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Sample OSHA Standards Employee Checklist

A good, compliant infection control program carefully documents when staff members of the ASC review and gain an understanding of the many components of the program. One such component is the rules and regulations of the Occupational Safety and Health Administration.


Brainerd Lakes Surgery Center in Baxter, Minn., uses a checklist outlining OSHA standards to document its employees' acknowledgement that the ASC has reviewed these standards with staff members.


To download a Sample OSHA standards employee checklist, provided by Sandy Berreth, administrator of the ASC and a AAAHC surveyor, click here (doc). A copy of the checklist is also below. Ms. Berreth says the completed and signed checklist is kept in the employee's HR record.


Employee Checklist OSHA Standards


The following items have been reviewed and the employee states an understanding of each:


  1. _________Hazard communication
  2. _________Bloodborne pathogens
  3. _________Sharps safety program
  4. _________Recordkeeping forms and tests
  5. _________Safety and health
  6. _________Emergency preparedness and disaster plan
  7. _________Electrical and mechanical policy
  8. _________Tuberculosis exposure control
  9. _________Ergonomics
  10. _________Workplace violence prevention


I acknowledge the above information has been discussed with me.



_______________________________                        _______________________

Employee Signature                                                                                            Date



_______________________________                        _______________________

Supervisor                                                                                                           Date


Source: Sandy Berreth, Brainerd Lakes Surgery Center. Adapted and reprinted with permission.

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