Safety Office
   
   
  

Compliance Indicators

This section contains a collection of "checklists" related to the main health and safety issues affecting the University. The intention is that these may be used by Schools to self-check their performance in these areas. Although the indicators are not exhaustive for each topic they do cover the principal aspects of statutory requirements or University safety policy. Consequently, satisfactory responses to the issues contained within the compliance indicator for any particular topic should be a strong indication that a good standard of performance is being achieved in this area.

For some topics it may be necessary to refer to more than one compliance indicator. For example if examining performance in managing machinery safety noise control could be an issue which in turn could relate to personal protective equipment issues for hearing protection issued.

The checklists contained in the Executive Summary should be used as compliance indicators for the management of health and safety.

It is intended that the range of compliance indicators will be expanded over time. In particular the coming into force of significant new regulations or developments in safety policy will be supplemented with a compliance indicator.

Accident Reporting and Investigation

    • Have School arrangements been produced and disseminated which describe how accidents which resulted in injury, or incidents which had the potential to do so, are reported?
    • Does the DSO receive a copy of all report and investigation forms after completion?
    • Is the Head of School informed of all serious incidents at the earliest opportunity?
    • Are clear, factual and contemporaneous records kept of the circumstances of all injury accidents?
    • Do the factual records include photographs, diagrams, observations and measurements along with witness statements as appropriate?
    • Are the circumstances of all injury accidents and other serious incidents discussed at the School's safety committee meeting and/or management meeting?
    • Is the School's accident performance reviewed annually?
    • In the event of a serious accident, are there arrangements for ensuring the area is left undisturbed, other than work needed to make the situation safe, until the incident has been investigated?
    • Are there arrangements to ensure that the Safety Office receives prompt notification of those incidents which require reporting to the Health and Safety Executive?

Biological Hazards

    • Are there School copies of the relevant principal guidance documents?
    • Is there a School Biological Safety Officer?
    • Are local rules for biological safety available?
    • Is there an inventory of all Biological Agents used in the School?
    • Is written information concerning the hazards, precautions and hazard/containment categories of Biological Agents used in the School available (ACDP document; MSDS  available via Safety Office Web Page).
    • Is there a mechanism for approving proposals for introducing new biological agents so as to ensure that appropriate containment measures are available?
    • Are all category 3 biological agents and containment level 3 laboratories registered with the Safety Office?
    • Are microbiological cabinets tested annually for containment performance? Is this recorded?
    • Are new Genetic Modification projects approved by the Genetic Manipulation Safety Committee?
    • Are workers exposed to genetically modified organisms or hazard group 3 biological agents subject to health surveillance via Occupational Health?
    • Are the appropriate disinfection and decontamination procedures documented and followed?
    • Is Biological Waste clearly identified and segregated from other waste?
    • Is instruction and training in appropriate biological safety procedures recorded?
    • Is there a list of workers with laboratory animals for the purpose of ensuring that health surveillance via Occupational Health is occurring?

The principal documents are: 

    • ACDP 4th edition (1995) re categorisation and containment of biological agents;
    • HSC guidance (1991) re safe working and the prevention of infection in clinical laboratories (and similar for post-mortem rooms);
    • ACDP guidelines (1995) re working with HIV and hepatitis;  ACDP guidelines (1994) for work with transmissible spongiform encephalopathies;
    • Genetically Modified Organisms (Contained Use) Regulations 1992 and associated guidance notes.

Chemical Safety

    • Are materials safety data sheets available and readily accessible for all hazardous substances in the School?
    • Do chemicals ordering procedures take into account the availability of precautions needed for working with the chemical?
    • Have all procedures been assessed to determine the likelihood and extent of exposure to the substance?
    • Are there written procedures for operations with hazardous chemicals which describe the hazards and precautions to be taken?
    • Has information, instruction and training appropriate to the level of hazard been provided to enable the people carrying out the work to understand and apply the precautions?
    • Are there clearly defined waste disposal procedures?
    • Are all hazardous substances in storage or use contained in clearly labelled and suitable containers?
    • Are there secure storage arrangements for very toxic chemicals (R26 , 27 and/or 28)? Is access to and use of these restricted to authorised individuals?
    • Certain very toxic chemicals (nerve agents e.g. sulphur and nitrogen mustards, ricin, saxitoxin) are subject to licencing controls under the Chemical Weapons Act 1996. These must be authorised via the Safety Office.
    • Are the requirements relating to personal protective equipment being correctly applied?
    • Have respiratory sensitisers (R42) been identified? If significant exposure is likely are those working with the material subject to health surveillance through Occupational Health?
    • Have carcinogenic materials been identified (risk phrases R45 or R49)? Do assessments consider justification for their use? Is use confined to designated areas to minimise the spread of contamination? Are those working with carcinogens subject to health surveillance?
    • Are local exhaust facilities (fume cupboards and other fume/vapour/dust extraction units) examined and tested on an annual basis to ensure continuing effectiveness? (NB. the Estate Office arrange for the annual testing of fume cupboards).

Display Screen Equipment

    • Has somebody in the School being designated to co-ordinate compliance with the regulations? Are they or other nominated staff trained in assessment of DSE? (attended University course on Assessing for Safe Use of Display Screen Equipment or other similar course, proof of attendance).
    • Have all "users" in the School been identified and a list maintained up-to-date by the above person?
    • Have all "users" received training on Safe Use of Display Screen Equipment, eg attended University Course, completed Learning Link on-line training?
    • Have all "users" received an eye and eyesight test if they wished to have one? Does the School hold a current list of who has had eye and eyesight tests and when (maintaining list not essential)?
    • Have the workstations of all "users" been assessed and remedial actions identified?
    • Is there a programme for carrying out actions arising from assessments with target times for completion and persons responsible?
    • Have assessments which were carried out more than two years ago been reviewed to ensure the information is still valid? Has the review been recorded?
    • Are the School arrangements for DSE safety incorporated in the School Safety Policy?
    • Is there a system for new comers to the School being considered as to whether they are "users"?

If all the above are answered positively, the School has an adequate management system in place for this issue.

Electrical Safety

    • Is there a register of all portable electrical equipment in the School?
    • Is this inspected and tested in accordance with university policy?
    • Are records of the tests available?
    • Is all in-use equipment marked with current pass labels?
    • Is there a procedure to take defective equipment out of use until fixed?
    • If equipment is loaned out, is it checked before lending?
    • If loaned equipment is on prolonged loan, are there arrangements for ensuring any inspections or tests due are carried out and recorded?
    • Is new equipment inspected and/or tested before use?
    • Is equipment which is brought back into service after a period of storage inspected and tested before use?
    • If electrical equipment is designed and /or built in-house, is this done in accordance with Part B of the University Code of Practice for Electrical Safety?
    • If electrical testing on exposed live conductors at dangerous voltages (i.e. 50v AC, 110v DC and above) is carried out, is this done in a facility complying with standard described in part 3 of the University Code of Practice for Electrical Safety?
    • Are those carrying out live working at dangerous voltages competent?
    • Are the other aspects of Part C (e.g. justification and isolation) considered in relation to live working?

Fire Safety

    • Are all persons who work in your School aware of the following?
        • Sound of the fire alarm.
        • Location and method of operation of the fire alarm call points.
        • Location of the internal telephones and the need to dial 8888 to call the Fire Service via Trent Security.
        • The various exit routes available from the building.
        • Procedure for safe evacuation of the building.
        • The location of the assembly point.
        • The location of the fire extinguishers.
    • Has training been provided in the use of the fire extinguishers provided?
    • Are all exit routes from the building capable of being easily and immediately negotiated?
    • Has a fire evacuation co-ordinator been appointed with several deputies, to provide cover at all times?
    • If your School is operating the "token" system for determining the clear evacuation of the building, are the tokens - building plans - co- ordinators hi-visibility tabard in place?
    • Are details of potential hazards clearly indicated on the plans?
    • Has someone been given the responsibility for a weekly/monthly inspection of exit routes, signs, tokens, extinguishers, fire doors, fire exit doors, internal telephones t o ensure that they are available and would be effective if needed?
    • Is the fire alarm tested weekly?
    • Is the emergency lighting tested monthly?
    • Does your School have an annual/six monthly fire drill?
    • Are these checks recorded in a fire log book? (Does the Safety Office and Estate Office know who holds the Log Book?)
    • Is there a system for fire hazards to be reported? Are staff aware of this?
    • Is fire safety information given on induction and to other occasional users of your facilities or to contractors working in the building?
    • If members of the public or others use the building after hours are sufficient staff available to ensure that the fire safety procedures are followed?
    • Have emergency shut down procedures for specialised equipment been established? Have staff been trained in this?

First Aid Provision

    • Have written arrangements for the local provision of First Aid been disseminated?
    • Have sufficient First Aiders been appointed to ensure cover is available during holiday and sickness absence etc, and for all aspects of the School's activities, including work at remote locations?
    • Are travelling first aid kits provided in the School's vehicles?
    • Are first aid boxes checked frequently and the contents replaced. Are these checks recorded, eg on a card within each box?
    • Are first aid boxes accessible, ie not within offices which may be locked?
    • Is the number of First Aiders within the School monitored for sufficiency?
    • Are the names and extensions of First Aiders disseminated, eg by a list at each first aid box, other notices, appendix to the School's safety policy?

Lasers

    • Is there a School Laser Supervisor?
    • Are all lasers except Class 1, 2 and those contained within office equipment registered with the Safety Office?
    • Is the acquisition of new lasers notified to the DLS and registered with the Safety Office?
    • Is the use of Class 3B and Class 4 lasers restricted to Designated Laser Areas?
    • Are local rules for the safe use of lasers available? Have these been issued to the users? Is this recorded? 
    • Have risk assessments been carried for all work involving Class 3B and Class 4 lasers?
    • Are written protocols provided for each Class 3B and Class 4 laser? 
    • Are all users of Class 3A lasers and above registered with the Safety Office?
    • Have users of Class 3B and Class 4 lasers completed the Laser Users questionnaire and been approved for laser work by Occupational Heatlh prior to commencing their laser work.
    • Are laser systems inspected on an annual basis and the laser survey form completed in respect of each system?
    • Is use of laser systems restricted to authorised ie registered and trained operators?
    • Is laser eye protection (Class 3B and 4) available, appropriate, in good condition and worn?
    • Are laser systems correctly labelled (i.e. hazard, class, point of emission)?
    • Are laser areas indicated with warning signs?
    • Are copies of the 1992 CVCP "Notes of Guidance" for lasers readily available?
    • Are all new laser pointers restricted to a maximum output of class 2.

Lifting Equipment

    • Is there a register of all lifting equipment in the School (held locally and/or by the Estate Office)?
    • Are new items entered onto this register on receipt into the School?
    • Are all ropes, chains and lifting tackle (rope and chain slings, rings, hooks, shackles and swivels) examined every 6 months by the engineering surveyor appointed by the Estate Office?
    • Is a table showing the safe working load of all types of ropes, chains and lifting tackle in use displayed in the store and in other suitable and prominent positions? (Equipment which is marked with the SWL does not need to listed in the table).
    • Are all lifting machines (crane, crab, winch, teagle, pulley block, gin wheel, transporter or runway) examined by the engineering surveyor every 14 months?
    • Are certificates of examination kept with the register in the School's records (these are forwarded from the Estate Office)?
    • Are all lifting machines clearly marked with their safe working load?
    • Is there a system to ensure that appropriate action is taken in the event of defects being identified during the examinations?
    • Are new items of lifting equipment accompanied by a certificate of testing and thorough examination? (Equipment may not be taken into use for the first time without such a certificate).
    • Is all lifting equipment correctly stored to prevent damage or deterioration and is it maintained (where appropriate) in accordance with the manufacturers instructions?
    • Have people involved in slinging operations received training and is this recorded?

Machinery Safety

    • Does new and recently acquired machinery comply with the Machinery (Safety) Regulations as indicated by the "CE" mark and a "declaration of conformity"? (These relate to manufacturer and supplier duties for the machinery to be safe for its intended use).
    • Are the dangerous parts of the machine effectively guarded ( to prevent accidental and careless or inattentive contact but not reckless or malicious contact)?
    • Are guards securely fixed in place?
    • If frequent removal is needed are the guards interlocked to prevent operation with guards missing?
    • Is guarding sufficiently robust to contain ejected process material, (e.g. swarf, hot liquids, fragmenting workpiece or tool)?
    • Are regular checks on the availability, integrity and functioning of guards, interlocks and other safety devices and equipment made?
    • Where a range of interchangeable guards and safety devices are needed to cover a range of different operations are these readily available?
    • Are there written operating instructions which include the safety precautions to be followed? Do these cover setting up, cleaning, adjustment, maintenance etc. as well as use?
    • Have noise assessments been carried out where necessary? Has remedial action where identified been implemented?
    • Are the operating controls and any emergency stops clearly labelled?
    • Can the equipment be securely isolated from power supplies to enable maintenance work to be safely carried out or to prevent unauthorised use?
    • Is the machine stable and well lit?
    • Are signs provided to warn of hazards, safe operating parameters ( e.g. max. spindle speed, temp, pressure, load), action reminders ( e.g. wear eye protection) or prohibitions (e.g. restricted to authorised persons)?
    • Is information, instruction and training appropriate to the hazard provided for the operators? Is this recorded?
    • Are there "local rules" governing use of machinery ( i.e. general procedures which form part of the School safety policy)?

Manual Handling Operations

    • Has somebody in the School been designated to co-ordinate compliance with the regulations? Are they trained in assessment of Manual Handling Operations (eg attended University course on Assessing of Manual Handling Operations)?
    • Have all those who regularly carry out work involving manual handling attended the University Lifting and Handling course?
    • Have Manual Handling Operations where there is a risk to the health and safety of employees been assessed and remedial actions identified?
    • Are the records maintained by the co-ordinator/assessor and are they available to members of the School?
    • Is there a programme for carrying out actions arising from assessments with target items for completion and persons responsible?
    • Have assessments which were carried out more than 3 years ago have been reviewed to ensure that the information is still valid? Has the review being recorded?
    • Have the School's arrangements for Manual Handling operations been incorporated in to the School's Safety Policy?
    • Are newcomers to the School made aware of any information relevant to them concerning handling and lifting (eg the findings of assessments and safety working procedures)? Does this include arrangements for them to receive training where appropriate?
    • Are assessments reviewed in the light of manual handling accidents to ensure that the risk is minimised to the lowest level practicable?

Noise

    • Have noisy operations been identified? (Rule of thumb 90 dB(A) equates to needing to shout to carry on a conversation with someone 1 metre away).
    • Have operations involving high instantaneous noise levels, ( e.g. percussive noises (hammering or other loud impacts) or explosive releases (cartridge operated tools, guns) been identified?
    • Have noise assessments been carried out to determine exposure levels?
    • If noise exposures exceed 85dB(A) as an 8-hour time weighted average, or the peak action level of 200 pascals (140 dB) for instantaneous noise, have all reasonably practicable steps been taken to reduce this?
    • Are noise assessments reviewed at least at three-yearly intervals; or in the light of changes to the equipment or work area; or if other events cause their validity to be questioned?
    • Is hearing protection issued only as the "last resort"?
    • Is use of hearing protection compulsory for areas or operations exceeding 85dB(A)?
    • Have those issued with hearing protection received instruction on its use and the reasons for this?
    • Do wearers of non-disposable hearing protection (i.e. muffs) routinely check its condition.
    • Are signs prominently displayed where hearing protection must be worn?
    • Is hearing protection available for all those exposed to noise levels exceeding 85 dB(A)?
    • Is hearing protection available for and issued to visitors?
    • Is audiometry provided via Occupational Health for those exposed to high noise levels as follows:
        • 85dB(A) and above, initially and at a minimum of three-yearly intervals
        • 80 to 85dB(A), minimum of five-yearly intervals

Personal Protective Equipment (PPE)

Personal Protective Equipment includes clothing and equipment which is worn to protect against a risk to health and safety.

Clothing includes aprons, lab. coats, chemical suits, gloves, safety footwear and safety helmets, thermal clothing and high visibility jackets. It also includes clothing to protect against environmental hazards such as adverse weather where this is to ensure health an safety but not comfort. Uniforms, ordinary working clothes or clothing to protect the product rather than the wearer are not items of PPE.

Equipment includes eye, hearing and respiratory protection, life jackets, safety harnesses, underwater breathing apparatus.

    • Is PPE issued as a "last resort" only, i.e. after considering maximising protection through engineering controls or safe systems of work first?
    • New PPE should comply with PPE (Safety) Regulations which place duties on manufacturers and suppliers to confirm that it meets certain standards of performance. It should be marked with "CE".
    • Where more than one item of PPE needs to be worn simultaneously are these compatible?
    • Is the performance of the PPE appropriate to the nature of the hazard? (E.g. type of glove resistant to the particular solvent, respiratory protection appropriate to the nature and concentration of the contaminant).
    • Is information, instruction and/or training (as appropriate to the level of the risk and complexity of the PPE) given to the user of the equipment? Is this recorded?
    • Do users of PPE carry out basic checks on its condition? Are losses or defects reported?
    • Are spare items of PPE, or replaceable components, readily available?
    • Are there arrangements for providing PPE to visitors?
    • For complex equipment protecting against significant hazards (e.g. active respiratory protection or breathing apparatus, safety harnesses) is there a formal system of examinations to ensure that the performance of the equipment is being maintained?
    • Is suitable storage provided for PPE when not in use to protect against deterioration or contamination? (Storage accommodation for PPE which may become contaminated should be separate from that provided for ordinary clothing).

Pressure Systems

NB a "pressure system" is a system which contains a relevant fluid and comprises either a rigid pressure vessel and its associated pipework and protective devices; or the pipework and devices attached to a transportable gas container. A relevant fluid is either steam, a gas at a pressure exceeding 0.5 bar, or a liquid having a vapour pressure exceeding 0.5 bar when in equilibrium with its vapour at either the actual temperature of the liquid or at 17.5 degrees Celsius (i.e. typically a liquefied gas held at high pressure but would also include pressurised hot water held above its boiling point - loss of pressure would cause the water to vaporise).

    • Are all existing and new pressure systems registered with the Estate Office?
    • Is a copy of the written scheme of inspection available in the School or area concerned?
    • Are written operating instructions provided which contain all the information needed to ensure safe operation, including start-up, shut-down, stand-by and emergency situations?
    • Do the operating instructions identify foreseeable adverse situations which could arise and the action to make these safe?
    • Is operation of the system confined to authorised users following the provision of an appropriate level of instruction or training? Is authorisation and training recorded?
    • Are the safe working limits clearly displayed on the system? (The minimum requirement is for the maximum safe working pressure. Complex systems may also require other parameters such as temperature, time, volume, flow-rate, heat input or coolant flow to be marked)
    • Are the pressure systems examined in accordance with the written scheme (ie frequency and nature of checks)?
    • Are copies of the examination reports received from the Estate Office, actioned where necessary and kept readily available?
    • Are regular visual checks made in addition to the above? (E.g. looking for corrosion, leaks, damage etc)

Work Equipment

The term "work equipment" includes machinery, appliances, apparatus, tools and assemblies of components. It includes hand tools, laboratory apparatus, lasers, overhead projectors, engineering machinery and grounds maintenance vehicles. There are separate compliance indicators for some specific types of work equipment such as machinery, electrical equipment, lifting equipment and pressure systems.

    • Is work equipment suitable for the purpose and location (i.e. the right equipment for the task)?
    • Are the safety related features of equipment checked periodically to ensure that their integrity is maintained? (The nature and frequency of the checks depends upon the severity of hazard should the equipment fail and the complexity of making the check - at the simplest level this could be visual checks by the user and/or as a part of general safety inspections of the work area).
    • For equipment which could pose a serious hazard if it failed in service, is planned preventative maintenance carried out? (This should take account manufacturers recommendations and would include replacement /refurbishment of components or equipment before the end of its service life).
    • Is an appropriate level of written information and instruction provided to enable the equipment to be used safely? Are users and supervisors aware of this?
    • Do the information and instructions describe the conditions in which, and methods by which, the equipment may be used; foreseeable abnormal situations which could arise and the action to be taken? ( This may vary from a short section in the School's safety policy to specific and detailed literature for the individual item).
    • Has training been provided and recorded to enable the safe use of more complex and hazardous equipment?
    • Is equipment marked with safety information such as hazard warnings, safe operating limits, action reminders as appropriate?
    • Is equipment stable in use if unintended movement could be hazardous?
    • Is sufficient lighting provided to enable safe use?
 

Safety Office

Pharmacy Building - Lower Ground Floor
University Park
University of Nottingham
Nottingham, NG7 2RD

Telephone: +44 (0)115 951 3401
email: bb-safety-office@exmail.nottingham.ac.uk