Audit Information
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Supervisor/Observer Ron Marlow

Employees 1 Steve Drouillard

Employee (type if not listed above)

Location Kalkaska T&SO

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Job Type PI Coordinator

Job Type

Pre-Job Briefs

Were the potential job hazards reviewed? Ice/Slippery conditions. Hazardous walking conditions. Perform penguin walk. Appropriate footwear utilized.

Were the Distribution & FSO Procedures available for review?

Does the employee(s) have a full understanding / knowledge of the job task?

Personal Protective Equipment (PPE) all appropriate PPE needed to perform job duties is present.

Does the employee(s) have the required PPE for the job task?


Are the proper tools/equipment in use or available when needed? Yes

Are all tools/equipment in good working condition?safety wise yes.

Is work area in a safe condition? Housekeeping is a little messy, but no obstacles inside of office.

Is the vehicle(s) and/or equipment parked properly on site? Yes

If an excavation, are proper sloping, shoring, ingress and egress methods being utilized? N/A

Is proper signage and barricading being used as necessary?N/A

Were any safety defects observed in building / parking lot / stock room / yard area? Ice is present in parking lot area.

Human Performance

Was employee(s) using 3 points of contact and observing potential slip, trip, and fall hazards? Yes, always

Is vehicle(s) in good operating condition and are all DOT pre/post inspections completed where required? Yes

Is vehicle(s) housekeeping in good shape or is a 5S needed? Yes

Are there other safety defects observed, corrected and/or being entered on a countermeasure worksheet?NO

Corrective Actions

Discussed with Employee

Enter any corrective actions that will be undertaken

Sign Off
Supervisor's Signature
Drawing / Notes
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.