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:
- _________Hazard communication
- _________Bloodborne pathogens
- _________Sharps safety program
- _________Recordkeeping forms and tests
- _________Safety and health
- _________Emergency preparedness and disaster plan
- _________Electrical and mechanical policy
- _________Tuberculosis exposure control
- _________Ergonomics
- _________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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