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Sample Programs
These checklists are provided by the Maine Department of Labor SafetyWorks! program as a guide to assist employer in compliance with safety and heath regulations. It is the responsibility of the employer to modify these documents to meet site-specific hazards.
- Exposure Control Plan (Word)
- Hepatitis B Vaccination or Declination Record (Word)
- Hepatitis B Vaccination Declination (Word)
- Sharps Log (Word)
- Contact List Template (Word)
- Safety Meeting Record Template (Word)
- Control of Hazadous Energy Sources Ver. 1 (Word)
- Control of Hazadous Energy Sources Ver. 2 (Word)
- Energy Control Procedures Inspection Form (Word)
- Energy Control Procedures Periodic (Word)
- Inspections of Authorised Employee Form (Word)
- Energy Control Procedures Template (Word)
- Lock Removal Procedure Template (Word)
- LOTO Training Template (Word)
- Sample Procedure: Dump Body Trucks (Word)
- Sample Procedure: Front End Loaders (Word)
- Sample Procedure: Waste Water Pumps (Word)
- Alloy Steel Sling Inspection Report (Word)
- Crane Inspection Report (Word)
- Daily Overhead Crane (Word)
- Overhead Crane Monthly (Word)
- Pre-use Inspection (Word)
- Synthetic Sling Inspection Record (Word)
- Wire Rope Sling Inspection Record (Word)
- VDT Booklet (PDF)
- VDT Poster (PDF)
- Workstation Checklist (Word)
- Body Harness Inspection (Word)
- General Inspection Procedures (Word)
- General Inspection Procedures Lanyards (Word)
- Sythetic Sling Protection (Word)
- Maine 301 Illness and Incident Report (Excel)
- OSHA Forms 300, 300A, 301 (Excel)
- OSHA Forms 300, 300A, 301 and Instructions (PDF)
- Healthcare Covid Log (PDF)
- COVD JAS Supplement (Word)
- Interim COVID Guidlines for Field Work (Word)
- Sample Pandemic Plan (Word)
- Site Safety Plan with COVID (Word)
- Workplace COVID Resources (Word)
- Medical Evaluation Checklist (Word)
- Qualitative Respirator Fit Testing All Methods (Word)
- Qualitative Respirator Fit Testing Saccharin Only (Word)
- Respirator Fit Testing Checklist (Word)
- Respirator Medical Evaluation Form (Word)
- Respirator Selection Logic (Word)
- Respiratory Protection Program Template (Word)
- Respiratory Protection Program Template for N-95 Users (Word)
- Written Respiratory Protection Program Evaluation Checklist (Word)
- Facility Inspection Form (Word)
- Jobsite Inspection Checklist (Word)
- Heat Illness Prevention Plan (Word)