• Client / Site

  • Conducted on

  • Auditor

  • Location
  • Field Engineer Audited

Environmental Awareness/Pre-Job Planning

Pre-Job Planning and Environmental Awareness

  • Did FSE perform a Job Safety Analysis or Job Hazard Analysis before starting job?

  • Did PICW conduct a toolbox safety discussion prior to start of, and/or, change in any maintenance activities?<br>(When multiple people are working.)

  • Did FSE restrict access to the worksite by using cones / barriers / caution tape?

  • Does FSE know location of muster point in the event of evacuation?

  • Does FSE know location of muster point in the event of inclement weather?

  • Are first aid supplies available and nearest AED location known?

  • Is access and egress unobstructed?

  • Is there adequate ventilation?

  • Is the noise level acceptable or has PPE been put in use?

  • Is the lighting adequate in all areas to complete the job or has alternate lighting been provided?


Personal Protective Equipment

  • Did FSE remove all jewelry and other exposed metal prior to starting electrical work?

  • Did FSE bring and wear safety glasses?

  • Did FSE wear cotton uniform?

  • Did FSE wear 8 calorie/cm2 (or higher) arc flash clothing at all times while onsite?

  • Was 40 calorie/cm2 (or higher) arc flash clothing and hood available?

  • Did FSE inspect arc flash gear prior to use?

  • Did FSE bring and use balaclava and 8 calories/cm2 or higher face shield? (If needed.)

  • Did FSE bring and inspect leather gloves?

  • Did FSE bring electrically rated rubber gloves? Were electrically rated rubber gloves tested in the last 6 months?

  • Were rubber gloves air tested prior to use?

  • Did FSE wear full leather EH rated work boots?

  • Did FSE use hearing protection when required?

  • Was any additional PPE required to complete this job? (Chemical face shield, chemically rated gloves, head protection, respiratory protection, fall protection, snake chaps, etc.)

Tools & Equipment

Tools & Equipment

  • Does FSE have insulated tools available?

  • Are insulated tools segregated from other tools?

  • Are insulated tools in good working condition?

  • Were tools inspected prior to use?

  • Is test / measurement equipment in good working order and calibration valid?

  • Were test equipment and accessories inspected and tested prior to use?

  • Is GFCI in good working condition?

  • Are power tools in good condition, including cords? (including being double insulated or grounded)

  • Are ground fault equipment used and tested to be in good working condition? (GFCI, RCD, ELCB)



  • Did FSE use knee pads / mats if in a kneeling position for more than 5 minutes?

  • Was it necessary for FSE to use forceful exertion? Shoulder, elbow, wrist.

  • Was work above shoulder height necessary for an extended period?

  • Was FSE working in an awkward position for an extended period of time without taking microbreaks?

  • Did FSE lift and place following proper back safety procedures?

Policies & Procedures

Policies & Procedures. (Were the following company policies followed if used?)

  • Proper Ladder Safety?

  • Work Hours? Has FSE exceed 12 hours more than once in the last 10 days?

Electrical and Lockout/Tagout

Electrical and Lockout Tagout

  • Is the system or facility single line diagram available?

  • Have all energy sources been identified and controlled via lock or tag?

  • Are equipment specific lockout procedures available and IN USE?

  • Are lockout devices available along with any required accessories?

  • Do all members of team working on locked equipment have locks applied to equipment or in a group lock box?

  • Is locked equipment verified to be in an electrically safe working condition via appropriate testing means? (Live, Dead, Live, ABB Seven Steps)


  • Is vehicle kept in a clean/good condition? Is all maintenance up to date and records available? No smoking inside? Windshield is not cracked?

  • Is driver's license valid?

  • Is vehicle registration current?

  • Is an emergency roadside kit available?

Overall Assessment

  • What is the one thing we can do as an organization to make your job better?

  • Comments from FE or Auditor?

  • Signature of FSE

  • Signature of auditor

  • Date of Signatures

  • Pictures to be added

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.