Information
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Department
- Mixing
- Material Prep
- Tire Assembly
- Curing
- Finishing
- Warehouse
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Document No.
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Machine / Location
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Conducted on
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Prepared By:
- Bill Cassilly
- Pete Betts
- Robert Strickland
- Ray Powell
- Terry Weeden
- Stanley Manning
- Ken Midkiff
- Barry Poole
- Sony Shelton
- Ricky Houston
- Terry Hunsicker
- David Foster
Daily Checklist
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Was daily safety check completed?
5S Housekeeping
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Aisles/Walkways kept clear?
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Work area kept organized?
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Housekeeping: spills, cords or other trips, trash/clutter, lighting, or Flammables
Personal Protective Equipment
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All appropriate equipment or gear worn correctly?
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PPE kept in good condition?
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Machine Guarding
Working Position
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Body position
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Location in working environment
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Work Position / Posture
Tools and Equipment
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Appropriate tools or equipment being used?
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Tools or equipment being used correctly?
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Tools or equipment in good condition?
Safe behaviors observed-actions taken to encourage safe behavior
Unsafe behaviors observed-action taken to correct and prevent recurrence
Line of fire. Is the worker in the line of fire?
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Grinding or drilling operations creating flying objects or particles - goggles/face-shield. Heavy equipment movement in the area - operator aware of pedestrian? Around rigging operations - hand in pinch point not under equipment? Working in front of live electrical panel - NFPA70E PPE
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Grinding, drilling or other operation that would cause flying debris
Safety procedures
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Lock-out/Tag-out, Arc Flash, Hot Work Permit, Confined Space
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Notes / Comments / Photos
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Auditor signature