Title Page
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Conducted on
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Prepared by
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Location
Engineer Field Inspection Form
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Scoring Criteria Gap = 0 Minor Gap = 5 No Gap =10
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Engineer Name:
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Department :
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Location of Inspection:
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Auditor Name:
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Date:
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Description of Work Observed:
Inspection
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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)
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What did the Engineer identify whilst carrying out an LMRA and/or using CDM 007 and what controls were implemented?
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What cardinal rules and Field Safety Standards are applicable to the task and how did the engineer demonstrate compliance
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Engineer to demonstrate and explain the process for safe isolation including LOTO/testing for dead and/or Compressed Gasses (PFX)/ Control of Hazardous Energy
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Engineer to demonstrate and explain the process for safe working at height. (e.g. ladders, steps, MEWP's)
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Engineer to talk through each section of the SWF to demonstrate understanding and confirmation it's up to date
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Engineer to demonstrate and explain how tools, equipment and materials are stored safely in their vehicle
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Engineer to explain the Kit & PPE Self-Assessment document and to show all required Kit & PPE is in good order
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PHOTO OF COMPLETED PPE/KIT CHECKLIST
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Action Required
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Responsibility
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Action Closed Date
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Engineer Signature
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Auditor Signature
