• Does the employee perform overhead rigging duties

  • Review the employee rigger card to ensure it is current.
    If not current advise that rigger duties are suspended and contact supervisor immediately

  • Is the employee familiar with and capable of demonstrating proper hand signals

  • Can the employee demonstrate the proper method in which they would rig a load

  • Can the employee demonstrate a proper pre-use inspection of the rigging equipment

  • Is the employee able to identify rigging gear by name

  • Can the employee explain proper tag line usage and also restrictions in regards to tag lines?

  • Are you able to witness tag lines being used properly? (Not wrapped around one's body (i.e., hand, arm, torso), attached to load (not any sling), long enough for safe operation

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  • Does the employee perform welding duties as part of their regular duties

  • Is the employee familiar with PPE requirements associated with welding duties

  • Can the employee demonstrate or describe proper hand tool selection and inspection associated with welding duties?

  • Are the welding machines on location grounded

  • Have all the oxygen and acetylene connection fittings been checked for leaks prior to use? (Spray bottle with soap and water)

  • Are all of the leads properly insulated with no bare wire exposure

  • Is the welding area well ventilated

  • Are compressed gas cylinders secure and stored in an upright position? Are the valves closed when not in use (Break Time)

  • Is the employee aware of when a fire watch must be assigned (Verify training card)

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  • Is the employee familiar with Acadian Contractors Inc. PPE policies

  • Is the employee wearing long sleeves and are they rolled down?

  • Is the employee utilizing all other PPE required for the task being performed

  • Can the employee demonstrate proper inspection of PPE

  • Does the employee understand the limitations of PPE

  • Is all of the employee's PPE in good condition

  • Are machine guards in place

  • Is the employee familiar with Acadian Contractors' cellular device policy?

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  • Does the employee perform painting and/ or also abrasive blasting duties as part of their regular position related responsibilities

  • Is hearing protection being utilized if the exposure is greater than 80dB and double hearing protection if the exposure is greater than 100dB

  • Has the employee inspected airlines and connections for wear and damage prior to use

  • Have all fittings and valves been checked for tightness and found to be in good operating condition

  • Is the employee using proper lifting devices and/or techniques while loading and handling abrasives

  • Is the employee wearing the proper PPE while mixing and handling hazardous chemicals such as paint and solvents lifting, i.e. goggles, face shield and correct gloves

  • Is the employee equipped with and also utilizing a NIOSH approved respirator when required? Is it properly maintained and stored?

  • Are safety labels protected for task affiliated damages? (Manufactures warning labels and equipment gauges protected from overspray or blasting damage)

  • Does the affiliated blasting machine equipment have in place a working dead man switch

  • If there is scaffolding equipment in use; has it been setup properly and inspected daily

  • Is the breathing air filtered to remove moisture, oil mists, and particulates

  • Is the air supply at least CGA "Grade D"

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  • Does the employee perform hot work or fire watch duties as part of their regular position related responsibilities

  • Can the employee describe when a hot work permit is required

  • Can the employee explain when a fire watch is required

  • Is the employee aware of how long a fire watch must remain on site following the completion of hot work

  • Can the employee explain what safety equipment is required when a hot-work permit is required, i.e. proper extinguisher, gas detector, evacuation plan, permit...

  • Does the employee understand the differences between types of fire extinguishers (Classes A, B, C, D & K)

  • Is the employee aware of specific fire blanket requirements

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  • Was a hot-work permit required for this site during this visit? If so was it in place prior to task commencement?


  • Is athe employee proficient with using the company's BBS process and are cards available on site

  • Is there evidence of employee participating in the BBS process

  • Does the employee understand how to properly complete a behavior based TAKE 5 CARD

  • Is feedback given after a BBS observation

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  • Is the employee familiar with the company's stop work authority policy

  • If so are they comfortable with utilizing the process


  • Was there a JSEA prepared for the task being performed upon arrival

  • Can the employee explain when a JSEA must be updated

  • Are all (SSE) short service employees identified on the JSEA along with their assigned mentor

  • Can the employee demonstrate proper completion of a JSEA

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  • Is the employee familiar with reporting criteria and procedures

  • Can the the employee clearly define near miss

  • Can the employee clearly define a first aid

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  • Can the employee describe and/or demonstrate proper fueling procedures

  • Is the employee aware that all spills must be reported immediately

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  • Is the employee able to describe how SSE's are identified (HI VIS ORANGE HARDHAT)

  • Are all SSE employees assigned a mentor who is documented on the JSEA

  • Verify the mentor knows that they are assigned to the SSE and that SSE's safety is their responsibility

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  • Does the employee operate the specified equipment as part of their duties

  • Can the employee demonstrate proper inspection procedures

  • Is the employee able to demonstrate that they are able to raise a load in a controlled safe manner

  • Can employee demonstrate lowering a load in a controlled safe manner

  • Does the employee lock out the equipment when operations are complete

  • Ask the employee about traveling with a load and what is required of them as an operator if they are within 10FT of an obstacle. Are they aware of the policy?

  • Is the employee able to identify proper rigging and lifting equipment? If so can they also describe the required maintenance and inspection process?

  • If possible, have an experienced operator are supervisor familiar with proper equipment operations available during review.

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  • Does the employee operate a crane as part of their duties

  • Ask to verify the crane operator card. Is the card current and appropriate for the crane being operated

  • Can the operator demonstrate a proper crane inspection (N/A if not a requirement for the observed task)

  • Can the operator demonstrate knowledge of crane load chart (N/A if not a requirement for the observed task)

  • Does operator appear to have proper and reasonable control of the machine while in operation

  • Give the operator some test hand signals, does he understand proper handsignals

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  • Is the employee assigned a company vehicle for transportation? If so, is the vehicle on site

  • Does the employee have available to verify a valid correct class drivers license

  • Was a pre-trip inspection performed before travel on the morning of this evaluation? Verify mileage-

  • Can the employee describe the company's journey management plan- (Must include the 360 walk-around or when a spotter in required in their inspection)

  • Is the vehicle equipped with an up-to-date inspected and properly mounted fire extinguisher

  • Can the employee explain the company's policy about using communication devices while operating a motor vehicle

  • Is the vehicles preventive maintenance current- i.e. fluid level accurate, tires in good condition, oil vs mileage accurate, lights work, etc.

  • Is the vehicle clean considering the work environment? Ask when was it washed last-

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  • Is the evaluated employee a supervisor

  • Did the employee oversee the JSEA process and approve the written precautions documented?

  • Is the employee participating in task functions, oppose to delegating and overseeing- answer should be no, overseeing

  • Does the employee have available or immediate access to company forms such as incident occurrence, statement, property damage, early departure, etc. (Verify)

  • Can the employee describe their plan of action in the case of an emergency? (Heat Exhaustion) Prevention is the key-

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  • Is the employee assigned to this site

  • Position

  • Can the employee describe emergency fire prevention practices associated with this site

  • Can the employee describe emergency evacuation procedures associated with this site

  • Can the employee describe emergency general alarm procedures

  • Is the employee able to identify the location of Safety Data Sheets and explain briefly what HAZARD COMMUNICATION is

  • Is employee familiar with machine guarding and hand held equipment inspections? If so, have the employee demonstrate an inspection-

  • Is the employee familiar with site specific rules and regulations, i.e. first-aid, eye-wash

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  • Is additional training required?

  • Is the employee's current position knowledge capable of assuring the safety of personnel around them from danger? (If not contact their department manager immediately)



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  • Evaluator Name

  • Employee Signature

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