RIGGING

  • 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

  • Add media

WELDER or WELDER HELPER

  • 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)

  • Add media

PERSONAL PROTECTIVE EQUIPMENT

  • 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?

  • Add media

PAINT AND ABRASIVE BLASTING

  • 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"

  • Add media

HOT WORK AND FIRE WATCH

  • 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

  • Add media

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

BEHAVIOR BASED SAFETY PROCESS

  • 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

  • Add media

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

  • If so are they comfortable with utilizing the process

JSEA

  • 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

  • Add media

ACCIDENT/NEAR MISS REPORTING

  • 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

  • Add media

FUEL TRANSFER

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

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

  • Add media

SHORT SERVICE EMPLOYEES

  • 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

  • Add media

FORK-LIFT/ INDUSTRIAL TRUCK/ GENERAL

  • 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.

  • Add media

CRANE/ LIFTING OPERATIONS

  • 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

  • Add media

DRIVER/ VEHICLE OPERATOR

  • 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-

  • Add media

SUPERVISOR

  • 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-

  • Add media

SITE SPECIFIC

  • 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

  • Add media

CONCLUSION

  • NOTES OR OBSERVATIONS:

  • 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)

  • CONTACT DEPARTMENT MANAGER IMMEDIATELY

  • ENSURE TRAINING IS SCHEDULED ASAP

  • Add media

ACKNOWLEDGEMENTS

  • Evaluator Name

  • Employee Signature

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.