Information
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Business Unit:
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Function:
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Workgroup:
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Conducted on
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Contractor Prepared by:
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Location
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Crew Leader:
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Observer:
Tailboard/Hazard Assessment
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Tailboard /Hazard Assessment
- In Compliance
- Coaching Opportunity/Best Practice
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Comments:
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Effective Control Plan in Place?
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Confined Space
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Job Hazards Documented and Identified?
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Emergency Plan Discussed, Understood and documented?
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Communication of all Tailboard/Hazard Assesment Info.?
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Other
Worksite Safety
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Overall Worksite safety
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Comments:
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Equipment Set up
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Worksite Properly Marked and /or barricaded?
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Scaffolding or Ladders
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Flagmen and/or required traffic vest?
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DOT Signs and cones in Place?
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Public Safety
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Housekeeping?
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Animals, Insects & Plants mitigated?
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One Call Locates completed?
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Haz Communication Chemicals?
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Other
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Checking for and/or monitoring gaseous environment? (N/A)
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Fire Extinguishers staged in inspected?
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Guards on grinders and other tools?
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Intrinsically safe fans?
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FR Clothing (N/A)?
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Seat Belt use on machines or in vehicles?
Switching Tagging, Grounding
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Switching, Tagging and Grounding
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Comments:
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Switching Orders Properly Documented?
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Clearance Orders Properly Documented?
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ECHO Protocol was properly used in all switching and Clearance Orders?
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Pre-Switching Activities Performed?
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Switching Orders executed in sequence as exactly written?
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Clearance Orders executed as written, Circuits tested to be de-energized, and grounds installed as required?
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Danger Hold Tags completed and installed as required?
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MOS/gang operated switches/hookstick switches operated to fully open or closed and properly disengaged?
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Breaker or control systems opened/closed/disabled/enabled checked for correct operation and tagged as required?
Work Practices
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Overall Work Practices?
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Comments:
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Arc Flash Protection (N/A)
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Line of Fire/Pinch Points
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Lifting/Carrying Techniques
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Pushing/Pulling Techniques
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Ascend, Descend, Climb
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Overextended, bad posture
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qualified Observer
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Excavation & Trenching (N/A)
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Hard Hat
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Safety Glasses
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Hearing Protection
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Company Approved Work Gloves
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Rubber Gloves and Sleeves (N/A)
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Testing, Grounding and Clearance (N/A)
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Switching, Tagging (N/A)
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Proper Cover Up (N/A)
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Fall Protection/Rescue (N/A)
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Rubber Glove flag zone (N/A)
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Other
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De-Energizing Opportunity-Primary (N/A)
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De-Energizing Opportunity-Secondary (N/A)
Human Performance
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Overall Human Performance
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Comments:
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trap: Time Pressure
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trap: Distraction Interruptions
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trap: Multiple Tasks
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trap: Overconfidence
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trap: Vague Guidance (written Verbal)
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trap: First Shift/Late Shift (N/A)
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trap: Peer Pressure
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trap: Off-Normal/Infrequent Conditions
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trap: Physical Environment
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trap: Mental Streass
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trap: other
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Tool: Self Checking
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tool: Peer Checking
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tool: Post-Job Review (N/A)
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tool: Procedure Usage
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tool: Questioning Attitude
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tool: Place Keeping
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tool: effective communication
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tool: Pre-Job Briefing (N/A)
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tool: Coaching
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tool: Turnovers
Attitude/Leadership
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Overall Attitude/Leadership
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Comments:
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Safe Completion Priority of leads and Crews
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Exhibits Proactive Safety Behaviours
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Newer, Safer Ways to Complete Tasks
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Other
Other Items
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Overall Compliance with other items
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Comments:
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Power Safe
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Rubber goods in date (N/A)
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PVD operational (N/A)
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High Voltage Detectors (N/A)
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Cell Phone Usage
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Stripping/Skinning Tools used or approved skinning knives (N/A)
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Tools Proper use/condition
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Safety/Medical Equipment
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Corrective maintenance task initiation (N/A)
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Corrective Maintenance Prioritization (N/A)
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Other
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Any Additional Comments or observations:
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Crew Leader Signature
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Observers Signature
