Information
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Location (nearest town)
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Foreman
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Cooperative Name
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Conducted on
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Work being performed
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Prepared by
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Location
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Audit Guidance: -All unsafe acts shall be stopped immediately. -Field Observations shall include photos for both safe and unsafe operations. Photos should be annotated with what the observer is focused on at the time of the audit. -Any item marked as a deficiency shall have a photo (if possible) and a detailed description. -All comments should identify those crew members performing the task correctly and/or incorrectly. -Equipment being inspected shall be listed and/or have a photo with the unit number displayed. -All audits shall be reviewed with the PIC prior to departure from the site. Corrective actions shall be assigned with due dates and noted on the audit. -Any audits being forwarded to the client shall be reviewed by more than one safety team member prior to being sent.
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All audit findings shall have an assigned weight (1-4) assigned per the below matrix. Document the weighted number rating in the comment section associated with the applicable question.
Communication
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Human Performance tools observed and bieng utilized correctly?
Procedures and Documents
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Tailboard/Job Hazard/Driving assessment completed?
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Paperwork (Private Motor Carrier License, Haz-Mat Registration, Vehicle Registration(s), Insurance Certificate, IFTA License & Stickers, Annual Inspections(s).392.2-396.17?
Work Practices
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Proper PPE (Hard Hat, Glasses, Hearing Protection, leather or insulated gloves, FR, Safety Vest, Steel toe boots)?
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Slip/trip and fall hazards identified and mitigated?
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Are cell phones being use appropriately?
Supervision
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Designated person in charge and documented?
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Supervision verifying the job hazard analysis/job plan is being followed?
Change Management
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JSA updated periodically and whenever work task changes? Time stamped at lunch?
External Influence
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Heat/cold mitigation plan in use and documented?
System/Equipment Operation
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If applicable, Is FR clothing being worn?
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If applicable, 100% fall protection being utilized?
Management
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Short service employee's identified and assigned mentors? On JSA? Proper colored hard hat?
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incidents/near misses reported in a timely manner?
Design Configuration
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Are appropriate DOT signs and cones in place?
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Equipment properly barricaded when work is performed near live voltage or when grounded?
Summary and signatures
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Positive observations. List crew members and specific items they are doing correctly:
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# of Personnel-Personnel Present (first and last Names)
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Number of Trucks
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Number of Trucks Audited
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Inspectors signature
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Crew lead signature
