Title Page

  • ERS Region

  • Employee's Name

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

JOB SITE DOCUMENTATION CY18 V 1.0

  • Was a Pre-Job Risk Assessment (EHS Survey / Project Safety Tailgate Meeting) conducted? Is the form properly filled and available onsite?

  • Have all involved Service Engineers (SE) and Contractors (if applicable) participated in the Pre-Job Risk Assessment (EHS Survey/ Tailgate Meeting)?

  • Does the SE know what to do in the event of an emergency situation (evacuation routes, muster points, fire extinguisher use, etc.)?

  • Does the SE know the onsite emergency phone number?

  • Does the SE know who the emergency contact is?

  • Does the SE know where the nearest medical facility is?

  • Did the SE receive/ inquire about any site specific procedures?

  • Can the SE demonstrate access to (M)SDSs?

  • Can the SE demonstrate access to the Vertiv company safety and environmental manual?

  • Is the SE familiar with the Company work / rest notification rule?

  • If the Service Division has established a maximum safe lifting limit, did the SE understand and conform to the policy limit?

TRAINING

  • Has the SE received technical training related to the unit/equipment he is working on?

  • Has the SE received Arc Flash Safety Training? Training Date__________

  • Has SE received Back Safety Training? <br>Training Date_________

  • Has the SE received Blood Borne Pathogens training? Training Date__________

  • Has the SE been offered the Hepatitis B Vaccination (if applicable by local laws)?

  • Has the SE received Classes of Fire Extinguisher? ​ <br>Training Date________

  • Has the SE received Confined Space Training? Training Date__________

  • Is the Service Engineer (SE) certified in First Aid, CPR and AED? ​ <br> First Aid Expiration Date________ CPR Expiration Date________ <br>

  • Has SE received Defensive Driving / Drive Safe/ AlertDriving Training? <br>Training Date___________

  • Has the SE received Fall Protection training? Training Date_________

  • Has the SE received Fire Prevention and Hot Work training? Training Date_________

  • Has the SE received Electrical Safety Training? Training Date__________

  • Has SE received Hazard Communication Training?<br>Training Date__________

  • Has the SE received LOTO training? Training Date_________

  • Has the SE received PPE training? Training Date_________

JOB SITE CONDITIONS

  • Any conditions that present hazards at the jobsite (combustible material stored, asbestos, hydrogen sulfide, lead, heat etc.), have been accounted for?<br><br>

  • Is there sufficient ventilation on site to carry out the work being performed (e.g. generator testing, load banks, hot work, etc.)?

  • Does the SE understand his responsibilities in case of emergencies?

  • Is the work site clean of trash, and maintained in an orderly manner?

  • Have unsafe conditions been communicated to the Customer and conditions resolved before work begins?

  • Is SE familiar with the company’s Stop Work Authority policy or procedure?

  • Is the SE familiar with the fire suppression system? (e.g. Halon, FM 200, etc...)

PERSONAL PROTECTIVE EQUIPMENT

  • Does the Service Engineer (SE) have company approved safety glasses? ​

  • Does the Service Engineer (SE) have company issued hard hat? ​

  • Is the SE wearing appropriate safety/work shoes?

  • Is the SE conforming to customer’s required specific PPE requirements?

  • Does the SE have the appropriate PPE for the task being performed (electrolyte work, hot work, refrigerant, brazing/cutting, generator testing, batteries, etc.)?

  • Has the SE demonstrated the proper inspection technique for electrical gloves and sleeves?

  • Are electrical gloves stored properly (flat/ unfolded and segregated from leather protectors and other PPE)?

  • Are voltage insulating gloves marked with the current testing, MFG and or date placed in service?

  • Does the SE have two pairs of insulating gloves?

  • Are voltage insulating sleeves marked with the current testing, MFG and or date placed in service?

  • Are Electrical Sleeves stored unfolded and separate from other PPE?

  • Does the SE have all required Arc Flash ATPV cal/cm2 (Westex label) clothing and are they wearing the appropriate Arc Flash ATPV cal/cm2 for all tasks? ​

  • Is all required Arc Flash ATPV cal/cm2 clothing free of holes, damage and significant wear?

  • Does the SE have Arc rated face shield and is it in good condition, free of cracks and significant scratches, and stored in protective bag? <br>

  • Does the SE have the appropriate hearing protection for the task?

FALL PROTECTION

  • If work in areas requiring fall protection are identified as a job requirement, is the Service Engineer (SE) authorized to wear fall protection?​ <br>

  • If the work being performed requires fall protection, is the equipment available, has it been inspected prior to use, and certified for use as fall protection devices and tie offs?

  • Does the SE’s use retractable fall protection systems when working over 4 feet (1.2 m)?

HOT WORK

  • If job-required, has the Services Engineer (SE) obtained a Hot Work Permit?

  • If hot work is required, did another Person perform the Fire Watch duties?

  • Did the Fire Watch attend their post for the required amount of time after hot work was completed?

ELECTRICAL SAFETY / LOTO

  • Is the SE qualified to perform electrical work?

  • Has the SE removed all jewelry prior to beginning work?

  • Are prescription safety glasses non-conductive?

  • Does the SE know and understand the significance of the Approach Boundaries?

  • If required, has the safe work boundary been delineated using a safety barricade or tape? <br>

  • Has the SE coordinated with the customer to perform LOTO?

  • Have stored energy sources (capacitors, batteries, springs, charging mechanisms, etc.) been properly discharged, blocked or released?​

  • Have all energy sources (electrical & mechanical) been locked out and tagged?

  • When removing or installing panels on equipment, is correct PPE being used?

  • Require a demonstration of LOTO…did SE perform the procedure correctly?

  • Is all electrical test equipment calibrated and within current calibration date requirements?

  • Require a demonstration of "Live - Dead - Live", and was the demonstration preformed correctly?

  • Is the Insulated Blanket/ Shielding in good condition, properly stored, and in certification (if applicable)?

  • Are extension cords in good condition and properly rated?

  • Does the SE have a Ground Fault Circuit Interrupter (GFCI)?

  • Has SE requested a current One Line diagram for the electrical distribution, from the Customer?

  • Does SE have a company issued Lockout/Tagout Kit?

  • Is the appropriate company approved test equipment being used for the task (e.g. probes, meters, short tip, etc…)?

  • Does the SE only have required company issued/approved insulated tools?

  • Are all insulated tools in good condition and free of nicks and unmodified?

LADDERS

  • Have ladders been visually inspected prior to each use and are they in good condition, free of damage, defects, and repairs?

  • Are all SE ladders fiberglass and ANSI rated 1A (300 lbs/137 Kg) or 1AA (375 lbs/170 Kg)? OR <br>EN Class 131(150 Kg / 330 lbs), or Class 1 (175 Kg/385 lbs) maximum or Country specific standard?

  • If in use, have extension ladders been positioned so that the ratio of ladder height to distance from the wall / building is no greater than 4:1? ​

DOCUMENTATION

  • Does the SE have a valid Driver's license?

  • Does the SE have a current vehicle registration?

  • Does the SE have a current insurance and accident reporting documents?

  • If applicable, are vehicle inspection records up to date?

EXTERIOR VEHICLE CONDITION

  • Is vehicle exterior clean and undamaged?

  • Is the windshield in good condition (no cracks, stars)?

  • Vehicle not leaking fluids (water, oil, antifreeze, fuel, etc.)?

  • All exterior lights functional?

  • Outside mirrors attached and adjustable?

  • Are tires in good condition?

INTERIOR VEHICLE CONDITION

  • Is vehicle interior clean, organized and undamaged?

  • Are dashboard gauges functioning and warning lights out?

  • Does vehicle’s horn sound?

  • Are all interior lights functioning?

  • Is the vehicle safety shield/cage installed and all required materials stored behind?

  • If compressed gas cylinders are present, are they properly secured?

  • Are seat belts and rear view mirror in good condition?

VEHICLE SAFETY EQUIPMENT

  • If required, is vehicle equipped with an appropriate Fire Extinguisher?

  • If yes to A, is the inspection record complete and current?

  • If permitted (or required) by local law, does the SE have a hands free device?

  • Are flashlights used in the workplace conforming with electrical safety best practices (arc rated, non conductive, intrinsically) and provided by the company?

  • Does the Service Engineer (SE) have a current First Aid Kit?

  • If required, is the vehicle equipped with Reflective Safety Triangles or other equipment as required by local law?

CORRECTIVE ACTIONS

  • 1.

  • 2.

  • 3.

  • 4.

  • 5.

AUDIT SUMMARY

  • COMPLIANT- All requirements are being met.

  • MINOR NON COMPLIANCE- Some requirements are not being met – work is still performed safely.

  • MAJOR NON COMPLIANCE - Significant issues not addressed or repeated non-compliance, work must not proceed until resolved.

  • Is follow up necessary? If YES by whom? <br>

SIGNATURES

  • Auditor Signature

  • SE Signature

  • Service Manager

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