Ahold - Supervisor Observation

• Store Number:

• DTZ Supervisor:

• Technician:

• Work Order Reviewed:

• Conducted on

  Date

Safety Discussion

• Was Tool Box Topic discussed? If yes, what was the topic?

  YES

  NO

Personal Protection Equipment (PPE)

• Was the Technician utilizing proper PPE?

  YES

  NO

Work Area

• Lockout/Tagout procedures being used and if so, correctly?

  YES

  NO

  N/A

• Hot Works Permit Posted?

  YES

  NO

  N/A

• Spills and slippery surfaces identified and corrected?

  YES

  NO

• Tripping hazards identified and corrected?

  YES

  NO

• Proper guards and barriers in place to protect the store employees and customers?

  YES

  NO

Service Vehicle

• Tools and material stowed safely?

  YES

  NO

• Chemicals stowed properly?

  YES

  NO

• General overall condition of service van (safe to operate)

  YES

  NO

• Is Registration and Inspection up to date on vehicle?

  YES

  NO

Tools and Equipment

• Proper tools being used on the job?

  YES

  NO

• Are the tools being used properly?

  YES

  NO

• Are tools in safe working condition?

  YES

  NO

• Is the Eye Wash accessible and is it within expiration date?

  Good

  Unsafe

Work Reviewed

• Was the repair made satisfactorily?

  YES

  NO

• Was the work site cleaned and properly put back together?

  YES

  NO