1. PPE Worn at appropriate level for location
Select
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
(1) = Not Observed (2) = Retrain (3) = Needs Work (4) = Meets Requirements (5) = Above and Beyond
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2. Pre-shift completed on equipment - check at least two.
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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3. Traffic Control/Pedestrian Segregation in place and adequate
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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4. Seat belts worn by all observed
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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5. All guards in place and adequate
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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6. All containers secured/labeled properly
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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7. Haul truck back-up alarms working - check at least two.
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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8. Equipment back-up alarms working- check at least two
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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9. Three points of contact adhered to
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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Media
10. CPR First Aid qualified person onsite.
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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11. Proper lifting techniques observed
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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12. Fire extinguishers in good repair and inspected
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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Media
13. Housekeeping
(1) = Not Observed
(2) = Retrain
(3) = Needs Work
(4) = Meets Requirements
(5) = Above and Beyond
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Brandy Caldwell
Crew/Plant Safety Evaluation
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
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