Amended Field

• Conducted on

  Date

• Prepared by

• Location
  Address

Engineer Field Inspection Form

• Scoring Criteria Gap = 0 Minor Gap = 5 No Gap =10

• Engineer Name:

• Department :

• Location of Inspection:

• Auditor Name:

• Date:

  Date

• Description of Work Observed:

Inspection

• How did the Engineer demonstrate a safe start to the job by asking appropriate EH&S questions (i.e Restricted areas, PPE requirements, Asbestos etc)

  Gap

  Minor Gap

  No Gap

• What did the Engineer identify whilst carrying out an LMRA and/or using CDM 007 and what controls were implemented?

  Gap

  Minor Gap

  No Gap

• What cardinal rules and Field Safety Standards are applicable to the task and how did the engineer demonstrate compliance

  Gap

  Minor Gap

  No Gap

• Engineer to demonstrate and explain the process for safe isolation including LOTO/testing for dead and/or Compressed Gasses (PFX)/ Control of Hazardous Energy

  Gap

  Minor Gap

  No Gap

• Engineer to demonstrate and explain the process for safe working at height. (e.g. ladders, steps, MEWP's)

  Gap

  Minor Gap

  No Gap

• Engineer to talk through each section of the SWF to demonstrate understanding and confirmation it's up to date

  Gap

  Minor Gap

  No Gap

• Engineer to demonstrate and explain how tools, equipment and materials are stored safely in their vehicle

  Gap

  Minor Gap

  No Gap

• Engineer to explain the Kit & PPE Self-Assessment document and to show all required Kit & PPE is in good order

  Gap

  Minor Gap

  No Gap

• PHOTO OF COMPLETED PPE/KIT CHECKLIST

  Media

• Action Required

• Responsibility

• Action Closed Date

  Date

• Engineer Signature

  Sign

• Auditor Signature

  Sign