Safety Compliance Assessment Form

SAFETY COMPLIANCE ASSESSMENT FORM

Company Name: [Your Company Name]	Assessment Conducted By: [Your Name]
Company Number: [Your Company Number]	Assessment Date: [June 15, 2053]

This Compliance Assessment is conducted to ensure that the company complies with the relevant health and safety regulations and standards in the United States.

Please provide details for each section.

Safety Policies and Procedures
The company has established written safety policies and procedures.
All employees are trained on the safety policies and procedures.
Records of safety training are maintained.
Hazard Identification and Risk Assessment
The company conducts regular hazard assessments.
Risks associated with identified hazards are assessed and managed.
Corrective actions are taken to address identified hazards.
Emergency Response Plan
The company has an emergency response plan in place.
Employees are trained on the emergency response plan.
Emergency response drills are conducted periodically.
Personal Protective Equipment (PPE)
Appropriate PPE is provided to employees.
Employees are trained on the proper use of PPE.
PPE is regularly inspected for effectiveness.
Safety Inspections and Audits
Regular safety inspections are conducted.
Findings from safety inspections are documented and addressed
Reporting and Recordkeeping
Incidents and near misses are reported and investigated.
Records of incidents, investigations, and corrective actions are maintained.
OSHA 300 logs are accurately maintained.
Employee Training
New employees receive safety orientation.
Ongoing safety training is provided.
Safety Culture
Safety is promoted and prioritized at all levels of the organization.
Employees are encouraged to report safety concerns.
Additional Comments and Recommendations:
Assessment Results In Compliance Partially in Compliance Not in Compliance

Assessment Signatures

Assessor's Signature_______________________________

Date: [June 15, 2053]

[Your Company Name] Representative: ____________________

Date: [June 15, 2053]

[Client / Subscriber / User Name] (if applicable): ____________________

Date: [June 15, 2053]

Please ensure that this Compliance Assessment Form is reviewed, updated, and maintained regularly to ensure ongoing compliance with US health and safety laws and standards.