Exposure Control Plan Review Form
Assess a workplace exposure control plan and document findings, actions, and disposition.
Reviewer name
*
Worksite or department
*
Review date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Plan title and version
*
Work activities and exposure scope reviewed
*
Review criteria
*
Rows
Rating
Notes
Hazard identification
Meets expectations
Needs improvement
Not applicable
Selected controls
Meets expectations
Needs improvement
Not applicable
PPE
Meets expectations
Needs improvement
Not applicable
Training and communication
Meets expectations
Needs improvement
Not applicable
Exposure response
Meets expectations
Needs improvement
Not applicable
Documentation
Meets expectations
Needs improvement
Not applicable
Overall plan rating
*
Effective
Effective with revisions
Requires substantial revision
Findings and gaps
Corrective action plan, including responsible role and target completion date
Review disposition
*
Approved
Approved pending corrective actions
Revisions required
Submit Review
Should be Empty: