ALSTOM Grid EHS - HSV checklist and report

• Prepared by

HIERARCHICAL SAFETY VISIT

• Name of site

• Type of site

  industrial

  Field / construction

  office
• Area visited
  Address

• Conducted on

  Date

• USE CHECKLIST?

  Use

GENERAL CONDITIONS

• Is the site tidy and clean?

  Yes

  No

  N/A

• Are material and scrap properly stored?

  Yes

  No

  N/A

• Is EHS information properly posted ?

  Yes

  No

  N/A

• Have you done your EHS induction ?

  Yes

  No

  N/A

• Explain why

PERSONAL PROTECTIVE EQUIPMENT

• Safety boots?

  Safe

  At Risk

  N/A

• Safety hat?

  Safe

  At Risk

  N/A

• Ear protection?

  Safe

  At Risk

  N/A

• High visibility vest or straps?

  Safe

  At Risk

  N/A

• Safety glasses, face shield?

  Safe

  At Risk

  N/A

• No gloves for rotating hand tools?

  Safe

  At Risk

  N/A

• Respiratory protection?

  Safe

  At Risk

  N/A

• Fire resistant garments

  Safe

  At Risk

  N/A

* CONFINED SPACES

• Applicable ?

  Yes

  No

  N/A

• Are competency & training checked?

  Yes

  No

  N/A

• Air test done?

  Yes

  No

  N/A

• Was the permit delivered?

  Yes

  No

  N/A

• Are confined spaces clearly identified?

  Yes

  No

  N/A

• Is there a keeper dedicated to the confined space?

  Yes

  No

  N/A

• Emergency Arrangements checked ?

  Yes

  No

  N/A

* LOCK OUT TAG OUT

• Applicable?

  Yes

  No

  N/A

• LOTO procedure available?

  Yes

  No

  N/A

• One lock̀, one key, one person?

  Yes

  No

  N/A

• Are employees trained to LOTO?

  Yes

  No

  N/A

• Absence of residual Energy is checked before work?

  Yes

  No

  N/A

• Is LOTO done on all energized equipment?

  Yes

  No

  N/A

* ELECTRICAL SAFETY

• Applicable?

  Yes

  No

  N/A

• Are competency & training checked?

  Yes

  No

  N/A

• Is equipment dead prior to work?

  Yes

  No

  N/A

• Are electrical panels tagged?

  Yes

  No

  N/A

• Is there work live on Voltage?

  Yes

  No

  N/A

• Are appropriate tools available?

  Yes

  No

  N/A

• Are safe working distance respected?

  Yes

  No

  N/A

• Are appropriate PPE available?

  Yes

  No

  N/A

* MACHINE SAFETY

• Applicable?

  Yes

  No

  N/A

• Are competency and training checked?

  Yes

  No

  N/A

• Are all guards in place & checked?

  Yes

  No

  N/A

• Are electric tools inspected & conform?

  Yes

  No

  N/A

• Are equipment unplugged when changing tools?

  Yes

  No

  N/A

• Are extension cords protected or suspended?

  Yes

  No

  N/A

* WORKING AT HEIGHT

• Applicable?

  Yes

  No

  N/A

• Are competency & training checked?

  Yes

  No

  N/A

• Lifting equipments inspected?

  Yes

  No

  N/A

• Fall arrest equipments inspected?

  Yes

  No

  N/A

• Scaffolds inspected and tagged?

  Yes

  No

  N/A

• Temporary floor/roof openings protected?

  Yes

  No

  N/A

• Ladders attached and secured?

  Yes

  No

  N/A

• Full body harness & chinstrap worn?

  Yes

  No

  N/A

• Fall arrest equipments listed on a register?

  Yes

  No

  N/A

• Was the permit delivered?

  Yes

  No

  N/A

* EXCAVATION AND TRENCHES

• Applicable?

  Yes

  No

  N/A

• Permit delivered for excavation > or = 1,2 meters?

  Yes

  No

  N/A

• Are all excavations inspected daily?

  Yes

  No

  N/A

• Rigid barriers less than 1,5 from edges for excavation > or = 1,2 meters?

  Yes

  No

  N/A

• Slopes according to construction code?

  Yes

  No

  N/A

• Trenches identified and protected?

  Yes

  No

  N/A

• Vehicle parking 3 meters from hedge

  Yes

  No

  N/A

• Protective system against fall of the excavation?

  Yes

  No

  N/A

• Excavated material > or = 1 meter from hedge?

  Yes

  No

  N/A

• Ladders or exits every 15 meters?

  Yes

  No

  N/A

* LIFTING OPERATIONS

• Applicable?

  Yes

  No

  N/A

• Lifting permit to work issued?

  Yes

  No

  N/A

• Lifting plan available?

  Yes

  No

  N/A

• Are competency and training checked ? Respected?

  Yes

  No

  N/A

• Are lifting equipment in register?

  Yes

  No

  N/A

• Safety zone established under the lifting area?

  Yes

  No

  N/A

• Are lifting equipment inspected and conform?

  Yes

  No

  N/A

* VEHICULE MOVEMENTS

• Applicable?

  Yes

  No

  N/A

• Are vehicules tidy and clean?

  Yes

  No

  N/A

• Is traffic signing properly installed?

  Yes

  No

  N/A

• Parking Area & rules established?

  Yes

  No

  N/A

• Are competency and training checked ? Respected?

  Yes

  No

  N/A

• Forklifts with fork lowered, boom tilted back and seat belt fastened?

  Yes

  No

  N/A

• Circulation of mobile equipment and pedestrians seperated and clearly signalized?

  Yes

  No

  N/A

• Is a safe distance of 2 meters respected between pedestrians and vehicles?

  Yes

  No

  N/A

ENVIRONMENT

• Applicable?

  Yes

  No

  N/A

• Are MSDS available?

  Yes

  No

  N/A

• Are flammable segregated from oxidizing material?

  Yes

  No

  N/A

• Are compressed gases secured?

  Yes

  No

  N/A

• Are compressed gases stored in designated area?

  Yes

  No

  N/A

• Is oil store in designated area?

  Yes

  No

  N/A

FIRST AID, EMERGENCY AND ENVIRONMENT PREPAREDNESS

• First aid kit available and inspected?

  Yes

  No

  N/A

• Is evacuation plan & gathering point communicated ?

  Yes

  No

  N/A

• Is First aiders list posted ?

  Yes

  No

  N/A

• As there and inspected fire extinguisher?

  Yes

  No

  N/A

• Are spill kits available and inspected?

  Yes

  No

  N/A

SAFETY OBSERVATION REPORT

• Positive observations

• Add media

  Media

• Aspects to improve or Deviations

• Add media

  Media

• Action and person in charge

• Date of completion

  Date

• Satisfaction level of the visit (very poor; 10 excellent)

• Signature

  Sign