Audit

Interview Start

For the auditor to read to employee: Hi, my name is ______, I will be reading you some Safety and IES specific questions. These are anonymous and will be used for data collection purposes. Please answer the questions to the best of your ability, you may not have the answer to all the questions, that is to be expected.

DSM Name

Manager Name

Address and Job Name

What is your Job Title?

Length of Time with IES?

Length of Time on this specific job?

HAZCOM/GHS

What is an SDS? Answer: Safety Data Sheet

Where are the SDS's kept on this location?

Can you identify what pictograms tell you?

What are the two key signal words in describing a chemical hazard? Answer: Danger and Warning: the signal word “DANGER” identifies chemicals and products that present, relatively speaking, a greater or more immediate hazard to the worker, whereas “WARNING” identifies chemicals and products that present a lesser (although still potentially harmful) degree of hazard.

What are the classifications of a chemical hazard? Answer: Health Hazards
Physical Hazards
Environmental Hazards
Mixtures

Which one is the most severe 1, 2, 3, or 4 on the GHS Hazard Scale ? Answer:
1 = Most Severe 4 = Least Severe The GHS hazard ranking scale is as follows:
Category 1 = severe hazard, Category 2 = serious, Category 3 = moderate, Category 4 = slight, and
Category 5 = minimal

Can you show me how to locate one for PVC primer? Answer: Employee should be able to find that in the Binder or online (internal system)

STOP WORK

How does your STOP WORK authority/responsibility work? Answer: Stop work is the authority and obligation to suspend work when health, safety, and environmental risks are not understood or have not been clearly established.
•It is a form of intervention and is one of the most important safety tools on the jobsite.

Do you know who to turn your STOP WORK into or whom to Report it to? Answer: Safety Manager

IES Specific

Do you know where your "Safety Bill of Rights" are kept on this jobsite? - make note of answers

Did you participate in the Safety Orientation? If so can you remember four topics that were covered? - make note of answers

Do you have Pre-Task Huddles? If so, do you participate? - Note response

Can you name two hazards on this job? Are these discussed on your pre-task huddles or in other ways?- note response

How often is temporary power to be inspected? Answer: Weekly

Are you familiar with your Safety Committee or Safety Leadership? Can you explain?- note response

Do you attend the Safety meetings? Do you remember the last topic discussed? - Note response

Did you have a weekly toolbox talk? Do you remember the topic? - Note repsonse

Do you have an IES Training Card on you?

LOTO

What is an electrically safe work condition? Answer: A state in which an electrical conductor or circuit part has been disconnected from energized parts, locked/tagged in accordance with IESCI LOTO policy and verified to ensure the absence of voltage and grounded if determined necessary

How many steps are there to conduct a Lockout/Tagout? Answer: 6 - see page 2 of 5.3 LOTO policy

Can you just tag equipment instead of locking it? Answer: NO

How do you initiate a LOTO? Answer: should be able to describe step #1 of the LOTO policy on page 2

Where are the locks and tags kept for a LOTO? Answer: Site specific. Check with supervisor : Note Answer

Where is your voltage tester kept?

Energized Electrical Work

Did you sign the "Energized Electrical Work" Policy and understand that you cannot work on Energized electrical work without the proper training and approval?

ARC FLASH NFPA 70E
This group of questions only apply if Employee has ARC FLASH Training

What PPE is required to verify a PPE class 2 ARC Flash hazard? Answer: ARC rated long-sleeve shirt, pants, or coveralls, rated for 8 cal. Safety glasses, Hard hat with ARC rated face shield w/balaclava or ARC-rated suit hood with hard hat, hearing protection, leather and voltage rated gloves and leather work shoes.

What are the two risk assessments which must be completed prior to performing energized work? Answer: ARC Flash risk assessment and shock risk assessment

If an ARC Flash designation isn't available, what cal rating is necessary prior to performing energized work? Answer: 40 cal

What is the safe work distance for a second person assisting with an energized 266 volt lighting panel? Answer: Min 3ft

What is the time frame for rubber gloves to be re-certified? Answer: 6 months

General Safety

Can you demonstrate how to inspect a fall protection harness, lanyard, SRL and anchorage? Answer: review inspection process

Can you demonstrate how to inspect an extension cord? Answer: Review inspection process

Where is your rally point in case of an emergency? Answer; Site specific, check with supervisor : Note Answer

Name three hazards reviewed in your project safety orientation. Answer: Have FM complete a project safety orientation with you and review the pre-con JHA: Note answers

Describe how to report an injury. Answer: Should contact immediate supervisor immediately

Where is your first aid kit located? Answer: Site specific, check with supervisor: Note answer

Who is responsible for YOUR safety? Answer: The employee

Can you provide two examples of IES managements commitment to safety? Answer: This is employee perception: Please note their answer.

Is required PPE always available? How do you obtain it? Answer: Site specific: Note answer

What are four sources of energy that need to be locked out?
Answer:
1.    Electrical
2.    Hydraulic
3.    Pneumatic
4.    Mechanical
5.    Gravity
6.    Thermal
7.    Chemical
8.    Fluids & Gases
9.    Pressurized Fluids & Gases

Auditor Name:

Auditor Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.