Crane Operator Assessment Form

Information

Observation conducted by:
Client and/ or Facility:
Conducted on:
Prepared by:
Location:
Personnel present during observation:

The intent of this assessment is to provide the job-site or facility observer a documented guide to review the areas of focus outlined below. The areas of focus during a job-site or facility observation; however are not just limited to the focus items outlined and the observer shall use their best judgment in deciding whether observed items of concern require immediate action or can be listed in the comments section for EHS follow-up. Positive recognitions are also a portion of such assessments and shall also be listed in the comments section. Any item listed unsatisfactory will require follow-up actions and the Person-In-Charge shall be prepared to acknowledge with a plan of improvement(s). Such items, dependent on their severity shall be identified with improvement expectation dates as well. Safety Mindset: Unsafe Condition leads to an Unsafe Act which can result into a Near-Miss or worse an Accident!

1.0 Observation Guidance Items

1.1 Safety Meeting conducted pre-job (BBS cards available and utilized, facility and/or location rules and expectations documented; i.e. Section 0.16 Project Management Tool)
1.2 JSEA’s (written appropriate to job task, hazards accurately identified, document complete and signed. JSEA's should accompany the operator throughout the day and adjustments updated with details such as job scope and #, additional task/hazards, and weather conditions).
1.3 SSE’s (Short Service Employees) listed on the JSEA and assigned a Mentor (<25% of crew/ 1-5 person ratio)
1.4 Daily Pre-use Equipment Inspections are conducted and documented, discrepancies have been brought to and acknowledged by a member of management . Should be done in writing
1.5 Proper PPE for the task being utilized in a well maintained condition (head, eye, face, body, hands and foot protection applicable to the task)
1.6 Good Housekeeping Practices (tools stored, chemicals stored and situated as to not be at risk of creating a spill, no trash or loose objects in cab)
1.7 Employees are Fit-for-Duty (focused on job task, well rested, well-hydrated; etc.)
1.8 Ergonomics (employees are using proper body mechanics- lifting techniques, proper footing and hand placement- operating from their core or green zone) no straining, awkward positioning, pushing or pulling.
1.9 Hazard Controls (what could cause a slip, trip or fall, pinch risk, line-of-fire and other risk properly identified and managed) Hierarchy of Risk- a. Elimination b. Substitution c. Engineering Controls/ Isolation d. Administrative Controls/ Policies, Procedures and/ or Training e. Personal Protective Equipment
1.10 Safety and Compliance (Ecoserv, LLC's Safety Culture) Company Purpose- Innovative and driven people providing superior environmental solutions Core Values- Safety is No Accident Science Beyond Compliance We are People of Character One for All No Status Quo Safety Mission Safety pays, accident cost. When you work safe, nothing is lost.
1.11 Established swing radius and has ensured that personnel are out of the line of fire.
1.12 Safe Lifting and Rigging Practices (Has the crane operator establish communication w/ radios, ensuring the use of tag-lines/push poles, designated signal-man. Does the operator move the load slow and low to avoid sudden impacts with the dump and rinse rack.Does the operator demonstrate full control of the load when lifting and lowering)
1.13 Operator understands their role/ responsibility, has full knowledge of their equipment understanding it's functions and limitations (load chart)

2.0 P.A.L.S. is an acronym for (PERFORMANCE, ACCOUNTABILITY, LIFE, & SYSTEMS = Safe and Sustainable). The program influences safe behavior alignment by the use of (14) icons and written guidance that correlates to all EHS Manual programs. “Core rules are/ were determined based off constant hazards; Supplementary Rules are/ were determined based off contextual hazards”.

Core Rules: Based on observance is compliance being achieved for all CORE Rules 1. Confined Space 2. Heights (Working/ Ascending and Descending) 3. Safe Lifting Practices/ Suspended Loads (Line of Fire) 4. Transportation (Operator Shall-Plan Trips, Obey Laws and Cellular Usage is Prohibited) 5. Permitting Systems (Working and Regulating Requirements) 6. Energy Isolation
Select the number of rule categories applicable to your recognized deficiencies and provide a positive comment as to explain how compliance achievement can be obtained:
- Confined Space
- Heights - Fall Protection
- Safe Lifting Practices/ Suspended Loads
- Transportation
- Permitting Systems (Working and Regulating Requirements)
- Energy Isolation
Compliance Achievement Comments (describe steps for achieving compliance, along with est. date of completion):
Supplementary Rules: Based on observance is compliance being achieved for all SUPPLEMENTARY Rules 7. Hazardous Atmospheric Exposure (Chemical/ Gas Hazards) 8. Working around Heavy Equipment 9. Dropped Objects 10. Safety Barriers and Equipment Guards 11. Severe Weather 12. Proper Personal Protective Equipment Practices 13. Fit-for-Duty (Health Management) 14. Stop-Work-Authority (Associated with Every Rule)
Select the number of rule categories applicable to your recognized deficiencies and provide a positive comment as to explain how compliance achievement can be obtained:
- Hazardous Atmospheric Exposure
- Working around Heavy Equipment
- Dropped Objects
- Safety Barriers and Equipment Guards
- Severe Weather
- Proper Personal Protective Equipment Practices
- Fit-for-Duty
- Stop-Work-Authority (Associated with Every Rule)
Compliance Achievement Comments:

3.0 Comments

3.1 Recommendations, Action Items and/or Observance Concerns:
3.2 Positive Recognition(s):
Overall evaluation experience with safety of personnel and environmental consideration primarily in mind on a scale from 1-10 with (1) being the lesser value- Please assess:
Media and/ or Photographs