OSHA Assessment-Form

Name

Last Name

Email Address

Phone Number

1. Do you have a designated OSHA Compliance manager?YesNoUnsure

2. When was the last time you conducted an OSHA self assessment of your facility?Within the last 12 monthsOver 12 months agoUnsure

3. Are you familiar with your state specific OSHA requirements?YesNo

4. Do you have an updated OSHA Job Safety and Health Protection poster placed in a common employee area?OSHA trainer comes to the practicePurchased online OSHA compliance trainingFree resources from dental association/societyUnsure

5. Do you have any financial coverage or insurance to protect you against OSHA audit related fines?YesNoUnsure

6. Do you have a Fire and Emergency Plan, and are all employees aware of it?YesNoUnsure

7. Do you have a written Covid-19 Employee Safety Plan?YesNoUnsure

8. Do you have documentation proving all employees have completed a Covid-19 Employee Safety Training?YesNoUnsure

9. Do you have a Respiratory Protection Standard Plan documented, and when was the last time it was updated?Yes, updated within the last 12 monthsYes, but updated over 12 months agoUnsure

10. Do you have documentation proving all employees have completed Infection Control Training within the last 12 months?YesNoUnsure

11. Do you have a Bloodborne Pathogens Exposure Control Plan and when was it updated?Yes, updated within the last 12 monthsYes, but updated over 12 months agoNo, I do not have a Bloodborne Pathogens Plan on file

12. Do you have documentation proving all employees have completed Bloodborne Pathogen Training within the last 12 months?YesNoUnsure

13. Do you have a Bloodborne Pathogens Exposure Incident Log?YesNoI would like to learn more about this

14. Did you provide Hepatitis B vaccinations to any employee who is reasonably anticipated to have exposure within 10 days of employment and at no cost to the employee?YesNoUnsure

15. If you answered "No"/"Unsure" to the above, did you require employees to sign Hepatitis B Vaccine Declination Form?YesNoSome, but not all employees

16. Do you have a written Hazard Communication Plan and when was the last time it was updated?Yes, updated within the last 12 monthsYes, but updated over 12 months agoNo

17. Do you have documentation proving all employees have completed Hazard Communication Training within the last 12 months?YesNoSome, but not all employees

18. For California practices ONLY: Do you have documentation proving all employees have completed Aerosol Transmissible Diseases Training within the last 12 months?YesNoSome, but not all employeesN/A

19. Do you have an inventory of all your Safety Data Sheets (SDS) for all chemicals on-site?YesYes, but this likely needs to be updatedNo

20. What are your biggest pain points/challenges when it comes to your OSHA compliance?Annual training requirementsOSHA Law updates and changesDocumentation and policiesAll of the above

Welcome to your OSHA Quick Assessment!

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