CY19 Vertiv Services- Safety Performance Review Version 1.0

• Region

  West

  Central

  Northeast

• District

  Select Air Tech (7845) Air Tech (7975) Atlanta (7648) Baltimore (7641) Boston (7645) CA Cooling (7616) Central Region (7620) Charlotte (7623) Chicago (7634) Columbus (7632) Connecticut (7646) Cooling Training (7605) Critical Uptime Services (7628) Dallas (7621) Denver (7613) East Area (7640) Houston (7622) Indianapolis (7631) Kansas City (7624) Los Angeles (7612) Long Island (7647) Manhattan (7642) Monitoring (7671) Nashville (7625) New Jersey (7643) Northeast Region (7630) NY Cooling (7615) OH Cooling (7617) Orlando (7649) Philadelphia (7644) Remote Monitoring (7030) San Francisco (7611) Seattle (7614) Thermal Mgmt (7626) VA Cooling (7618) West Region (7610)

  • Air Tech (7845)
  • Air Tech (7975)
  • Atlanta (7648)
  • Baltimore (7641)
  • Boston (7645)
  • CA Cooling (7616)
  • Central Region (7620)
  • Charlotte (7623)
  • Chicago (7634)
  • Columbus (7632)
  • Connecticut (7646)
  • Cooling Training (7605)
  • Critical Uptime Services (7628)
  • Dallas (7621)
  • Denver (7613)
  • East Area (7640)
  • Houston (7622)
  • Indianapolis (7631)
  • Kansas City (7624)
  • Los Angeles (7612)
  • Long Island (7647)
  • Manhattan (7642)
  • Monitoring (7671)
  • Nashville (7625)
  • New Jersey (7643)
  • Northeast Region (7630)
  • NY Cooling (7615)
  • OH Cooling (7617)
  • Orlando (7649)
  • Philadelphia (7644)
  • Remote Monitoring (7030)
  • San Francisco (7611)
  • Seattle (7614)
  • Thermal Mgmt (7626)
  • VA Cooling (7618)
  • West Region (7610)

• Employee's Name

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

JOB SITE DOCUMENTATION CY19 V 1.0

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does the SE know the onsite emergency phone number?

  Yes

  No

  N/A

• Does the SE know who the emergency contact is?

  Yes

  No

  N/A

• Has the SE identified an emergency communication plan and are they familiar with it?

  Yes

  No

  N/A

• Has the SE verified the functionality of the communication devices? (e.g. cellular phone, two-way radio, etc...)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Did the SE receive/ inquire about any site specific procedures? (e.g. required work permits, site safety orientation)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are the (M)SDSs of the products/chemicals being used readily available?

  Yes

  No

  N/A

• Are the products/chemical being stored in appropriate containers and properly labeled?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

TRAINING

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

  Yes

  No

  N/A

• Has the SE received Arc Flash/Electrical Safety (NFPA70E) training?

  Yes

  No

  N/A

• Has SE received Back Safety Training?

  Yes

  No

  N/A

• Has the SE received Blood Borne Pathogens training?

  Yes

  No

  N/A

• Has the SE been offered the Hepatitis B Vaccination?

  Yes

  No

  N/A

• Has the SE received Classes of Fire Extinguisher?

  Yes

  No

  N/A

• Has the SE received Confined Space Training?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has SE received Defensive Driving / Drive Safe/ AlertDriving Training?

  Yes

  No

  N/A

• Has the SE received Fall Protection training?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has SE received Hazard Communication training?

  Yes

  No

  N/A

• Has the SE received LOTO training?

  Yes

  No

  N/A

• Has the SE received PPE training?

  Yes

  No

  N/A

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>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is the SE familiar with the installed fire suppression system and it’s operations? (e.g. Halon, FM 200, etc.)

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Does the SE have company approved safety glasses? ​

  Yes

  No

  N/A

• Does the SE have company issued hard hat? ​

  Yes

  No

  N/A

• Is the SE wearing appropriate safety/work shoes?

  Yes

  No

  N/A

• Is the SE conforming to customer’s required specific PPE requirements and the task the SE is performing?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does the SE have the Arc Flash Rated work gloves? Does the SE know when it is appropriate to use them?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are voltage insulating gloves marked with the current testing and or date placed in service? (6 months from test or service date)

  Yes

  No

  N/A

• Does the SE have two pairs of insulating gloves?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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? ​

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does the SE have a current First Aid Kit? (Verify eye saline expiration date)

  Yes

  No

  N/A

FALL PROTECTION

• Is the SE trained in the proper use and authorized to use fall protection equipment?

  Yes

  No

  N/A

• Has the fall protection been inspected prior to use?

  Yes

  No

  N/A

• Has a competent person completed an annual documented inspection on the fall protection equipment?<br>

  Yes

  No

  N/A

• Is the fall protection free from damage/defects, and stored per manufacturer requirements?

  Yes

  No

  N/A

• Does the SE have the proper fall protection system when working over 4 feet (1.2 m)? (i.e. Fall Arrest, Fall Restraint)

  Yes

  No

  N/A

HOT WORK

• If job-required, has the SE obtained a Hot Work Permit?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

ELECTRICAL SAFETY / LOTO

• Is the SE qualified to perform electrical work?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are prescription safety glasses non-conductive?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are extension cords and electrical portable hand tool cords in good condition and properly rated?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are flashlights used in the workplace conforming with electrical safety best practices (nonconductive) and provided by the company?

  Yes

  No

  N/A

LADDERS

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• 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? ​

  Yes

  No

  N/A

DOCUMENTATION

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

  Yes

  No

  N/A

• Does the SE have a current vehicle registration?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

EXTERIOR VEHICLE CONDITION

• Is vehicle exterior clean and undamaged?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• All exterior lights functional?

  Yes

  No

  N/A

• Outside mirrors attached and adjustable?

  Yes

  No

  N/A

• Are tires in good condition?

  Yes

  No

  N/A

INTERIOR VEHICLE CONDITION

• Is vehicle interior clean, organized and undamaged?

  Yes

  No

  N/A

• Are dashboard gauges functioning and warning lights out?

  Yes

  No

  N/A

• Does vehicle’s horn sound?

  Yes

  No

  N/A

• Are all interior lights functioning?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

VEHICLE SAFETY EQUIPMENT

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

THERMAL MANAGEMENT SEs

• Is the SE wearing goggles during spray or brush cleaning of coils either dry, or when using water or chemicals?<br><br>No spraying or brushing is allowed without goggles…NO exceptions.

  Yes

  No

  N/A

• Are the required flares, fire extinguishers, and roadway triangles in the vehicle?

  Yes

  No

  N/A

• Are the Red (acid) and Blue (base) chemicals segregated in vehicle?<br><br>Acids (red) and Bases (blue) are reactive. Store in different parts of the truck.<br>

  Yes

  No

  N/A

• Is the SE wearing #3 or #5 shade goggles when brazing or cutting metal?<br><br>Ask the associate which shades are required for soldering (3), brazing (3), or torch cutting (5). They must know the difference between No 3 and No 5 shades, and know when to use them.<br>

  Yes

  No

  N/A

• Does the SE have an Oxygen/ Acetylene Rig?<br><br>The Oxygen/ Acetylene rigs will be either blue or green.

  Yes

  No

  N/A

• Are the Oxygen and Acetylene rig equipped with flashback arrestors and check valves?<br><br>Have the Associate show you…the check valves must be installed at the torch end of the rig and flashback arrestor should be installed at the cylinder or regulator.

  Yes

  No

  N/A

• Has the SE completed their quarterly Compressed Gas Cylinder Inspection form?

  Yes

  No

  N/A

BATTERY SAFETY

• Is the SE aware of Vertiv Services policy about transporting batteries in their vehicle?<br><br>The SE should indicate that they are not permitted to transport batteries in their vehicle unless the site is unmanned and this has been approved by Safety. They must also have the battery securing device.

  Yes

  No

  N/A

• Require the Associate to demonstrate how to use the battery securing device. Did they demonstrate correctly?

  Yes

  No

  N/A

• Is the SE wearing the appropriate PPE for VLA Battery Work? (e.g. specific gravity readings, watering batteries)<br><br>Associates must wear Vertiv standard battery gear when working on all wet cells. This includes goggles, battery face shield, orange arc flash acid apron, rubber insulating gloves and leather protectors.

  Yes

  No

  N/A

• Are SEs and Battery Specialists wearing Rubber Insulated Gloves and Leather Protectors when making connection?<br><br>All battery work is energized. Associates must use insulating gloves and leather protectors at all times. When using tools, they must also wear the balaclava, arc flash coveralls, and arc flash face shield.

  Yes

  No

  N/A

• Is the SE verifying zero voltage each time before making a battery connection?<br><br>Have the Associate show you how they verify the string is not connected elsewhere. They must verify Zero volts before making any battery connection.

  Yes

  No

  N/A

CONTROL OF HAZARDOUS ENERGY (CoHE) PROCEDURES

• Did the Associate check TKO to determine if there is a CoHE procedure?

  Yes

  No

  N/A

• Did the Associate use the Hazardous Energy Reference Tables (HERT)?

  Yes

  No

  N/A

• Were all CoHE and HERT documents accurate? If no, explain.

  Yes

  No

  N/A

VERTIV SERVICES COMPANY VEHICLES

• Does the SE have a Drug Screening Kit (Medtox Kit) in their Vehicle?

  Yes

  No

  N/A

• The SE has NOT received a moving vehicle violation in the last 12 months?

  Yes

  No

  N/A

• If they had a moving vehicle violation in the last 12 months, did they report it to their direct Manager?<br><br>If they had a clean driving record, mark "N/A"

  Yes

  No

  N/A

• Is the telematics functioning?

  Yes

  No

  N/A

RESPIRATORS Respirators are NOT issued to Associates unless they are an Emergency Egress Respirator. This would be a cutomer requirement, the safety department must be notified.

• Are respirators maintained in a sanitary condition?<br><br>Ask the associate if they have a respirator. If they haven’t been issued that respirator from Corporate Safety…it must be confiscated…we do not permit voluntary use of respirators (except dust masks…see below). If issued, have them show you the respirator. It should be in a re-sealable bag. If they are using Filtering Face piece Respirators (i.e. Dust Masks) on a voluntary basis, they must have a copy of Appendix D of the OSHA respiratory standard with them at all times. Contact Safety Dept for assistance

  Yes

  No

  N/A

• Is the SE able to demonstrate the proper pre-use inspection procedure?<br><br>Have them demonstrate their pre-use inspection. Check all rubber fittings. Check seals, if half or full face, perform negative pressure test with no cartridges applied. Have them explain why they check the respirator. The SE must be clean shaven while wearing a respirator.

  Yes

  No

  N/A

• Are the unused detachable cartridges in a sealed bag?<br><br>Any detachable cartridge not in its original sealed wrapping is considered to be used

  Yes

  No

  N/A

• Are the detachable cartridges disposed of after use?

  Yes

  No

  N/A

• Did Associate perform negative and positive pressure test correctly?<br><br>Have SE demonstrate seal check.

  Yes

  No

  N/A

CORRECTIVE ACTIONS

• 1.

  Yes

  No

  N/A

• 2.

  Yes

  No

  N/A

• 3.

  Yes

  No

  N/A

• 4.

  Yes

  No

  N/A

• 5.

  Yes

  No

  N/A

AUDIT SUMMARY

• COMPLIANT- All requirements are being met.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

SIGNATURES

• Auditor Signature

  Sign

• SE Signature

  Sign

• Service Manager

  Sign