TEXAS HAZARD COMMUNICATION ACT COMPLIANCE INSPECTION CHECKLIST FOR PUBLIC AGENCIES
TEXAS DEPARTMENT OF HEALTH
DIVISION OF OCCUPATIONAL HEALTH
Complete all items in this checklist. If a question is not applicable, write "N/A".
A. Pre-Inspection Information
1. Name of facility: ___________________________________________________
2. Address of facility: __________________________________________________
City: ______________________ Zip code: _________________
Telephone No.:_____________________________________________________
3. Facility Administrator: _______________________________________________
Title: _________________________________________________
4. Facility representative contacted: _______________________________________
Date: ___________________ Title: ____________________________________
5. Name of inspector: __________________________________________________
Title: ________________________ TDH Region No. : _______
6. Inspection Type: Complaint _______ Targeted ______ Follow-up _______
Requested ________ Other ________________________
a. Date of inspection: ___________________ Time: _____________________
b. If complaint, date complaint received: ________________________________
Comments: ______________________________________________________________
7. Has the facility filed a Texas Tier Two report for the previous calendar year with the hazard Communication Branch in Austin? Yes__________ No _____________
B. Opening Conference
1. List facility representatives in attendance:
a. Name: ________________________ Title: _____________________________
b. Name: ________________________ Title: _____________________________
c. Name: ________________________ Title: _____________________________
2. List other TDH representatives in attendance:
a. Name: ____________________ Title: ___________________________
b. Name: ____________________ Title: ___________________________
3. Notice of Inspection explained, signed, and copy provided to facility?
Yes ______ No ______
4. Nature and scope of the inspection explained? Yes _______ No _______
5. List facility areas to be included in the inspection:
a. ____________________________________________________________
b. ____________________________________________________________
c. ____________________________________________________________
C. Records Review
1. Has the employer compiled and maintained a workplace chemical list for all hazardous chemicals normally used or stored in the workplace in excess of 55 gallons or 500 pounds? (HSC Sec. 502.005 (a).
Yes _______ No _______
2. Has the employer implemented a written hazard communication training program?
(HSC Sec. 502.009 (b)
Yes ________ No _______
Comments: _____________________________________________________________
3. Has training been provided to all affected employees? (HSC Sec. 502.009 (a) and (e)}
Yes ________ No ________
Comments: ______________________________________________________________
4. Has the employer provided training to new or newly assigned employees before the employee works with or in a work area containing a hazardous chemical? {HSC Sec. 502.009 (f)}
Yes _______ No ________
5. Has the employer maintained the following training records? {HSC Sec. 502.009 (g) }
a. Dates of training sessions? Yes _______ No _________
b. List of employees trained? Yes _______ No _________
c. Topics covered? Yes _______ No ________
d. Instructors? Yes _______ No ________
6. Other training given: respiratory protection ______ first - aid _____
confined space entry ______ other ____________________________________
Comments: ____________________________________________________________
7. Has facility experienced any employee accident (s) resulting in one or more employee deaths or 5 or more employee hospitalizations? {HSC Sec. 502.012}
Yes _______No ________
Comments: _____________________________________________________________
If yes, was accident reported to TDH? Yes _______No _______
8. Has the employer compiled and maintained in the workplace a Texas Tier Two Chemical inventory (facility chemical list) for all hazardous chemicals present in excess of established EPCRA thresholds (10,000 pounds for OSHA hazardous chemicals, 500 pounds or TPQ, whichever is less, for EHSs)? {HSC Sec. 506.006 (a)}
Yes ________No ________
Comments: _______________________________________________________________________
9. If the employer is required to file and maintain a Tier Two form, has the employer:
a. provided a copy of the Tier Two form to the fire department having jurisdiction over the facility? {HSC Sec. 506.006 (c)}
Yes _______No ________
b. Has the employer provided a copy of the Tier Two form to the appropriate local emergency planning committee? {HSC Sec. 506.006 (c)}
Yes _______ No _______
D. Physical Inspection of Facilities
1. Randomly inventory hazardous chemicals used or stored in at least one (preferably more) work area (s) and obtain the following information:
Work area: ______________________________________________________________
Properly Proper
Chemical Quantity Location Labeled? MSDS?
Chemical
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Quantity |
Location |
Properly Labeled? |
Proper MSDS? |
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Provide details of improperly labeled containers and/or improper MSDSs:
__________________________________________________________________
Other comments: ___________________________________________________
Work area: ________________________________________________________
Properly Proper
Chemical Quantity Location Labeled? MSDS?
Provide details of improperly labeled containers and/or improper MSDSs:
__________________________________________________________________
Other comments: ___________________________________________________
Work area: ________________________________________________________
Properly Proper
Chemical Quantity Location Labeled? MSDS?
Chemical
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Quantity |
Location |
Properly Labeled? |
Proper MSDS? |
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Provide details of improperly labeled containers and/or improper MSDSs:
__________________________________________________________________
Other comments: ___________________________________________________
This page can be photocopied for additional work area inventories as necessary to obtain a representative sample of hazardous chemicals in the facility/workplace.
2. Were any reportable quantities of hazardous chemicals observed which were not listed on the Tier Two chemical list? {HSC Section 506.006}
Yes _____ No ______
If yes, provide the following information.
Properly Proper
Chemical Quantity Location Labeled? MSDS?
Chemical
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Quantity |
Location |
Properly Labeled? |
Proper MSDS? |
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Comments: ________________________________________________________
3. If EHS (s) present in excess of TPQ or 500 pounds has the employer filed an emergency planning letter with TDH? (This is an EPCRA requirement only. Make recommendations as needed.)
Yes _______ No ________
4. Are MSDSs readily available, upon request, for review by employees? {HSC Sec. 502.006 (c) }
Yes _______ No _______
Comments: _______________________________________________________
5. For missing MSDSs, has the employer requested these in writing from the chemical manufacturer or distributor? {HSC Sec. 502.006 (b)}
Yes ________ No _________
6. Is the THCA "Notice to Employees" posted at locations where notices are normally posted? {HSC Sec. 502.017 (a) }
Yes _______ No ________
Comments: ________________________________________________________
a. Is the Notice unobstructed and legible?
Yes _______ No _______
b. Latest version? Yes _______ No _______
7. Other potential exposure hazards:
a. Asbestos Yes _______No _______
b. Dust Yes _______No _______
c. Compressed gases Yes _______ No _______
d. Inadequate ventilation Yes _______No _______
e. Confined spaces Yes _______ No _______
f. Other: ___________________________________________
_________________________________________________________
8. Other observations: (Make recommendations as necessary)
a. Are employees using protective equipment in hazardous chemical work areas?
Yes _______ No _______
b. Does protective equipment function properly and is it in good repair?
Yes _______ No _______
c. Is protective equipment properly stored?
Yes ________ No _______
d. Are employees using protective equipment properly?
Yes ________ No _______
e. Is protective equipment adequate?
Yes ________ No _______
f. Do employees smoke, eat, or drink in hazardous chemical work areas?
Yes ________ No _______
g. Are hazardous chemicals stored properly?
Yes ________ No _______
h. Are there confined space entry procedures in place?
Yes ________ No _______
I. If yes, are there confined space entry procedures in place?
Yes ________ No _______
j. Are there exposures to hazardous chemical by-products, engine exhaust,
etc., in work areas?
Yes ________ No _______
Comments: ________________________________________________________
__________________________________________________________________
E. Employee Interview Questions
Employees should be individually interviewed in private. Be sure that you select a randomly chosen, representative group of employees for the interviews. Do no allow the employer to select those employees who will be interviewed.
A minimum of three employees should be interviewed in order to objectively determine compliance status. Prior to each interview, explain to the employee the following: (a) the purpose of the inspection, (b) that replies will be held in confidence and respondents will remain anonymous to determine an overall picture of that facility’s compliance status.
Do not record the names of employees interviewed.
Employee Interview Questions
1. Can you:
a. Speak English? 1. Yes ___ No ___
2. Yes ___ No ___
3. Yes ___ No ___
b. Read English? 1. Yes ___ No ___
2. Yes ___ No ___
3. Yes ___ No ___
2. How long have you been employed at this facility?
1. _____________________________________________________________
2. _____________________________________________________________
3. What type of work do you do?
1. _____________________________________________________________
2. _____________________________________________________________
4. How long have you been employed in your current position?
1. _____________________________________________________________
2. _____________________________________________________________
5. Have you ever heard of the Texas Hazard
Communication Act or the Texas Right-to-Know Law?
1. Yes ___ No___
2. Yes ___ No ___
6. Have you ever seen the THCA Notice to Employees poster?
1. Yes____No____
2. Yes____No____
a. Where is it posted? 1. _________________________________
2. _________________________________
b. Have you read the Notice?
1. Yes___ No___
2. Yes___ No___
c. Did you understand your rights under the THCA? (Have employee explain some of their rights to verify this.
1. Yes___ No___
2. Yes___ No___
7. Do you work with hazardous chemicals? (If employee is not sure, give examples such as janitorial chemicals, gasoline, compressed gas cylinders, cement, welding rods, etc.)
1. Yes___ No___
2. Yes___ No___
8. Do you know what a Material Safety Data Sheet or MSDS is?
1. Yes___ No___
2. Yes___ No___
Where are MSDSs located? 1. _______________________________
2. _______________________________
9. Have you ever received training on the hazardous chemicals in your work
area?
1. Yes___ No___
2. Yes___ No___
When did you last receive this training?
1. __________________________________
2. __________________________________
10. Did this hazardous chemical training include:
a. Information on interpreting labels and MSDSs
1. Yes___ No___
2. Yes___ No___
b. The location, by work area, of the hazardous chemicals in the workplace?
(HSC Sec. 502.009 (c) (2)}
1. Yes___ No___
2. Yes___ No___
c. The acute and chronic effects of the hazardous chemicals {HSC Sec. 502.009 (c) (2)
1. Yes___ No___
2. Yes___ No___
d. Proper use of appropriate protective equipment?
1. Yes___ No___
2. Yes___ No___
e. First aid treatment to be used with respect to the hazardous chemicals to which employees may be exposed? {HSC Sec. 502.009 (c) (3)}
1. Yes___ No___
2. Yes___ No___
f. General safety instructions on the handling, cleanup, and disposal of hazardous chemicals? {HSC Sec. 502.009 (c) (4)
1. Yes___ No___
2. Yes___ No___
11. What kind of information would you look for on hazardous chemical labels I in your work area?
1. Chemical name? ____ Hazard warnings? ____ Other? _______
2. Chemical name? ____ Hazard warnings? ____ Other? ________
12. Are there any hazardous chemical containers in your work area that are unlabeled?
1. Yes___ No___
2. Yes___ No___
a. If Yes, do you know what is in these containers?
1. Yes___ No___
2. Yes___ No___
b. If yes, explain:
1. ________________________________________________
2. ________________________________________________
13. Have you ever asked for chemical information (or an MSDS) on a particular hazardous chemical in your work area?
1. Yes___ No___
2. Yes___ No___
14. What type of personal protective equipment is issued or provided to you in your workplace?
1. _______________________________________________________
2. _______________________________________________________
a. Have you been adequately trained on the use of this equipment?
1. Yes___No___
2. Yes___ No___
b. Have you been adequately trained on the use of this equipment?
1. Yes___ No___
2. Yes___ No___
c. Do you feel this equipment is adequate for the work that you perform?
1. Yes___ No___
2. Yes___ No___
d. If no, explain:
1. _______________________________________________
2. _______________________________________________
15. Have you ever had an injury or illness that you thought may have been caused by a hazardous chemical in your work area?
1. Yes___ No___
2. Yes___ No___
3. Yes___ No___
If yes, explain:
1. __________________________________________________________
2. __________________________________________________________
16. Do you know anyone else in your work area who has had an illness or injury that may have been caused by a hazardous chemical?
1. Yes___ No___
2. Yes___ No___
If yes, explain:
1. _________________________________________________________
2. _________________________________________________________
17. Have you ever been disciplined or harassed for:
a. Asking for hazardous chemical information?
Yes___ No___
b. Voicing concern about hazardous chemical exposures?
Yes___ No___
c. Asking for safety training on hazardous chemicals?
Yes____ No___
d. Asking for additional or better protective equipment?
Yes___ No___
e. If yes for any a-d, explain:
1. __________________________________________________
2. __________________________________________________
18. Do you know of other employees in your work area who have been disciplined or harassed in such situations?
Yes___ No___
a. If yes, explain:
1. __________________________________________________
2. ___________________________________________________
F. Closing Conference
1. Were the results of the inspection explained to facility representative(s)?
Yes___ No___
2. If violations were found, were the actions necessary for obtaining compliance explained explained? (The inspector should suggest that the facility representative(s) take written notes detailing the specific violations and the steps they will need to take to come into compliance as soon as possible.
Yes___ No___
Emphasize the need for starting corrective action immediately.
Briefly summarize violations observed.