HAZARD COMMUNICATION PROGRAM COMPLIANCE

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--- PROGRAM WRITTEN AND MAINTAINED ---
[ ] Date of Last Program Review/Update
[ ] Summary of Changes Made During Last Review/Update
[ ] Program Availability (Electronically Accessible, Hard Copy Available, Both Electronically and Hard Copy)
[ ] Name of Person Responsible for Program Administration
[ ] Frequency of Program Review (e.g., annually, bi-annually)
[ ] Program Accessibility to Employees (Readily Available, Requires Request, Not Easily Accessible)
[ ] Description of how the program is communicated to new employees

--- CHEMICAL INVENTORY & SDS MANAGEMENT ---
[ ] Total Number of Chemicals Present
[ ] Method for Maintaining Chemical Inventory (e.g., spreadsheet, software)
[ ] Copy of Current Chemical Inventory List
[ ] Date of Last Chemical Inventory Update
[ ] SDS Access Method(s) (Printed SDS Binder, Online SDS Database (specify provider: ________), Mobile App (specify app: ________), Other (specify: ________))
[ ] Number of SDS Currently Available
[ ] Process for Ensuring SDS are Up-to-Date (e.g., subscription service, manual updates)
[ ] Date of Last SDS Review and Update
[ ] Is the SDS readily accessible to all employees during their work shifts? (Yes, No)

--- CONTAINER LABELING ---
[ ] Are all containers of hazardous chemicals clearly labeled? (Yes, No, N/A - No hazardous chemicals in use)
[ ] Do labels include the chemical identity? (Yes, No, N/A - All containers properly labeled)
[ ] Do labels include appropriate hazard warnings? (Yes, No, N/A - All containers properly labeled)
[ ] Are labels legible and in English (and other languages as needed)? (Yes, No, N/A - All containers properly labeled)
[ ] Describe any instances where labels are missing or incomplete:
[ ] Number of containers inspected for proper labeling:
[ ] For employee-transferred containers, are labels consistent with the SDS? (Yes, No, No employee-transferred containers)

--- EMPLOYEE TRAINING ---
[ ] Which topics were covered in the Hazard Communication training? (Hazardous Chemicals in the Workplace, Reading Safety Data Sheets (SDS), Container Labeling, Personal Protective Equipment (PPE), Emergency Procedures, Agriculture-Specific Hazards (e.g., Pesticides), Employee Rights and Responsibilities)
[ ] Date of last Hazard Communication training for employee:
[ ] Number of hours spent in training:
[ ] Brief description of the hands-on component of the training (e.g., SDS review, label practice):
[ ] Training format? (In-person, Online, Hybrid)
[ ] Attach training records/attendance sheets:
[ ] Was refresher training provided? (Yes, No)
[ ] Date of last refresher training:

--- COMMUNICATION OF HAZARDS ---
[ ] Are SDS readily accessible to all employees (e.g., online, binder)? (Yes, No, Partially (specify location))
[ ] How are employees notified of new chemicals or updated SDS? (Email, Safety Meetings, Posting Notices, Other (specify))
[ ] Describe the method(s) used to ensure employees understand the information provided on container labels.
[ ] Which of the following methods are used to communicate hazard information? (Safety Data Sheet (SDS) review, Container Label review, Employee training sessions, Warning signs posted in work areas, Other (specify))
[ ] Date of last SDS review and update (if applicable).
[ ] Contact person responsible for maintaining SDS and communicating hazards.

--- AGRICULTURE-SPECIFIC HAZARDS ---
[ ] Are pesticides used on-site? (Yes, No, Occasionally)
[ ] Are fertilizers used on-site? (Yes, No, Occasionally)
[ ] Is anhydrous ammonia used or stored on-site? (Yes, No, Potentially (needs assessment))
[ ] Describe any unique agricultural chemical hazards present on-site (e.g., grain dust, silage fermentation gases).
[ ] Number of employees potentially exposed to pesticides annually.
[ ] Type of pesticide application method(s) used (select all that apply). (Spraying (Aerial), Spraying (Ground), Granular Application, Seed Treatment)
[ ] Date of last anhydrous ammonia leak prevention inspection.
[ ] Describe procedures for dealing with accidental releases or spills of agricultural chemicals.

--- RECORDKEEPING ---
[ ] Date of Last Hazard Communication Program Review
[ ] Date of Last Employee Hazard Communication Training
[ ] Number of Employees Trained (last training)
[ ] Summary of Changes Made to the Hazard Communication Program (if any)
[ ] Copy of Training Sign-in Sheets (last training)
[ ] Copy of the Written Hazard Communication Program
[ ] Description of how SDSs are made available to employees (e.g., binder, electronic access)
[ ] SDS Management System Type (Paper-Based, Electronic, Combination)

--- END OF TEMPLATE ---
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