Information
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Conducted By
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Branch
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Created Date
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Job Site
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Employee Audited
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Employee Audited Cell Phone #
1. Alive @ Five Safety Questions
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What job is the employee performing?
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What existing and potential hazards has the employee identified? List hazards and how they will be controlled.
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Does the employee know what policies apply to the job? Does the employee have the right tools and safety equipment to do the job safely? (List tools and equipment below)
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What training is required to do the job? Does the employee have the required training?
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Is the employee aware of the potential consequences of not following safe work procedures and policies? (Detail employee's answer below.)
2. General Requirements
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Employee knows that they must immediately report all work-related incidents (including near misses) and knows who to call.
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Employee has the Injury Reporting Hotline, Regional Safety Manager's phone number and Fleet Help Desk number programmed into their phone.
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Employee is familiar with and understands the Stop Work Policy.
3. Personal Protective Equipment
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Cut Resistant Gloves Used
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Eye/Face Protection Used
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Bump Cap or Hard Hat Used
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Foot Protection Used
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Hearing Protection Used
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Fall Protection Used
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Respiratory Protection Used
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Chemical Gear Used
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Arc Flash Protection Used
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Hot Work Protection Used
4. Body Positioning
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Working off a Ladder Properly
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Clear of Pinch Points, Sharp Edges and Hot Surfaces
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Staying Out Of The Line Of Fire
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Proper Handling Of Load
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Proper Footing
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Proper Body Mechanics when Lifting, Reaching, Pulling, Pushing or Carrying
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Ascending/Descending Stairs, Steps or Fixed Ladder Properly
5. Work Environment
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Eyes on Path or Task
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Warning Cones, Barriers, Barricades
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Work Area Clean and Free from Slip or Trip Hazards
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Adequate Lighting
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Adequate Working Space
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Congested Work Area
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Weather Conditions
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Walkways are Free of Tripping Hazards
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Materials are Properly Staged/Stored
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Hoses, Cords Protected
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Clear Path to Emergency Equipment (Fire Extinguisher, Alarm Box, Safety Shower)
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Roof Hatch Properly Working & Locked In Place When Open
6. Tool/Equipment Use
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Correct Tool/Equipment for Task
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Tool/Equipment in Good Condition
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Proper Use Of Tool/Equipment
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Inspection Up To Date
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Proper Tool/Equipment Positioning
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Equipment De-Energized
7. Procedures - ALIVE @ FIVE
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Pre Job Checklist (SAFE-24)
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Lock Out / Tag Out
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Proper Training/Certification
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Lift Plan Completed and Reviewed
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Proper Use Of Hand Signals
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Work Area Barricaded
8. Suggestions/Comments
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Comments
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Auditor Signature
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Employee SIgnature
