Form OP130107 B "Monthly Environmental Health and Safety Inspection Report" - Oklahoma

What Is Form OP130107 B?

This is a legal form that was released by the Oklahoma Department of Corrections - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2019;
  • The latest edition provided by the Oklahoma Department of Corrections;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form OP130107 B by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Corrections.

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Download Form OP130107 B "Monthly Environmental Health and Safety Inspection Report" - Oklahoma

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Page 1 of 4
Oklahoma Department of Corrections
Monthly Environmental Health and Safety Inspection Report
Inspected by Safety Consultant__________________________________________________
Click here to enter a date.
Date:
Facility or Building(s)/ Area Inspected:
Click here to enter a date.
Assignments have been made to correct deficiencies noted in this report
____
Date
Choose an item.
___________________________________________
All outside regulatory agencies reports, weekly Environmental Health and Safety Inspections and all plans of corrective action have been
reviewed, prior to conducting the monthly inspections.
TH
THIS REPORT IS DUE BYTHE 15
OF THE MONTH
Identify C – Compliant / NC – Noncompliant / NA – Non Applicable / WO# - Work Order # (if applicable)
All deficiencies require plans of corrective action to include Upkeep work orders submitted by facility
C
N/C
N/A
WO #
staff/responsible department head. All POA’s need to be to the Environmental Health and Safety Unit.
A. Fire Safety
1. Are fire evacuation diagrams posted in orientation of the building and current (no renovations, exits are unobstructed,
etc.)?
2. Are fire extinguishers in all locations in accordance with the evacuation diagram, mounted, numbered, charged, sealed
and accessible (unobstructed and easy access)?
3. Are fire doors closed, unobstructed and door closures working properly?
4. Are alarm systems operational? Are lights and horns free from obstruction or damage?
5. Are exits and exit access visible, unobstructed and identified on the evacuation diagram?
6. Are exit signs illuminated?
7. Are sprinkler risers green tagged, unobstructed (3’ clearance) and gauges in working order?
8. Is the hood system in the kitchen green tagged and all nozzles capped and free of grease build up?
9. Date of last Fire Marshal Inspection ________; ensure all required corrective action is completed and/or has an
anticipated date of completion. (Attach most recent plans of corrective action)
Comments:
B. Electrical
1. Are electrical panels unobstructed and properly labeled?
2. Is lock out tag out (LOTO) being utilized? (check the log for required documentation)
3. Are electrical cords in good working order free of splices, oils and/or grease? (kitchen, maintenance, OCI)
4. Are GFCI outlets in proper working order? (required in areas all areas with a water source)
5. Are extension cords free of debris and used in accordance with NEC code?
Comments:
Page 1 of 4
Oklahoma Department of Corrections
Monthly Environmental Health and Safety Inspection Report
Inspected by Safety Consultant__________________________________________________
Click here to enter a date.
Date:
Facility or Building(s)/ Area Inspected:
Click here to enter a date.
Assignments have been made to correct deficiencies noted in this report
____
Date
Choose an item.
___________________________________________
All outside regulatory agencies reports, weekly Environmental Health and Safety Inspections and all plans of corrective action have been
reviewed, prior to conducting the monthly inspections.
TH
THIS REPORT IS DUE BYTHE 15
OF THE MONTH
Identify C – Compliant / NC – Noncompliant / NA – Non Applicable / WO# - Work Order # (if applicable)
All deficiencies require plans of corrective action to include Upkeep work orders submitted by facility
C
N/C
N/A
WO #
staff/responsible department head. All POA’s need to be to the Environmental Health and Safety Unit.
A. Fire Safety
1. Are fire evacuation diagrams posted in orientation of the building and current (no renovations, exits are unobstructed,
etc.)?
2. Are fire extinguishers in all locations in accordance with the evacuation diagram, mounted, numbered, charged, sealed
and accessible (unobstructed and easy access)?
3. Are fire doors closed, unobstructed and door closures working properly?
4. Are alarm systems operational? Are lights and horns free from obstruction or damage?
5. Are exits and exit access visible, unobstructed and identified on the evacuation diagram?
6. Are exit signs illuminated?
7. Are sprinkler risers green tagged, unobstructed (3’ clearance) and gauges in working order?
8. Is the hood system in the kitchen green tagged and all nozzles capped and free of grease build up?
9. Date of last Fire Marshal Inspection ________; ensure all required corrective action is completed and/or has an
anticipated date of completion. (Attach most recent plans of corrective action)
Comments:
B. Electrical
1. Are electrical panels unobstructed and properly labeled?
2. Is lock out tag out (LOTO) being utilized? (check the log for required documentation)
3. Are electrical cords in good working order free of splices, oils and/or grease? (kitchen, maintenance, OCI)
4. Are GFCI outlets in proper working order? (required in areas all areas with a water source)
5. Are extension cords free of debris and used in accordance with NEC code?
Comments:
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C. Flammable/Caustics/Toxics
Flammable Materials
1. Are flammable materials properly stored and SDS available?
2. Are logs available for inventory and issuance of products? (verify several products for accuracy)
Caustics/Toxics
3. Are caustics/toxics properly stored and SDS available for each product?
4. Are logs available for inventory and issuance of products? (verify several products to ensure accuracy)
5. Do containers/caddies, used to issue products, have a list of products/quantities issued? Are they consistent with label?
Comments:
D. PPE
1. Is the correct PPE provided for the job, in good repair, being utilized when needed? (Hazard assessments for jobs
should identify required PPE and/or on job description as required by OP-030103.)
Comments:
E. X-Ray Cabinets
1. Is the Annual Survey complete? (provide the date of the last survey)
2. Are radiation exposure warning signs posted?
3. Is there a list of staff authorized to operate the system on site (with machine)?
4. Are checks being performed daily on each shift and documented? (review logs or inspection documents)
5. Is X-Ray cabinet operational? (Assess equipment by viewing while in operation?)
Comments:
F. General
1. Are floors and walkways free of clutter and debris?
2. Are plumbing fixtures in proper working order (faucets, showers, toilets operable)?
3. Are ladders the proper length and in working order? (ensure they have not been altered, compromising safety)
4. If in use, are ladders being used in a safe manner?
5. Are outside walkways and stairs are free of ice/snow? (when applicable)
6. Are waste receptacles are covered? (required if 20 gallons or over)
7. Are housekeeping plans developed and being enforced? (ensure sanitation throughout the facility promotes a clean
environment which assists in reducing health related issues)
8. Do boilers have current inspections? (date of last inspection:
)
9. Do hot water tanks have current inspections? (date of last inspection
)
10. Are First-Aid kits in locations authorized by the CHSA/Facility Head? (verify locations with local procedure)
11. Are FA kits labeled with contents? (review a sampling of kits to ensure contents are consistent with the content label)
Page 3 of 4
12. Are FA kits inspected monthly? (list date of last inspection for each kit, to include vehicles.)
13. Are AED's are inspected monthly? (provide the locations and date of last inspection)
14. Are AED’s operational? (charged and battery not expired)
15. Are washers and dryers are in proper working order? (observe in operation and through interviews with staff/inmate
workers)
16. Are dryer lint traps cleaned daily? (observation and inmate job description/interviews)
Comments:
G. Food Service Areas
1. Are hairnets and beard guards used/being worn? (observation/interviews staff, inmates all person entering food prep
area)
2. Are items stored 6” from the wall and 6”off the floor?
3. Are hot foods being held above 135 degrees?
4. Are cold foods held below 41 degrees?
5. Are food trays inverted or covered when not in use?
6. Are sample trays being maintained and dated? (review Daily Work Production schedule and trays in cooler)
7. Do all waste receptacles have coverings?
8. Are inmates/staff eating in the kitchen area?
9. Are dishes being stacked wet?
10. Are freezer temperatures 0 degrees or below? (review actual temperature reading the day of inspection and several
examples of the Daily Word Production sheet within the month)
11. Are cooler temperatures 35-41 degrees? (review actual temperature reading the day of the inspection and several
examples of the Daily Work Production sheet within the month)
12. Is the floor mixer cleaned upon use and free from debris?
13. Are floor fans clean free from grease build up and/or debris?
14. Are the Daily Work Productions Schedules completed?
15. Are caustics/toxics/flammable controlled, stored, inventoried and issued as required by policy?
16. Are SDS’s available on all chemical/cleaning products in the food service area?
17. Date of last Department of Health Inspection ________; ensure all required corrective action is completed and/or has
an anticipated date of completion. Identify current compliance level below and attach most recent plans of corrective
action.
Comments:
H. Barbershop/Beauty Shop Programs
1. Are tools sanitized after each use?
2.. Are towels available for use?
3. Are clean towels used with each inmate?
4. Are drapes cleaned after each?
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5. Are neck guards being used with drape, for each use?
6. Is running water (hot and cold) available in the barber/beauty shop area?
Comments:
Overall Comments: (Advise of the level of sanitation for the facility/area as well as concerns and/or positive findings/results)
If needed, provide photos of areas found in noncompliance and/or areas of concern.
DOC 130107B
(R 9/19)
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