ADI UK Rochdale HSE Gemba - External

• Conducted on

  Date

• Prepared by

• Location
  Address

External

• Loading Bay door opened / closed fully?<br>Water cleaned immediately & hazard signage utilised?

  Safe

  At Risk

  N/A

• Security barrier down & alarmed?

  Safe

  At Risk

  N/A

• Lighting adequate?

  Safe

  At Risk

  N/A

• Are surfaces level and in good condition?

  Safe

  At Risk

  N/A

• Any damage to grids, gutters, drainage pipes?

  Safe

  At Risk

  N/A

• Any evidence of smoking in non designated areas? Any evidence of refuse or pallet accumulating?

  Safe

  At Risk

  N/A

• Any damage to trees, loose branches, plants overgrowing or moss accumulating?

  Safe

  At Risk

  N/A

• Emergency exits clear of obstruction?

  Safe

  At Risk

  N/A

• Are carrier vehicles marshalled & chocked where required?

  Safe

  At Risk

  N/A

• Are wheel chocks in good condition and secured when not in use?

  Safe

  At Risk

  N/A

• Are delivery drivers a safe distance away from lift truck activity?

  Safe

  At Risk

  N/A

• Are pedestrians excluded from loading areas?

  Safe

  At Risk

  N/A

Employee Behaviours

Powered Device Operator Behavioural Checks

• Device operator looking in the direction of travel?

  Safe

  At Risk

  N/A

• Device operator using horn / warning devices where required?

  Safe

  At Risk

  N/A

• Device operator wearing a seat belt?

  Safe

  At Risk

  N/A

• Device operator traveling at a speed suitable depending on amount of traffic, etc?

  Safe

  At Risk

  N/A

• Device operator vision impaired - clear view over the load?

  Safe

  At Risk

  N/A

Employee Behaviour Observation Checks

• Discuss unsafe observation programme with employee.

• Discuss unsafe observation programme with employee.

• Discuss evacuation procedure with employee.

• Discuss accident reporting with employee.

• Any recognition: