M&A Due Diligence Assessment
HIGHLY CONFIDENTIAL
**CONFIDENTIAL**
Date
*
-
Month
-
Day
Year
Date
State
Project Name
*
Name- Company HSE Contact
First Name
Last Name
Email- Company HSE Contact
example@example.com
Man Hours Last 365
Number of Recordable Injuries 365
Number of LTIs 365
TRIR
EMR
OSHA Citation(s) Last 3 Years
Yes
No
Other Regulatory Citation(s) Last 3 Years
Yes
No
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Summary
1. HSE RECORDKEEPING
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
1.1 All injuries and illnesses (other than those only requiring first aid) are recorded on the OSHA 300 log.
1.2 Employee training records are available for review.
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2.0 EMERGENCIES
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
2.1 Contingency plans for handling emergencies or unexpected events.
2.2 Emergency action plan(s) readily available to workers.
2.3 Procedures for accessing emergency services.
2.4 Emergency evacuation plan.
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3.0 WRITTEN PROGRAMS
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
3.1 A documented Hazard Communication Program exists, and Safety Data Sheets (SDS) are accessible to employees.
3.2 The confined space program, including procedures for obtaining permits and entering permit-required confined spaces, is documented.
3.3 The lockout/tagout program is clearly written so employees know how to de-energize equipment.
3.4 A written respiratory protection program lays out the rules of selecting, testing, wearing, storing, and cleaning this personal protective equipment (PPE).
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4.0 SAFETY AND HEALTH PROGRAM
Satisfied
Somewhat Satisfied
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Notes
4.1 An active safety program exists for maintaining employee safety and health, and it’s clear who oversees this program.
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5.0 EMPLOYER POSTING
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
5.1 The mandatory OSHA Job Safety and Health Protection Poster is prominently displayed where employees can see it.
5.2 Emergency phone numbers are clearly posted.
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6.0 FIRST AID
Satisfied
Somewhat Satisfied
Not Satisfied
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6.1 Stocked first aid kits are available in all work areas. Someone is responsible for refilling these on a regular basis.
6.2 Eyewash stations, sinks, and/or showers are available for flushing the eyes or skin after exposure to harmful substances.
6.3 Employees have received appropriate first aid training and instructions about what to do in an emergency.
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7.0 FIRE PROTECTION
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
7.1 The fire alarm system is certified and tested annually.
7.2 All fire doors are clear from obstructions.
7.3 Fire extinguishers of the appropriate type are mounted in accessible locations.
7.4 Fire extinguishers are regularly recharged, and this is noted on the tag.
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8.0 PERSONAL PROTECTIVE EQUIPMENT
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
8.1 Appropriate PPE such as face, head, eye, hand, and foot protection are available for employees who need to wear it to safely perform their jobs.
8.2 Procedures exist for testing, storing, and cleaning of PPE.
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9.0 GENERAL WORK ENVIRONMENT
Satisfied
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9.1 The workplace is clean and sanitary.
9.2 The workplace is organized—tripping hazards and other problems associated with a messy workplace do not exist.
9.3 The minimum number of restrooms is provided for employees.
9.4 Lifting devices and rigging is in proper order without damage.
9.5 Overhead falling object hazards present.
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10.0 WALKWAYS
Satisfied
Somewhat Satisfied
Not Satisfied
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10.1 All aisles are appropriately marked and unobstructed.
10.2 Holes in the walking surface are covered or repaired so people can walk safely.
10.3 Non-slip materials are used on wet surfaces to improve traction.
10.4 Walkways that pass by moving equipment or other hazards are positioned so people won’t be exposed to hazards.
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11.0 EGRESS & EVACUATION
Satisfied
Somewhat Satisfied
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11.1 Exits are labeled with exit signs and illuminated so they’re always visible.
11.2 Enough exits exist so people can leave quickly during an emergency.
11.3 All doors and routes that could be mistaken for exits are marked so people aren’t confused about their purpose (e.g. “NOT AN EXIT” or “TO STORAGE ROOM”).
11.4 All exits are free from obstructions.
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12.0 LADDERS
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
12.1 All ladders are in good condition and receive maintenance when needed.
12.2 All employees have received training about how to safely use a ladder.
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13.0 HAND TOOLS AND POWER TOOLS
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
13.1 All tools used in the workplace are in good condition.
13.2 Moving parts are guarded to prevent injury.
13.3 Tools are stored in a secure, dry location.
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14.0 MACHINE GUARDING
Satisfied
Somewhat Satisfied
Not Satisfied
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14.1 All machinery and equipment are regularly inspected and serviced as needed.
14.2 Power shut-offs exist within reach of operators.
14.3 Emergency stop buttons are red.
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15.0 LOCKOUT / TAGOUT
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
15.1 Procedures require that all equipment is de-energized or disengaged and locked out during maintenance or cleaning.
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16.0 WELDING & CUTTING
Satisfied
Somewhat Satisfied
Not Satisfied
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16.1 Compressed air gas cylinders are examined on a regular basis for leaks, rust, or defects.
16.2 Signs clearly stating smoking, matches, and other ignition sources are not allowed are posted.
16.3 PPE including eye protection, helmets, goggles, and hand shields meet standards.
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17.0 COMPRESSORS/AIR RECEIVERS
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
17.1 Every receiver has a pressure gauge and at least one automatic safety valve.
17.2 There is a current operating permit.
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18.0 COMPRESSED GAS CYLINDERS
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
18.1 All cylinders are legibly labeled to identify their contents.
18.2 All cylindars are properly secured to prevent tipping.
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19.0 FORKLIFTS
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
19.1 Employees who operate forklifts have received proper training for the trucks they operate.
19.2 Untrained employees are not allowed to operate forklifts.
19.3 Forklifts are equipped with warning horns that can be heard above normal noise levels.
19.4 Brakes can bring trucks to a complete stop even when the truck is fully loaded.
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20.0 CONFINED SPACES
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
20.1 Permit-required confined spaces are only entered with the proper permit and according to the procedures of the confined space program.
20.2 Regular tests of the atmosphere are performed before and while people are inside a confined space.
20.3 An attendant is posted outside confined spaces while work is performed in case of an emergency.
20.4 Respiratory protection is required if the atmosphere is unsafe.
20.5 If an emergency occurs, responders only enter the confined space with respiratory protection and a lifeline.
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21.0 ENVIRONMENTAL CONTROLS
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
21.1 All work areas have adequate lighting.
21.2 Work areas have appropriate ventilation systems.
21.3 Hazardous substances such as blood and infectious materials are identified.
21.4 Water for drinking, cooking, and washing is potable.
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22.0 FLAMMABLE AND COMBUSTIBLE MATERIALS
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
22.1 Proper storage containers and methods are used to prevent spontaneous combustion of materials.
22.2 All combustible waste, debris, and scrap is stored in metal containers and removed from the worksite appropriately.
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23.0 HAZARD COMMUNICATION & HANDLING DANGEROUS SUBSTANCES
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
23.1 Employees are trained so they understand hazards, can read SDSs and labels, and know how to safely handle chemicals such as acids, bases, caustics, etc.
23.2 Employees who handle hazardous chemicals must wear appropriate PPE.
23.3 There is a comprehensive list of hazardous substances used in the workplace and the corresponding SDS for each chemical.
23.4 Employees are trained so they understand OSHA’s blood borne pathogens standard.
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24.0 ELECTRICAL
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
24.1 Electrical equipment is installed appropriately and receives regular maintenance.
24.2 Necessary labels of electrical hazards are posted on equipment.
24.3 Employees who will work on or near electrical equipment have received proper training.
24.4 Temporary wiring such as flexible cords does not cause a tripping hazard.
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25.0 NOISE
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
25.1 Noise levels in the workplace do not exceed 85 decibels.
25.2 In locations where loud noises occur, employees wear hearing protection.
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26.0 PIPE IDENTIFICATION
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
26.1 Outlets and taps attached to pipes with non-potable water are marked as unsafe for drinking, washing, etc.
26.2 Where colored painted bands or tapes are used on pipelines, they are spaced at appropriate intervals and at outlets, valves, and connection points.
26.3 A color code is posted for pipes so employees can see what hazards pipes present.
26.4 Names and name abbreviations are easily visible on pipe labels.
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27.0 TRANSPORTING EMPLOYEES
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
27.1 Vehicles that transport employees have brakes, lamps, mirrors, horns, windshields, and turn signals and are in good condition.
27.2 Vehicles have handrails, steps, and other devices to help employees mount or dismount.
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28.0 QUALITY MANAGEMENT
Satisfied
Somewhat Satisfied
Not Satisfied
Notes
28.1 A Quality Management System (QMS) is in place.
28.2 An Environmental Management System (EMS) is in place.
28.3 Procedures for product design, testing, and validation to ensure they meet industry standards and customer requirements.
28.4 Any environmental violations, fines, or ongoing investigations.
28.5 Process for supply chain management, including supplier selection, evaluation, and quality assurance processes.
28.6 History of supply chain disruptions or quality issues.
28.7 Efficient operational processes, including manufacturing, logistics, and service delivery.
28.8 Any bottlenecks, waste, or inefficiencies that could impact quality.
28.9 Recent wage reductions for hourly or salary employees.
28.10 Accurate documentation and record-keeping practices for quality, safety, and environmental compliance.
28.11 Records are accurate, complete, and easily accessible.
28.12 Does the company collect, analyze, and respond to customer feedback and complaints.
28.13 Does the company have a risk management processes, including hazard identification, risk assessment, and mitigation strategies.
28.14 Metrics related to customer satisfaction and retention.
28.15 Processes for continuous improvement and corrective actions.
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29.0 NOTES
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