OSH Self-Certification Form for District and State Offices

The Congressional Accountability Act (CAA) applies provisions of the Occupational Safety and Health Act (OSHAct) to the legislative branch. The OSHAct requires that workplaces be free from recognized hazards that might cause death or serious injury.

The Office of Congressional Workplace Rights (OCWR) presents Safety Recognition Awards to those Members of Congress who presented a hazard-free workplace on the date of the OCWR inspection and completed a brief self-certification form regarding basic safety measures for all of their additional district or state offices. The self-certification is voluntary and not required by the CAA.

Each district and state office should complete the checklist (a PDF copy is available here), but only one certification form below is required to be submitted for each Member of Congress. The deadline is December 31, 2024.

Please consult the publication Common Office Safety Hazards for additional guidance or contact the Office of Congressional Workplace Rights at (202) 724-9250, the House Service Center at (202) 225-4141, or the Senate Service Center at (202) 224-3141.

Note: For assistance with ANY electrical, structural, and/or design issues within an office space, and any issues that are not within an immediate office space (hallways, common areas, stairwells, etc.), staff should notify the appropriate entity to address such issues (e.g. landlord/building maintenance staff).

    I hereby certify that state/district offices have inspected their locations to meet basic safety standards:










    Electrical

    1. Extension cords cannot be used to make permanent wiring connections. Replace all extension cords with surge protector power strips or have permanent electrical outlets installed. Surge protector power strips should be plugged directly into the electrical outlets and not “daisy-chained” (plugged in a series – see photo below).

    a lot of extension cords interconnected

    Have all extension cords (if any) been replaced and are all surge protector power strips plugged directly into electrical outlets?

    2. Power cords, plugs, and electrical outlets must not be damaged or frayed. Are all power cords, plugs, and electrical outlets in good condition?

    3. Electrical outlets near water sources such as sinks located in bathrooms or kitchens must have functioning Ground Fault Circuit Interrupters (GFCI). Test GFCI outlets periodically by tripping the test button. Reset the unit by pushing the reset button. (See Video) If you have a water source within your office suite, have you completed the tests and reset for all GFCIs in the office?

    Fire

    4. Have all employees been trained on the emergency action plan and know what to do in the event of a fire or other emergency?

    5. Are all aisles, stairs, and hallways clear of obstructions that could block pathways that are used as emergency exits?

    Notice of Rights

    6. Do you have Notice of Rights posted in a conspicuous place where notices to covered employees are customarily posted?