2013 Emerson Safety Audit - with Liebert Services

• Conducted on

  Date

• Employee being audited

• Site Name

• Location
  Address

• Name of Customer Contact

• Prepared by

Scope of Work

• Scope of Work

  Select Annual Preventitive Maint Semi-Annual Breaker Testing Retrofitting Installation/Startup Project Manager Contractor Load Bank Test Other

  • Annual Preventitive Maint
  • Semi-Annual
  • Breaker Testing
  • Retrofitting
  • Installation/Startup
  • Project Manager
  • Contractor
  • Load Bank Test
  • Other

• Other SOW:

• Ticket Number:

JOB SITE DOCUMENTATION

• Was a EHS Survey / Project Safety Tailgate Meeting conducted? Is the form properly filled and available onsite

  Yes

  No

  N/A

• Did the Service Engineer (SE) receive instructions regarding evacuation in the event of an emergency

  Yes

  No

  N/A

• Does the SE know the onsite emergency phone number?

  Yes

  No

  N/A

• Does the SE know who the emergency contact is?

  Yes

  No

  N/A

• Does the SE know where the nearest hospital or burn center is?

  Yes

  No

  N/A

• If required by the Customer, did the SE use a Method of Procedure?

  Yes

  No

  N/A

• If provided by the customer, did the SE attend site-specific safety training?

  Yes

  NO

  N/A

• What did it cover?

  Select PPE LOTO Safety Requirements Emergency Evacuation

  • PPE
  • LOTO
  • Safety Requirements
  • Emergency Evacuation

• If required, has the arc flash boundary been delineated using a safety barricade or tape?<br>

  Yes

  No

  N/A

• Are MSDS's available for the materials being used on site?

  Yes

  No

  N/A

• Is there an ENP-company safety and environmental manual available on site?

  Yes

  No

  N/A

• Is the SE familiar with the Company work / rest notification rule?

  Yes

  No

  N/A

• How many hours on site?

• How many hours of travel today?

TRAINING

• Is the Service Engineer (SE) certified in First Aid, CPR and AED? ​ <br> First Aid Date________ CPR Date________<br>

  Yes

  No

  N/A

• First Aid Training Date

  Date

• CPR Training Date

  Date

• Is the SE’s carrying their current First Aid and CPR card, if appropriate?

  Yes

  No

  N/A

• Has the SE received Blood Borne Pathogens training? Training Date__________

  Yes

  No

  N/A

• BBP Training Date

  Date

• Has the SE received PPE training?

  Yes

  No

  N/A

• PPE Training Date

  Date

• Has the SE received Fall Protection training? Training Date_________

  Yes

  No

  N/A

• Fall Protection Training Date

  Date

• Has the SE received LOTO training? Training Date_________

  Yes

  No

  N/A

• LOTO Training Date

  Date

• Has the SE received Arc Flash Training? Training Date__________

  Yes

  No

  N/A

• Arc Flash Training Date

  Date

• Has the SE received Confined Space Training? Training Date__________

  Yes

  No

  N/A

• Confined Space Training Date

  Date

• Has the SE received Electrical Safety? Training Date__________

  Yes

  No

  N/A

• Electrical Safety Training Date

  Date

• Has the SE received Fire Extinguisher or Fire Prevention training? ​ <br> Fire Extinguisher Training Date________Fire Prevention Training Date_________

  Yes

  No

  N/A

• Fire Extinguisher Training Date

  Date

JOB SITE CONDITIONS

• Is the work site clean of trash, and maintained in an orderly manner?

  Yes

  No

  N/A

• Are Tripping Hazards identified and minimized?

  Yes

  No

  N/A

• Does the site contain potable drinking water?

  Yes

  No

  N/A

• Are chemicals/combustible liquids identified and stored properly?

  Yes

  No

  N/A

• Are appropriate fire extinguishers with current inspection tags available?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Does the Service Engineer (SE) have company issued hard hat and<br>safety glasses as required? ​ <br>

  Yes

  No

  N/A

• Is the SE wearing appropriate safety/work shoes?

  Yes

  No

  N/A

• Is the SE conforming to customer’s required specific PPE requirements?

  Yes

  No

  N/A

• Does the SE have an acid faceshield and apron, if required?

  Yes

  No

  N/A

• Are electrical gloves & sleeves inspected before use?

  Yes

  No

  N/A

• Are voltage insulating gloves marked with the current testing or MFG dates?

  Yes

  No

  N/A

• Glove Date

  Date

• Glove photo

  Media

• Are voltage insulating sleeves marked with current testing or MFG dates?

  Yes

  No

  N/A

• Sleeve Date?

  Date

• Sleeve photo

  Media

• Does the SE have all required Arc Flash ATPV cal/cm2 clothing and are <br>they wearing the appropriate Arc Flash ATPV cal/cm2 for all tasks? ​

  Yes

  No

  N/A

• Does the SE have Arc rated face shield and is it in good condition?

  Yes

  No

  N/A

• Does the SE have the appropriate arc rated hearing protection?

  Yes

  No

  N/A

• K. Do 3rd Party Service Providers working for our company have appropriate<br>PPE including arc flash protection? ​ <br>

  Yes

  No

  N/A

FALL PROTECTION

• If work in areas requiring fall protection are identified as a job requirement,<br>is the Service Engineer (SE) authorized to wear fall protection?​ <br>

  Yes

  No

  N/A

• If the work being performed requires fall protection, is the equipment available,has it been inspected prior to use, and is it being used correctly?

  Yes

  No

  N/A

• Where practical, are all SE’s using fall protection systems over 4 feet (1.2 m)?

  Yes

  No

  N/A

HOT WORK

• If job-required, has the Services Engineer (SE) obtained a Hot Work Permit?

  Yes

  No

  N/A

• If hot work is required, did another SE performed Fire Watch duties?

  Yes

  No

  N/A

• Did the Fire Watch attend their post for at least 30 minutes after hot work?

  Yes

  No

  N/A

ELECTRICAL SAFETY / LOTO

• Has the Service Engineer (SE) removed all jewelry before working on<br>energized equipment? ​ <br>

  Yes

  No

  N/A

• Has the Customer opened main breakers controlling equipment or wiring?

  Yes

  No

  N/A

• Have stored energy sources (capacitors, batteries, springs, charging mechanisms, moving machinery parts,<br>hydraulic systems, etc.) been properly discharged, blocked or released?​

  Yes

  No

  N/A

• Have energy sources (electrical & mechanical) been locked out and tagged?

  Yes

  No

  N/A

• Require a demonstration of LOTO…did SE perform the procedure correctly?

  Yes

  No

  N/A

• Has the SE tested the circuit being worked on to verify that it is at a zero energy<br>state (de-energized) using a company approved voltage detector?​​​ <br>

  Yes

  No

  N/A

• Meter Calibration Date

  Date

• Meter Calibration Photo

  Media

• Are electrical panels covered when not being worked on?

  Yes

  No

  N/A

• Is the SE using insulated battery mats if required?

  Yes

  No

  N/A

• Are extension cords in good condition and properly rated?

  Yes

  No

  N/A

• Has Customer provided a One Line diagram for the electrical distribution,<br>if requested?​

  Yes

  No

  N/A

• Does the SE know what the shock limited, restricted and prohibited approach<br>boundaries are, and does he understand their significance?​

  Yes

  No

  N/A

• Does the SE know what the Arc Flash, Limited Approach, Restricted Approach<br>and Prohibited Approach Boundaries are for the task and do they understand their significance?

  Yes

  No

  N/A

• Unless long tip probes are permitted by the business unit, are only only<br>short tip multimeter probes available for use?​

  Yes

  No

  N/A

• Does the SE have required company issued insulated tools?

  Yes

  No

  N/A

• Are insulated tools in good condition and free of nicks?

  Yes

  No

  N/A

LADDERS

• Have ladders been visually inspected and are they in good condition?

  Yes

  No

  N/A

• Are all ladders fiberglass and ANSI rated 1A (300 lbs/137 Kg) or 1AA (375 lbs/170 Kg)? OR<br>EN Class 131(150 Kg / 330 lbs), or Class 1 (175 Kg/385 lbs) maximum?​

  Yes

  No

  N/A

• If in use, have extension ladders been positioned so that the ratio of ladder height to distance from the wall / building is no greater than 4:1? ​

  Yes

  No

  N/A

ERGONOMICS

• Proper Lifting – Back Straight; tested weight of unknown object before attempting to lift; No twisting at the hips; Lifting with Legs & buttocks; Feet offset for stability; Hug load to body.

  Yes

  No

  N/A

• Did the Service Engineer (SE) create a “clear path” before lift and carry?

  Yes

  No

  N/A

• Carry – 28 feet distance (8.5 m) @ 1 per 5 minutes < 26 lbs (12 Kg)?

  Yes

  No

  N/A

• Overhead – Not lifting objects >14 lbs (6.4 Kg), above 6’10” (2 m)?

  Yes

  No

  N/A

• If the company has established a maximum safe lifting limit, did the SE<br>understand and conform to the policy limit? ​

  Yes

  No

  N/A

EXTERIOR VEHICLE CONDITION

• Is vehicle exterior clean and undamaged?

  Yes

  No

  N/A

• Is the windshield in good condition (no cracks, stars)?

  Yes

  No

  N/A

• Vehicle not leaking fluids (water, oil, antifreeze, fuel, etc.)?

  Yes

  No

  N/A

• All exterior lights functional?

  Yes

  No

  N/A

• Outside mirrors attached and adjustable?

  Yes

  No

  N/A

• Are tires in good good condition?

  Yes

  No

  N/A

INTERIOR VEHICLE CONDITION

• Is vehicle interior clean and undamaged?

  Yes

  No

  N/A

• Are dashboard gauges functioning and warning lights out?

  Yes

  No

  N/A

• Does vehicle’s horn sound?

  Yes

  No

  N/A

• Are all interior lights functioning?

  Yes

  No

  N/A

• Are the insurance, registration, and accident report forms readily available?

  Yes

  No

  N/A

• If applicable, are vehicle inspection records up to date?

  Yes

  No

  N/A

• Is the vehicle safety shield/cage installed?

  Yes

  No

  N/A

• Are seat belts and rear view mirror in good condition?

  Yes

  No

  N/A

VEHICLE SAFETY EQUIPMENT

• If required, is vehicle equipped with an appropriate Fire Extinguisher?

  Yes

  No

  N/A

• Is the monthly inspection record complete?

  Yes

  No

  N/A

• Does the vehicle contain a Spare Tire and Jack?

  Yes

  No

  N/A

• Does the Service Engineer (SE) have a current First Aid Kit?

  Yes

  No

  N/A

• Is the first aid kit completely stocked with required, unexpired supplies?

  Yes

  No

  N/A

• Is there a flashlight in the vehicle or in the SE’s toolkit?

  Yes

  No

  N/A

• If required, is the vehicle equipped with Reflective Safety Triangles or flares?

  Yes

  No

  N/A

AUDIT SUMMARY

• Overall Assessment

  Select Compliant Minor Non-Compliance Major Non-Compliance

  • Compliant
  • Minor Non-Compliance
  • Major Non-Compliance

• Is follow up necessary?<br>

  Yes

  No

  N/A

• By Whom?

CORRECTIVE ACTIONS

• 1.

  Yes

  No

  N/A

• 2.

  Yes

  No

  N/A

• 3.

  Yes

  No

  N/A

• 4.

  Yes

  No

  N/A

• 5.

  Yes

  No

  N/A

• 6.

  Yes

  No

  N/A

Safety Survey Comments/Reccomendations

SIGNATURES

• Auditor Signature

  Sign

• SE Signature

  Sign

• Service Manager/Supervisor Signature

  Sign

Cooling CE's

• Is CE a Cooling CE?

  Yes

  NO

  N/A

• Are Cooling CE"s wearing goggles during spray or brush cleaning?

  Yes

  No

  N/A

• Required Flares, Fire Extinguisher and Roadway Triangles in Vehicle?

  Yes

  No

  N/A

• Red (Acid) and Blue (Base) chemicals segregated in vehicle?

  Yes

  No

  N/A

• Flammable gasses (acetylene, MAPP) secured with multiple hold-downs?

  Yes

  No

  N/A

• Associates wearing No. 3 or 5 shade goggles when brazing or cutting metal?

  Yes

  No

  N/A

Battery Safety

• Does the Associate perform battery work?

  Yes

  No

  N/A

• Are CE's and Battery Specialists wearing gloves when making connections?<br>

  Yes

  No

  N/A

• Associate checking for Zero voltage each time before making connection?

  Yes

  No

  N/A

• Associate wearing goggles when taking hydrometer readings?

  Yes

  No

  N/A

• Associate wearing new arc flash apron for potential exposure to acid?

  Yes

  No

  N/A

• Associate wearing special battery shield (not arc flash shield) for acid?

  Yes

  No

  N/A

Respirator

• Is a Respirator in use?

  Yes

  No

  N/A

• Are company issued respirators maintained in sanitary condition?

  Yes

  No

  N/A

• Require associate to perform pre-use inspection. Conforms to standard?

  Yes

  No

  N/A

• Unused detachable cartridges are in original sealed bags?

  Yes

  No

  N/A

• Detachable cartridges are disposed of after one use?

  Yes

  No

  N/A

• Demonstrate user seal checks? Did associate perform neg and pos test?

  Yes

  No

  N/A

Control of Hazardous Energy (CoHE) Porcedures

• Is Lockout Tag-out required to perform the scheduled service work?

  Yes

  No

  N/A

• Did Associate perform LOTO Correctly?

  Yes

  No

  N/A

• If No LOTO required the associate must verbally discuss how he would perform LOTO if it was required. Did the associate successfully demonstrate?

  Yes

  No

  N/A

• Did the associate check TKO to determine if there is a CoHE procedure?

  Yes

  No

  N/A

• Did the Associate use the Hazardous Energy Reference Table (HERT)?<br>

  Yes

  No

  N/A

• Where all COHE and HERT documents accurate?

  Yes

  No

  N/A

Liebert Services Company Vehicle

• Has the company vehicle been altered from the original issued state?

  Yes

  NO

  N/A

• Install of Sound/Video or permanent GPS equipment?

  Yes

  NO

  N/A

• Installation of Trailer Hitch?

  Yes

  NO

  N/A

• Window Tinting?

  Yes

  NO

  N/A

• Any other Alterations?

• Inspect for GPS Jammer. Does the Associate have one?

  Yes

  NO

  N/A