CNE Site Safety Observation Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Personal Safety Equipment

• Head

  Safe

  At Risk

  N/A

• Eyes, Face

  Safe

  At Risk

  N/A

• Ears

  Safe

  At Risk

  N/A

• Respirator

  Safe

  At Risk

  N/A

• Hands

  Safe

  At Risk

  N/A

• Feet

  Safe

  At Risk

  N/A

• Body

  Safe

  At Risk

  N/A

• Fall

  Safe

  At Risk

  N/A

• Life Jacket

  Safe

  At Risk

  N/A

• FCIB Personal Safety Equipment

  Yes

  No

  N/A

Tools and Equipment (Power Tools, Extension Cords, Welding/Cutting, etc.)

• Selection

  Safe

  At Risk

  N/A

• Condition

  Safe

  At Risk

  N/A

• Tool Use

  Safe

  At Risk

  N/A

• Ladders

  Safe

  At Risk

  N/A

• Scaffolding

  Safe

  At Risk

  N/A

• Rigging

  Safe

  At Risk

  N/A

• Mobile Equipment Use

  Yes

  No

  N/A

Body Mechanics

• Lifting/Twisting/Body Position

  Safe

  At Risk

  N/A

• Eyes on Task/Path

  Safe

  At Risk

  N/A

• Line of Fire

  Safe

  At Risk

  N/A

• Ascending/Descending

  Safe

  At Risk

  N/A

Work Environment

• House Keeping

  Safe

  At Risk

  N/A

• Barriers

  Safe

  At Risk

  N/A

• Warning Signs

  Yes

  No

  N/A

• Guard Rails

  Safe

  At Risk

  N/A

• Fire Extinguishers

  Safe

  At Risk

  N/A

• First Aid Kit

  Safe

  At Risk

  N/A

• Facilities/Structures

  Safe

  At Risk

  N/A

• Temperature Extremes

  Safe

  At Risk

  N/A

Procedure Related

• Job Hazard Analysis

  Yes

  No

  N/A

• Lockout/Tagout

  Safe

  At Risk

  N/A

• Hot Work Permits

  Yes

  No

  N/A

• Lifting Plan

  Yes

  No

  N/A

• Excavation/Trenching

  Safe

  At Risk

  N/A

• Arc Flash

  Safe

  At Risk

  N/A

Licensed Vehicle Use

• Seat Belt Usage

  Safe

  At Risk

  N/A

• Speed

  Safe

  At Risk

  N/A

• Following distance

  Safe

  At Risk

  N/A

• Light and signal Use

  Safe

  At Risk

  N/A

• Mirror Use

  Safe

  At Risk

  N/A

• Backing

  Safe

  At Risk

  N/A

• Cell Phone/Texting

  Safe

  At Risk

  N/A

Ergonomics

• Arms/Elbows/Hands/Wrists

  Safe

  At Risk

  N/A

• Neck/Head/Shoulders/Back

  Safe

  At Risk

  N/A

• Office Workstations

  Yes

  No

  N/A

• Force

  Safe

  At Risk

  N/A

• Repetitive Work

  Safe

  At Risk

  N/A

• Vibrations

  Safe

  At Risk

  N/A

Site Information

• Point of Contact

  Yes

  No

  N/A

• Phone Number

  Yes

  No

  N/A

• Emergency Contacts

  Yes

  No

  N/A

• Emergency Contact Numbers

  Yes

  No

  N/A

• MSDS/Chemical List

  Yes

  No

  N/A

• Postings Federal and State

  Yes

  No

  N/A

• Safety Meeting Documentation

  Yes

  No

  N/A

• Safety Training Documentation

  Yes

  No

  N/A

General

• Comments

• Observation By:

• Signature

  Sign

• Reviewed With:

• Corrective Actions Taken

• Follow Up

• Routing: EMAIL copy to CNEF Safety Analyst and the Site Safety Committee Chairperson.
  CNEF Safety Analyst - Daniel Steger Daniel.Steger@constellation.com