Here’s a SayPro Compliance Verification Form template designed to track compliance with health and safety regulations, highlighting areas that need attention or improvement. This form can be used to assess different health and safety criteria, ensuring that necessary corrective actions are taken.
SayPro Compliance Verification Form
Form No.: ___________________
Verification Date: ___________________
Facility/Location: ___________________
Department/Area: ___________________
Auditor(s): ___________________
Supervisor/Manager: ___________________
1. Compliance Categories
Compliance Area | Regulation/Standard | Status | Non-Compliant Area/Details | Required Action | Responsible Person | Due Date |
---|---|---|---|---|---|---|
Fire Safety | OSHA 1910.157 (Portable Fire Extinguishers) | [ ] Compliant [ ] Non-Compliant | Fire extinguishers obstructed by equipment. | Relocate fire extinguishers to accessible areas. | [Insert Name/Department] | [Insert Date] |
Personal Protective Equipment (PPE) | OSHA 1910.132 (General PPE Requirements) | [ ] Compliant [ ] Non-Compliant | Inconsistent PPE use in high-risk areas (e.g., gloves). | Conduct PPE training and enforce use in all designated areas. | [Insert Name/Department] | [Insert Date] |
Sanitation and Hygiene | OSHA 1910.141 (Sanitation) | [ ] Compliant [ ] Non-Compliant | Overflowing waste bins in some areas. | Increase frequency of waste disposal and ensure bins are emptied regularly. | [Insert Name/Department] | [Insert Date] |
Emergency Exits | OSHA 1910.36 (Exit Routes) | [ ] Compliant [ ] Non-Compliant | Emergency exit sign not illuminated. | Replace or repair the emergency exit light. | [Insert Name/Department] | [Insert Date] |
Health and Medical Facilities | OSHA 1910.151 (Medical Services and First Aid) | [ ] Compliant [ ] Non-Compliant | Missing items in first aid kit (bandages, gloves). | Restock first aid kits with necessary supplies. | [Insert Name/Department] | [Insert Date] |
Electrical Safety | OSHA 1910.303 (Electrical Safety) | [ ] Compliant [ ] Non-Compliant | Exposed wiring near wet areas. | Isolate wiring from wet areas and cover exposed wires. | [Insert Name/Department] | [Insert Date] |
Hazardous Materials Management | OSHA 1910.1200 (Hazard Communication) | [ ] Compliant [ ] Non-Compliant | Missing Safety Data Sheets (SDS) for certain chemicals. | Ensure SDS are available for all chemicals and accessible to employees. | [Insert Name/Department] | [Insert Date] |
Workplace Ergonomics | OSHA 1910.94 (Ergonomics) | [ ] Compliant [ ] Non-Compliant | Employees in high-stress environments have no ergonomic adjustments. | Provide ergonomic chairs and desks in high-risk areas. | [Insert Name/Department] | [Insert Date] |
Machine Safety | OSHA 1910.212 (Machine Guarding) | [ ] Compliant [ ] Non-Compliant | Safety guards missing on certain machines. | Install safety guards on all machines and perform regular checks. | [Insert Name/Department] | [Insert Date] |
Air Quality and Ventilation | OSHA 1910.1000 (Air Contaminants) | [ ] Compliant [ ] Non-Compliant | Insufficient ventilation in certain areas. | Install proper ventilation systems and ensure airflow is maintained. | [Insert Name/Department] | [Insert Date] |
2. General Compliance Status
- Overall Compliance Rating (Scale 1–5):
[ ] 1 – Non-compliant [ ] 2 – Partially compliant [ ] 3 – Compliant with minor issues [ ] 4 – Mostly compliant [ ] 5 – Fully compliant - Total Number of Non-Compliant Areas: __________
- Non-Compliant Areas Needing Immediate Attention:
[List any issues that require urgent attention to ensure employee safety.]
3. Follow-Up Actions
Non-Compliant Area | Corrective Action | Deadline for Action | Responsible Person | Follow-Up Date | Action Status [ ] Pending [ ] Completed |
---|---|---|---|---|---|
Fire Safety: Fire extinguishers obstructed | Relocate fire extinguishers to accessible areas. | [Insert Date] | [Insert Name/Department] | [Insert Date] | [ ] Pending [ ] Completed |
PPE Usage: Inconsistent use of gloves | Provide PPE training and enforce use in all high-risk areas. | [Insert Date] | [Insert Name/Department] | [Insert Date] | [ ] Pending [ ] Completed |
Waste Disposal: Overflowing bins | Increase waste collection frequency. | [Insert Date] | [Insert Name/Department] | [Insert Date] | [ ] Pending [ ] Completed |
Exit Routes: Emergency sign not illuminated | Repair or replace the emergency exit sign. | [Insert Date] | [Insert Name/Department] | [Insert Date] | [ ] Pending [ ] Completed |
4. Auditor’s Recommendations
Provide any additional recommendations to improve health and safety compliance in the facility. This could include suggestions for ongoing training, upgrades to safety equipment, or improvements to overall workplace safety culture.
- Recommendation 1:
[Insert Recommendation for improvement] - Recommendation 2:
[Insert Recommendation for improvement] - Recommendation 3:
[Insert Recommendation for improvement]
5. Auditor’s Signature
Name: ___________________
Date: ___________________
Supervisor/Manager’s Signature: ___________________
Date: ___________________
6. Compliance Verification Summary
Total Findings | Compliant Areas | Non-Compliant Areas | Pending Actions | Completed Actions |
---|---|---|---|---|
[Total Number] | [Number] | [Number] | [Number] | [Number] |
This SayPro Compliance Verification Form provides an organized way to assess and document compliance with health and safety regulations, track corrective actions, and ensure ongoing safety improvements. The form can be customized as needed to meet specific compliance standards or internal needs.
Let me know if you need further customization or additional sections for this form!