability of the written hazard communication program, including the required list(s) of hazardous chemical and MSDSs? Employee training shall include: a. methods and observations that may be used to detect the presence or release of hazardous chemicals in work area. b. physical and health hazards of chemicals in work area. c. protective measures employees can take such as appropriate work practices, emergency procedures and PPE. 14-2 SECTION 14 - HAZARDOUS MATERIAL CONTROL AND MANAGEMENT PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS 29 CFR 1910. 1200(h) OPNAVINST 5100.233, par. 7004.i. (3) OPNAVINST 5100.238, par. 7004.i. (2) d. details of the hazard communication program including explanation of labeling system, HSDSs and how to obtain and use hazard infor- mation. Is training provided at time of initial assign— ment and whenever a new hazard is introduced into their work area? EMERGENCY RESPONSE Has the OSH office identified from inspections, risk assessments, and work exposure, likely emer— gency and contingency situations for command and base planning? Does the OSH office provide technical assistance and consultation during formulation of response plans and actual emergency responses? SECTION 15 - INDUSTRIAL HYGIENE SURVEY PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Have all Navy workplaces been evaluated initially 5100.238, (baseline) by an industrial hygienist in order to par. 8102. identify and quantify all potential health hazards? and OPNAVINST Were all workplaces with potential health hazards 5100.238, evaluated at least annually by the cognizant medi- par. 8103. cal industrial hygienist? During the periodic evaluation, was a determination made on the status of the workplace? OPNAVINST Have all workplaces with potential health hazards 5100.238, been evaluated within the past year? par. 8103. OPNAVINST Has the cognizant industrial hygienist established 5100.238, procedures to ensure he/she is notified of any par. 8103. change which could effect worker exposure to potential health hazards and are changes in the workplace re-evaluated? OPNAVINST During periodic evaluations, was a determination 5100.238, made on any changes required in the monitoring par. 8103. plan or frequency of periodic follow-ups? OPNAVINST Was the information listed below obtained by the 5100.238, cognizant industrial hygienist or qualified indus- par. 8102.a. trial hygiene technicians during the walk-through survey of each workplace? (1) Descriptions of operations and work practices including sketches and the time operations take place. , List of potentially hazardous materials used or stored, how used, and quantities involved. List of potential physical hazards, (e.g., noise, radiation, etc.) and brief description of source. Brief description of existing controls (hoods, PPE, etc.) Number of persons assigned to the operation/ workplace and specific worksite occupied. (2) (3) (4) (5) 15-1 SECTION 15 - INDUSTRIAL HYGIENE SURVEY PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Based on the walk-through survey, has an assessment 5100.238, of each workplace been made by the cognizant indus- par. 8102.b. trial hygienist? OPNAVINST Do records include rationale for any negative 5100.233, determination? par. 8102.b. 15-2 SECTION 16 - WORKPLACE MONITORING PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST 5100.233, par. OPNAVINST 5100.233, par. OPNAVINST 5100.233, par. OPNAVINST 5100.238, par. 8102.g. and par. (2)(b) 8102.c. 8102.d. 8105.c. 8301.a. If the assessment conducted as part of the indus- trial hygiene survey indicated potential employee exposure: Was a workplace monitoring plan prepared and was monitoring conducted as prescribed in the plan? Was the workplace monitoring plan based on a sampling strategy designed to obtain samples representative of actual exposures and to analyze the data collected in such a way as to minimize any bias involved in the process? Was OPNAV Form 5100/14 used in developing the workplace monitoring plan and completed with the following information for each hazard to be monitored? (1) Number of measurements/samples required to evaluate each hazard (2) Method of measurement (e.g., direct reading instrument, charcoal tube, etc.) (3) Type/location of measurement (e.g., general area, breathing zone, etc.) (4) Frequency of a required series of measure— ments/samples during year (as prescribed by a specific NAVOSH standard or professional judgement of the industrial hygienist) (5) Work load requirements (man—hours of work— place monitoring per year) Is all workplace monitoring conducted by industrial hygienists or certified monitors under technical direction of an industrial hygienist? Are the industrial hygiene survey forms contained in the "NOHIMS INDUSTRIAL HYGIENE FORMS DEFINI- TIONS" TECHNICAL MANUAL or computer equivalent used to document industrial hygiene sampling, and are they properly filled out? Has the monitoring data been evaluated by the cog- nizant medical industrial hygienist to determine: (1) degree of personnel exposure? (2) controls required - both interim and per— manent? (3) whether periodic monitoring of the hazardous agent(s) is required and nature of monitoring (what, where, how, and how often)? (4) the relative priority to be assigned to the workplace? SECTION 16 - WORKPLACE MONITORING PROGRAM (Cont) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Are records which are pertinent to an individual's 5100.238, exposure incorporated into his/her medical record? par. 8104. 16-2 SECTION 17 - MEDICAL SURVEILLANCE 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS OPNAVINST Are military and civilian employee medical treat— 5100.238, ment and surveillance programs for preplacement or par. 8201. baseline, periodic or special purpose, and termina- a. and b. tion medical examinations established? OPNAVINST Does the facility use the Navy Occupational Health 5100.233, Information System (NOHIMS) Medical Matrix and par. 8202.b Medical Surveillance Procedures Manual, as revised, as the minimum requirements for medical surveil- lance and job certification examinations? OPNAVINST Is selection of personnel for medical surveillance 5100.238, examinations based primarily on results of the par. 8202.c. industrial hygiene program as interpreted by qualified occupational health professionals? OPNAVINST Is the cognizant medical command, branch clinic, 5100.233, etc., maintaining the required military and civi— par. 8203.a. lian medical records? (Are they available?) OPNAVINST Is OPNAV Form 5100/15 "Medical Surveillance Ques- 5100.23B, tionaire" used to record employees occupational par. 8202.a. exposure history? (1) 17-1 SECTION 18 - ASBESTOS CONTROL PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS ARE OPERATIONS INVOLVING ASBESTOS CONDUCTED AT THE ACTIVITY e.g., lagging removal/ripout, brake-arcing, brake drum cleaning, gasket fabrica— tion/removal, and Transite wallboards? SAMPLING OPNAVINST Has a workplace monitoring plan been established 5100.238, to characterize occupational exposures to asbestos? par. 17010.a. AND OPNAVINST Are personal samples collected in the breathing 5100.238, zone which are representative of both the 8 hour par. 17010. TWA exposure and the 30 minute short term exposure? a. and b. OPNAVINST Are repetitive operations involving asbestos 5100.238, within a class/category sampled at least every 6 par. 17010.a. months to verify that the operation has remained in the same class? AND/0R OPNAVINST Are non-repetitive removal operations sampled at 5100.238, least once to determine maximum exposure poten— par. 17010.a. tial? AND /OR OPNAVINST Is periodic monitoring of non-exempted construction 5100.238, activities conducted on a daily basis except where par. 17003.a. the employees within the regulated area are (2) equipped with supplied—air respirators operated in a positive—pressure mode? ANALYSES OPNAVINST Are air samples collected and analyzed using the 5100.238, NIOSH 7400 method? par. 17010. a. and b. 29 CFR 1910. 1001, App. A (90.3) or 29 CFR 1926. 58, App. A (QC-3) Have personnel who count asbestos fibers taken the NIOSH course for sampling and evaluating airborne asbestos or an equivalent course? 18-1 SECTION 18 - ASBESTOS CONTROL PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Have personnel who perform fiber identification 5100.238, using dispersion staining been specifically par. 17010. trained? c.(2) OPNAVINST Do personnel who count asbestos fibers participate 5100.238, in Proficiency Analytic Testing (PAT) Programs par. 17010.c. approved by NAVENVIRHLTHCEN? (3) NOTIFICATION OPNAVINST Are employees notified in writing of asbestos 5100.238, sampling results within 15 working days of receipt, par. 17005.c. and are employees exposed above the PEL notified in writing as soon as practicable but not later than 5 days after the finding? Did this notifica- tion include corrective action(s) taken? CONTRACT AND FACILITY MANAGEMENT OPNAVINST Has the activity established and implemented an 5100.238, ashore asbestos management program containing an par. 17007. inventory of all locations and sources of poten- and App. 17-8 tially friable asbestos? OPNAVINST Does a contract clause require contractors who are 5100.238, involved in work which releases asbestos fibers par. l7012.c. into the environment to measure and control the asbestos boundary to less than 0.1 fiber/cc at all times? In addition, do controlled/regulated areas meet this criteria prior to release for unrestric— ted access? REGULATED AREAS 29 CFR 1910. Are regulated areas established where exposures 1001(e)(1) exceed the PEL? or 29 CFR 1926. 58(9H1) OPNAVINST Does the command prohibit employee rotation as a 5100.233, means of compliance with the PEL? par. 17006. OPNAVINST Are specific procedures established for the con- 5100.23B, tainment of asbestos dust and the handling of par. 17006.a. asbestos materials to minimize secondary air con- (4) tamination (wet—down procedures, filtered vacuum cleaning, etc?) SECTION 18 - ASBESTOS CONTROL PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Are asbestos wastes collected and disposed of in 5100.233, accordance with this reference? par. l7008.b. RESPIRATORS OPNAVINST Are respirators for asbestos exposures selected 5100.233, in accordance with this paragraph and the summary par. 17006.e. table provided on pages 17-8 and 17-9? (3) OPNAVINST Does the command provide a powered air purifying 5100.233, respirator whenever the employee requests it and par. 17006.e. will it provide adequate protection? (3) (b) OPNAVINST Is quantitative fit testing performed for full—face 5100.233, negative pressure respirators every six months? par. 17006.f. Qualitative fit testing for half-face respirators (2) performed every six months? PROTECTIVE CLOTHING & CHANGE ROOMS OPNAVINST Do personnel engaged in handling asbestos-contain— 5100.23B, ing materials during "rip-out" operations or in par. 17006.d. situations where the concentration of airborne (1) fibers is likely to exceed the PEL wear the required protective clothing? OPNAVINST Are procedures promulgated for the removal of pro— 5100.233, tective clothing, i.e., vacuum clothing prior to par. 17006.d. removal while still wearing a respirator and using (2) a HEPA filter vacuum cleaner? OPNAVINST Are change rooms provided as close as practicable 5100.233, to the work area? Are shower facilities located par. 17006.d. between the "clean" and "dirty" change room? Are (2) & d.(3) separated "clean" and "dirty" locker facilities provided? OPNAVINST Does the command ensure employees exposed at or 5100.233, above the PEL shower at the end of their work par. 17006.d. shift? (3) CONTRACT LAUNDERING OPNAVINST Do contracts governing the laundering of asbestos 5100.233, contaminated clothing require contractors to com- par. 17006.d. ply with the precautions specified in 29 CFR 1910. (4) 1001(h)(3) or 29 CFR 1926.58(i)(2)? 18-3 SECTION 18 — ASBESTOS CONTROL PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS TRAINING OPNAVINST Do Navy employees who work with or handle asbestos 5100.238, or may be exposed to asbestos fibers in excess of par. 17009.a. the medical surveillance action level and their supervisors receive the following training prior to or at the time of initial assignment and annually thereafter? (1) The health effects/hazards of asbestos. (2) Association between the use of smoking tobacco products and asbestos exposure in producing lung cancer. (3) Uses of asbestos which could result in an exposure. (4) Engineering controls and work practices associated with an employees' work assignment. (5) Purpose, proper use and limitations of protective equipment. (6) Purpose and description of medical surveil— lance program. (7) Description of emergency and clean—up procedures. (8) Overall review of this chapter and the command's/activity's program. MEDICAL SURVEILLANCE OPNAVINST Are appropriate Navy employees included in the 5100.238, AMSP? par. 17011. b. and c. AND OPNAVINST Are asbestos workers receiving the appropriate 5100.238, medical examinations? par. 17011.d. — Preplacement - Periodic - Termination OPNAVINST Medical examinations shall include: 5100.238, (1) Comprehensive occupational history using par. 17011.d. Initial Medical Questionnaire (DD Form 2493—1) for preplacement, or Periodic Medical Questionnaire (DD Form 2493-2) for periodic exams. Physical examination with emphasis on chest (3) Chest x-ray - 14' x 17" posterior-anterior interpreted by certified 8 reader Pulmonary function tests Judgement of the individual's ability to use respirators 18-4 SECTION 18 - ASBESTOS CONTROL PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST FREQUENCY OF EXAMINATION 5100.238, par. 17011.d. (a) Personnel currently exposed at or above the (3) Action Level (AL) shall receive an annual physical and a chest x-ray in accordance with the below schedule. (b) Personnel ng§_§§;;§n§ly_gxpgggg to asbestos at or above the AL shall receive a medical evaluation and chest x-ray in accordance with the below schedule. AGE OF EMPLOYEE Years since first asbestos exposure 15 to 35 35 to 45 45 + 0 to 10 q 5 yrs q 5 yrs q 5 yrs 10 + q 5 yrs q 2 yrs annual MEDICAL SURVEILLANCE COUNSELING AND OPINIONS OPNAVINST Do personnel receive counseling on any abnormality 5100.238, detected during the examination? Is this noted par. 17011.d. in the medical record and signed by both physician (4) and patient? OPNAVINST Is a written signed opinion of the employees health 5100.233, as it relates to asbestos obtained from the exami- par. l7011.f. ning physician and provided to the command? Was this opinion also provided to the affected employee within 30 days of the medical examination? SECTION 19 - HEARING CONSERVATION PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS NOISE SURVEYS OPNAVINST Has a noise survey been conducted as part of the 5100.233, industrial hygiene surveillance program? par. 18103.a. AND OPNAVINST Was the survey conducted by qualified personnel 5100.238, (IH or safety personnel, workplace monitors, or par. 18103.a. others suitably trained by an IH or thru a recog- (1) nized course of instruction)? OPNAVINST Is personal dosimetry conducted where area monitor— 5100.23B, ing is inappropriate? par. 18103.a. (3) OPNAVINST Are noise hazardous work environments (i.e., 5100.238, greater than 84 dBA or 140 dB peak) resurveyed par. 18103.a. within 30 days of a significant change in opera- (4) tions? OPNAVINST Are noise measurements recorded on NOHIMS Forms 53A 5100.233, 84A and are all required data elements properly par. 18103.a. filled out? (6) LABELING AND POSTING OPNAVINST Have designated hazardous noise areas and items 5100.233, of equipment been posted/labeled? par. 18104. ROSTER OPNAVINST Does the activity maintain a current roster of 5100.233, personnel who routinely work in designated hazar- par. 18108.b. dous noise areas? TRAINING OPNAVINST Have all Navy personnel included in the hearing 5100.233, conservation program received instruction in: par. 18107. 1. Elements of and rationale for the program? 2. Proper wearing and maintenance of hearing protection? 3. The command program and their individual responsibilities? 4. Off-duty practices which will aid in the protection of their hearing? 19-1 SECTION 19 — HEARING CONSERVATION PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS AND Is appropriate training repeated annually for each employee in the hearing conservation program? PERSONAL HEARING PROTECTIVE DEVICES OPNAVINST In the absence of an 18's judgement to contrary, 5100.23B, are hearing protective devices worn by personnel par. 18106.a. when they must enter or work in an area where the operations generate noise levels greater than 84 dBA or 140 dB peak sound pressure level or greater? OPNAVINST Is a combination of insert type and circumaural 5100.238, type hearing protective devices worn where noise par. 18106.b. levels exceed 104 dBA? OPNAVINST Are only hearing protective devices listed in 5100.238, Appendix 18—8 used? par. 18106.d. HEARING MONITORING OPNAVINST Are personnel required to work in designated 5100.238, noise hazard areas or with noise hazardous equip- par. 18105. ment entered in a Hearing Conservation Program? AND OPNAVINST Have all personnel assigned duties in designated 5100.238, noise hazardous areas received a reference par. 18105.b. (baseline) hearing test prior to assignment? (1) ' AND OPNAVINST Are monitoring tests given within 90 days of 5100.238, assignment to a designated hazardous noise par. 18105.c. environment and annually thereafter? (1) OPNAVINST Do personnel who exhibit a significant threshold 5100.238, shift on monitoring hearing tests receive required par. 18105.e. follow—up hearing testing? (See Appendix 18-A) OPNAVINST Are personnel who exhibit a significant threshold 5100.238, shift informed of this, in writing, within 21 par. 18105.e. days? 19-2 SECTION 19 — HEARING CONSERVATION PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Are hearing tests recorded on DD 2215, Reference 5100.233, Audiogram DD 2216, Hearing Conservation Data as par. 18108.a. appropriate? Are originals placed in the health record, copy one sent to NEHC, copy two maintained for local files? AUDIOMETRIC EQUIPMENT & PERSONNEL OPNAVINST Are audiometric chambers certified every 2 years 5100.238, by cognizant industrial hygienists, or personnel par. 18105.a. under their supervision, to meet the requirements of ANSI 83.1-1977? NAVMEDCOMINST Are audiometers calibrated at least annually for 6260.5, encl. compliance with ANSI 83.6? (1) par. 3.a. (3) OPNAVINST Are hearing tests performed by qualified 5100.233, personnel? (audiologist, otolaryngologist, par. 18105.a. qualified physician or person certified by the Council for Accreditation in Occupational Hearing Conservation or who has received equivalent mili— tary training, NEHC training) NAVMEDCOMINST Are technicians recertified at least every 3 6260.5, encl. years? (1) par. 3.a. (9) 19-3 SECTION 20 — RESPIRATORY PROTECTION PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS RESPIRATORY PROTECTION PROGRAM MANAGER OPNAVINST Has the command appointed a Respiratory Protection 5100.23B, Program Manager (RPPM)? par. 15005.a. NEHC ltr 6260 Ser 333/12127 of 13 Dec 90 OPNAVINST 5100.233, par. 15005.a. (8) OPNAVINST 5100.238, par. 15004. OPNAVINST 5100.233, par. 15009. OPNAVINST 5100.238, par. 15012.a. (3) OPNAVINST 5100.233, par. 15008. Has the RPPM completed the required course work and/or passed the exam to receive a numbered certi- ficate from NEHC? RPPM AUDIT Does the RPPM cause the respiratory protection program to be audited annually? EMPLOYEE IDENT & RESPIRATOR SELECTION Is the use of any respiratory protection equipment by employees other than that identified by the RPPM prohibited? Are respirators selected by the RPPM on the basis of exposure hazards and respirator capabilities and limitations? Are only respirators approved by NIOSH/MSHA used? Are employees with beards prohibited from wearing all respirators except positive pressure supplied- air hoods? BREATHING AIR Does the breathing air meet the specified require— ments for Grade D breathing air? (CGA G7.1-1973) Is the routine monitoring of breathing air for supplied-air respirators a part of the command's workplace monitoring plan? And is breathing air from oil lubricated compressors monitored/analyzed quarterly? 20-1 SECTION 20 - RESPIRATORY PROTECTION PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS FACILITIES & SOPs OPNAVINST Is there a centrally located facility staffed to 5100.233, maintain and issue respirators? par. 15005.a. (1) OPNAVINST Is the inspection, cleaning and repair of respira- 5100.233, tors performed at the respirator facility by par. 15013. personnel who have received training approved by the RPPH or an industrial hygienist? OPNAVINST Are there written standard operating procedures 5100.233, (SOPs) governing the selection, care, issue and par. 15005.a. use of respirators? Are emergency and rescue (2) guidance included in SOPs? AND Have specific worksite SOPs been developed and posted in the general area of work requiring respirators? TRAINING OPNAVINST Are all respirator users and their supervisors 5100.233, trained in the nature and degree of respiratory par. 15014. hazards/respirator selection based on the hazard a.(l—4) and respirator capabilities and limitations; and care of the respirator, e.g., the need for cleaning, maintenance, storage, and/or replace- ment? AND OPNAVINST Is respirator user training repeated annually? 5100.233, par. 15005.a. (3) OPNAVINST Does the command's NAVOSH training records document 5100.233, respirator training by respirator type and model par. 15014.c. for which the individual has been trained? 20-2 SECTION 20 — RESPIRATORY PROTECTION PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS FIT TESTING OPNAVINST Are all personnel required to wear negative pres- 5100.23B, sure respirators given a fit test at the time of par. 15012.a. initial fitting? and par. 15005.a. AND (5) Is fit testing repeated every six months there— after when exposures are to lead or asbestos? AND Is fit testing repeated annually for all other exposures? OPNAVINST Is respirator fit testing documented by respirator 5100.23B, type, brand name and model; method of test and par. 15012.c. test results; test date; and the name of the instructor/tester? MEDICAL OPNAVINST Are respirator wearers evaluated medically in 5100.238, accordance with ANSI z88.6-1984 to assure they par. 15005.a. are physically able to perform their assigned (4) tasks while wearing their respirators? (90) (Note recommended examination frequency vs. age.) - every 5 years — <35 - every 2 years — 35-45 — annually — >45 - Special evaluations OPNAVINST Is a statement in the medical record indicating 5100.238, the respirator user is qualified/not qualified to par. 15005.b. wear respirators? (1)(d) MEDICAL AUDIT OPNAVINST Has the cognizant medical command provided an 5100.238, annual written evaluation on the effectiveness of par. 15005.b. the program based on occupational medicine and (2) industrial hygiene reviews? 20-3 SECTION 21 - IONIZING RADIATION PROTECTION PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS NAVMED P-SOSS, par. 6—2.(1) NAVMED P-5055, par. 4-1.(1) NAVMED P-5055, par. 2-4. NAVMED P-5055, par. 2-7.(8) NAVMED P-5055, par. 2-7.(9) NAVMED P-5055, par. 6-2.(1) NAVMED P-5055, par. 5-2.(2) (C) NAVMED P-5055, par. 5—2.(2) NAVMED P-5055, par. 1-6. 29 CFR 1910. 96(n)(1) BUMED Activities Only Does the activity maintain a Radiation Health Protection Program where military or civilian personnel may be exposed to ionizing radiation? and Are measures established to ensure individual exposures are maintained at levels as low as reasonably achievable and no greater than the specified limits? Are the required medical exams for radiation exposure performed? Pre-placement? (Only For Routinely Exposed Personnel) Reexamination (Over Age 25 Every 5 years) (Over Age 50 Every 2 years) (Age 60 Annually) Situational (Due to Exposure) Termination? Do the radiation medical exams clearly state whether the individual is qualified or disquali— fied for occupational exposure to ionizing radia- tion? Are health records marked to indicate a termina- tion radiation medical exam is required? Is personal exposure monitoring conducted? Are the results of personal exposure monitoring sent to the medical records custodian at least quarterly? Are radiation exposures recorded on DD—ll4l or computer equivalent and updated quarterly? Is the radiation health program reviewed semi— annually and are records retained for 3 years? Are employees notified of their individual expo— sures annually? 21-1 SECTION 21 - IONIZING RADIATION PROTECTION - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS NAVMEDCOMINST Are equipment performance tests and radiation 6470.6, protection surveys of the facility conducted at par. 6.a.(2) least every two years? NAVMEDCOMINST Are radiation protection surveys and performance 6470.6, tests of diagnostic x—ray equipment conducted at par. 6.a.(1) the following times: a. Within 30 days after new x-ray equipment is installed. b. Following major mechanical or electrical repairs or alterations of the equipment; replace- ment or reinstallation of the x—ray equipment in a new location? c. After any structural change which may effect the radiation protection barriers? NAVMEDCOMINST Are performance tests and radiation protection 6470.6, surveys conducted by qualified individuals? par. 6.c. NAVMEDCOMINST a. Assess and make necessary measure— 6470.6, ments of ionizing radiation from par. 5.e.(l) diagnostic x—ray equipment as and required. par. 5.e.(2) and b. Evaluate radiation protection pro— par. 5.9.(3) grams and provide advice regarding radiation protection of needs of medical and dental installations. c. Evaluate the performance of diagnostic x-ray devices including imaging devices, and advise regarding imaging technique improvement and quality assurance programs. 21-2 SECTION 22 ~ RADIOFREQUENCY RADIATION CONTROL PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS SURVEYS OPNAVINST Have all sources of radiofrequency radiation (RFR) 5100.238, been identified and measured to determine the par. 22207. intensity of the RF field (10 MHz to 100 GHz)? AND OPNAVINST Have sources of RFR hazards been evaluated by 5100.238, competent occupational health and safety personnel par. 22207. using ANSI C95.3-l973 and ANSI C95.5—1981? OPNAVINST Are copies of the surveys, reports and theoretical 5100.238, calculations for each RFR source retained by the par. 22207. activity for no less than 5 years? CONTROLS OPNAVINST Have commanding officers established and con— 5100.23B, trolled access to areas in which RFR exposures par. 22214. above the PELs could occur? e.(l) OPNAVINST Are RFR hazard warning signs posted at all access 5100.238, points to areas in which RFR levels may exceed par. 22209. the PEL? d. OPNAVINST Are warnings and controls other than signs used 5100.238, where RFR levels greater than 10 times the PEL par. 22209. exist? (such as flashing lights, audible signals, e. fences and interlocks - depending on potential for exposure). TRAINING OPNAVINST Have personnel who work with RFR sources or in an 5100.238, area where the potential may exist for exposure to par. 22211. RFR above the PELs received RFR training? and OPNAVINST Does the training include information on potential 5100.238, workplace RFR sources associated exposure hazards, par. 22214. and appropriate protective measures? e.(2) 22-1 SECTION 22 — RADIOFREQUENCY RADIATION CONTROL PROGRAM - (Cont'd) REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Is annual refresher RFR training provided to 5100.238, reinforce and reemphasize command training objec- par. 22211. tives? MEDICAL SURVEILLANCE OPNAVINST Are appropriate RFR personnel included in a 5100.233, medical surveillance program? par. 22214. e. OPNAVINST Periodic or situational exams for personnel 5100.238, exposed to 5 times the PEL. par. 22208. a.(2) OVEREXPOSURE INCIDENTS OPNAVINST Have any overexposure incidents occurred? 5100.233, (overexposure = 5 times greater than PEL) if so, par. 22208. b. OPNAVINST Were they investigated, documented and the 5100.238, results reported to BUMED (BONED—02) within 48 par. 22208. hours? b.(2) & par. 22214.e.(4) 22-2 SECTION 23 — LASER HAZARD CONTROL PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS BUMEDINST Does the command have class 3a (labeled with 6740.19 danger logo) class 3b, class 4 or military exempt lasers? If yes, LSSO BUMEDINST Has a laser system safety officer (LSSO) been 6740.19 appointed by the CO. AND BUMEDINST Has the Lsso successfully completed LSSO course 6740.19 meeting the requirements of ANSI Z136.3-1988 Safe Use of Lasers in Healthcare Facilities? LISTING BUMEDINST Does the LSSO maintain a list of all lasers and 6470.19 their locations and forward a copy to NAVENVIRHLTHCEN annually by 30 June? LSSO RESPONSIBILITIES BUMEDINST Does the Lsso investigate and report as required, 6470.19 all laser accidents and incidents? BUMEDINST Has the LSSO established and promulgated local 6470.19 laser safety regulations for operations and maintenance, and are they available for each laser? BUMEDINST Does the Lsso survey at least annually all local 6470.19 laser installations for safety and conduct hazard evaluations whenever needed to ensure hazard control? SECTION 23 - LASER HAZARD CONTROL PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS PROTECTIVE EQUIPMENT BUMEDINST Is protective equipment available and used? 6470.19 TRAINING BUMEDINST Do operators and support staff receive appropriate 6470.19 training? Is it documented? Does it contain command-specific requirements as well as infor— mation recommended in ANSI Standard 2136.1-1986 and ANSI Standard 2136.3-1988? MEDICAL SURVEILLANCE NAVMEDCOMINST Has the Lsso determined and designated incidental 6470.2A, and laser personnel? par. 7.b. NAVMEDCOMINST Laser Personnel - Do laser personnel receive pre— 6470.2A, placement, periodic (triennially or when suspected par. 7.c.(1) exposure occurs) and termination examinations? Do examinations include at least an ocular history, visual acuity, and external ocular and fundus examinations? NAVMEDCOMINST Incidental Personnel - Have all incidental person- 6470.2A, nel received eye examinations for visual acuity? par. 7.c.(2) SECTION 24 — LEAD CONTROL PROGRAM 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS Are operations involving lead conducted at the activity (e.g., melting, spray painting, burning, blasting lead paint)? SAMPLING OPNAVINST Have all operations involving lead been evaluated 5100.238, annually? Where a potential for exposure from par. 21008.a. inhalation of airborne lead particulates or person- nel contamination is found, has a workplace moni— toring plan been established to characterize exposures? OPNAVINST Are all operations where exposures are above the 5100.238, action level (AL) 30 ug/M3 monitored every 6 par. 21008.a. months? (1)(a)(1.) AND/0R OPNAVINST Are all operations where exposures are above the 5100.238, permissible exposure limit (PEL) 50 ug/M3 moni— par. 21008.a. tored at 3 month intervals? (b)(1~) NOTIFICATION OPNAVINST Are all employees notified in writing within 5 5100.238, working days of receipt of lead monitoring data? par. 21009 RESPIRATORS OPNAVINST Are respirators for lead work selected based on the 5100.238, selection table? par. 21005.d. (2) OPNAVINST Are negative pressure respirators prohibited from 5100.238, being worn for more than 4.4 hours per day? par. 21005.d. (lud) OPNAVINST Are quantitative respirator face fit tests per— 5100.238, formed at the time of initial fitting and at least par. 21005.d. every 6 months thereafter? (1)(d) SECTION 24 — LEAD CONTROL PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS OPNAVINST Are powered air-purifying respirators with HEPA 5100.233, filters available in lieu of negative pressure par. 21005.d. respirators? (1mm) PPE OPNAVINST Do protective clothing and equipment used by above 5100.233, employees meet established criteria? par 21005.c. (1)(a)—(d) OPNAVINST 5100.233, par. 21005.c. (1) OPNAVINST 5100.233, par. 21005.c. (2) OPNAVINST 5100.233, par. 21005.c. (5) OPNAVINST 5100.233, par. 21005.c. (3) OPNAVINST 5100.233, par. 21005.c. (4) OPNAVINST 5100.233, par. 21005.c. (4) OPNAVINST 5100.233, par. 21004. (2)(b) Do above employees remove personal clothing worn to and from work and wear protective clothing pro- vided by the Navy? Does the command provide clean protective clothing at least weekly or more often as required? Are procedures established to ensure contaminated clothing is laundered? CHANGE ROOMS Are change rooms provided to employees who work where airborne lead concentrations exceed the PEL? Are change rooms maintained under positive pressure relative to adjacent lead work areas? Are shower facilities located between "clean" and "dirty" change rooms? Are employees exposed above the PEL required to shower at the end of the shift? ENGINEERING/WORK PRACTICES Are engineering and work practice controls imple- mented to reduce employee's lead exposure? 24-2 SECTION 24 — LEAD CONTROL PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD N0 REMARKS OPNAVINST Are ventilation systems used to control lead expo- 5100.23B, sures tested by qualified engineers or industrial par. 21005.b. hygienists every 3 months or within 5 days of (3) operational change? Are ventilation records held for a minimum of 3 years? TRAINING OPNAVINST Have all personnel who work in areas where the 5100.238, potential exists for exposure above the AL received par. 21007 initial training? Annual training? 29 CFR 1910. 1025(1)(1) (i) OPNAVINST 5100.233, par. 21011. OPNAVINST 5100.233, par. 21010. (a) OPNAVINST 5100.233, par. 21010.b. (2) OPNAVINST 5100.238, par. 21010.b. (3) Are all employees with any potential exposure to airborne lead informed of Appendix A and B in 29 CPR 1910.1025? CONTRACTS Are the provisions of OPNAVINST 5100.233 for con- tractor work involving lead performed in the United States and overseas met? MEDICAL SURVEILLANCE Are employees potentially exposed to airborne lead, at or above the AL for 30 days or more per year, in a medical surveillance program? and Does it contain preplacement medical evaluation, semiannual blood lead monitoring, and follow—up medical evaluations? Are blood analyses conducted every 2 months when an employee's blood lead level exceeds 30 ug/lOO g of whole blood? Are employees reassigned to non—lead work when their blood lead concentration exceeds 60 ug/lOO 9 whole blood or their last 3 measurements average in excess of 50 ug/lOO g whole blood? SECTION 24 — LEAD CONTROL PROGRAM - (Cont'd) 10/91 REFERENCE NAVOSH PROGRAM ELEMENT YES INAD NO REMARKS OPNAVINST Does the cognizant industrial hygienist investigate 5100.238, the cause of each verified blood lead concentra- par. 21010.b. tion at or above 30 ug/100 9 whole blood? (3) _u_...mz_u_x _ INST. NO. 29 CFR 1910, 1926 Standards SECNAV 5100.14 Series SECNAV 5100.15 OPNAV 12810.1 OPNAV 4110.2 Series OPNAV 5040.7 Series OPNAV 5100.23 Series OPNAV 5102.1 Series MEDCOM 6260.5 Series MEDCOM 6470.2 Series NAVSEA SG470-AA- SAF-OlO SPAWAR 5100.12A ANSI Z88.2 Series ANSI Z88.6 Series BUMEDINST 5100.13 NEHC-TM-91—5 September 1991 REFERENCES TITLE General Industry Standards/Construction Military Exempt Lasers Department of the Navy Awards for Achievement in Safety Ashore Federal Employees' Compensation Act (FECA) Program Hazardous Material Control and Management Program Naval Command Inspection Program Navy Occupational Safety and Health (NAVOSH) Program Mishap Investigation and Reporting Occupational Noise Control and Hearing Conservation Laser Health Hazards Gas Free Engineering Program Navy Laser Radiation Hazards Prevention Program Practices for Respiratory Protection Respirator Use - Physical Qualifications for Personnel Bureau of Medicine and Surgery Safety Program Technical Manual, Medical Surveillance Procedures Manual and Medical Matrix (Edition 4) APPENDIX I U.C. BERKELEY LIBRARIES tllllllllllll C035'H35l7l: