Title Page
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Conducted on
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Prepared by
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Location
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1. Are all contract associates utilizing applicable personal protective equipment? Guidance Notes: Hard hats, Safety glasses, etc.
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2. Are all permit required work activities documented using JJ Safe To Work permits? Guidance Notes: Hot Work, PSM, Critical Lift, Work From Heights, Excavation/Trenching, etc.
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3. Are all work tools, portable tools, and equipment in good condition? Guidance Notes: Electrical cords, ladders, portable electrical tools, hand tools, hoses, cylinders, pipe threading machine, etc.
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4. Are all applicable signage and/or warning indicators posted? Guidance Notes: Chemical in Use, Emergency#, Lasers in Use, Authorized Person Only, Caution/Warning Barrier, etc.
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5. Is all waste managed in accordance with EHS regulations? Guidance Notes: Secondary containment, waste disposal, waste management
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6. Are all chemicals approved for use onsite and being used safely? Guidance Notes: SDS on file, management, storage
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7. Are all electrical safety practices adhered to? Guidance Notes: Daisy chains, wires exposed, GFCI, conduit covers in place, knock-outs in place, etc.
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8. Area is free from any fire code violations? Guidance Notes: Fire extinguisher, exits clear from obstruction, exit/fire doors are not propped open, etc.
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9. Are all applicable communications made to company representative including change in job scope? Guidance Notes: Reported injuries, incidents, spills, environmental releases, etc.
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10. Is work area kept in a safe and organized way? Guidance: Free of trip hazards, exposed sharp edges and/or puncture hazards, safe walkway, tip over hazards, spills, etc.
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11. Overall general EHS performance is acceptable? Guidance Notes: 0-3 findings are acceptable
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