AWP HSE GEMBA - AUGUST TOPIC: HEARING CONSERVATION AND CONFINED SPACE

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

• Department/Areas Reviewed:

  Yes

  No

  N/A

• Completed by:

AREA

• ITEM TO ASSESS

  Yes

  No

  N/A

• If No, list corrective actions*

  Yes

  No

  N/A

• Owner

  Yes

  No

  N/A

• Tier

  Yes

  No

  N/A

• Board #

  Yes

  No

  N/A

• Date of GEMBA Walk:

  Date

• Hearing

  Yes

  No

  N/A

• Protection

  Yes

  No

  N/A

• Hearing

  Yes

  No

  N/A

• Protection

  Yes

  No

  N/A

• Hearing

  Yes

  No

  N/A

• Protection

  Yes

  No

  N/A

• Confined

  Yes

  No

  N/A

Space

• Are all confined spaces marked in your work area?

  Yes

  No

  N/A

• Confined

  Yes

  No

  N/A

Space

• Confined

  Yes

  No

  N/A

Space

• Confined

  Yes

  No

  N/A

Space

• * If issues cannot be imediately corrected, move item to tier board for escalation

  Yes

  No

  N/A