ERGONOMICS PROCESS AUDITDate: _________________________

Audit Site:______________________

Audited By: _____________________

A. Management Commitment Yes No Points

1. Is there a Plant Health & Safety Policy and is it posted in conspicuous locations throughout the facility?

4

2. Is there a written Corporate Ergonomic Process available? (Plant Manager, Safety Coordinator, Medical Technician, Committee should each have a copy)

4

3. Is there an assigned Ergonomics Coordinator? 44. Does he/she have management support and authority to establish and maintain an ergonomic process?

4

5. Is there an annual audit of the ergonomics process? 4B. Employee Involvement

6. Is there an active Ergonomics Committee? 4

Please list membersA.B.C.D.

7. Does this Committee meet every quarter? 48. Are minutes kept of the Committee activities? 49. Is the quarterly plant ergonomic report completed and on file? (This report lists completion of projects and/or issues to be addressed)

4

10. Are the activities of the Committee communicated to the associates? 4C. Worksite analysis

11. Has the facility's ergonomic-related injury and illness experience been identified?

4

12. Have baseline symptom surveys of all employees been conducted? 413. Is there a prioritized list of jobs needing corrective action? 414. Are job ergonomic hazards reviewed annually / periodically? 415. Is there available a Job Safety & Hazard Analysis that incorporates ergonomic risk factors for each manufacturing job?

4

Please list all identified jobs:

A. EB. F C. G D. H