Worksite Assessment Guide (continued) Do workers use appropriate personal protective equipment? (Describe.) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ What other control measures are in place? (Describe.) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Are OSHA regulations adhered to? (Describe.) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Is there a fire safety program? How often are fire drills and inspections conducted? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Estimate the number of visits made to the health unit by employees. _____ number of weekly visits _____ percent of visits for preventive screening _____ percent of visits for illness/injury _____ percent of visits handled by nursing staff _____ percent of visits handled by physician staff What are the most common illnesses reported? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ What are the most common injuries reported? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 350 Guideline continues on next page