DTZ Field Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

ESH Section

• Did the technician perform their UTake5?

  Yes

  No

  N/A

• Have hazards been identified and mitigated?<br>

  Safe

  At Risk

  N/A

• Is PPE per SOW/JHA being worn (tyvek, gloves, respirator, fall protection, etc.) and in good working condition?

  Safe

  At Risk

  N/A

• Is work area free of slips trips and falls?

  Safe

  At Risk

  N/A

• Are barricades in place with proper signage?

  Safe

  At Risk

  N/A

• Are proper tools available for the task, being used correctly and in good working condition? (ladders, Electrical Cords, Etc.)

  Safe

  At Risk

  N/A

• Are tool carts and work benches neatly originised?

  Safe

  At Risk

  N/A

Lockout /Tagout Procedures

• Is LOTO required?

  Yes

  No

  N/A

• Has LOTO procedures been reviewed with by employees?

  Yes

  No

  N/A

• Are all LOTO isolation points identified?

  Yes

  No

  N/A

• Have the energy dissipation been verified?

  Yes

  No

  N/A

• Have LOTO measures been implemented effectively?

  Yes

  No

  N/A

Reliability, Manufacturing and Mechanical Systems

• Is paper work reviewed and signed by workers before starting the work? (SOW / Daily JHA / LOTO, etc)

  Yes

  No

  N/A

• Do workers understand the job task?

  Yes

  No

  N/A

• Is the work scope described in the work permit consistent with the work being performed in the field?

  Yes

  No

  N/A

• Are work procedures adequate, up to date and allow for safe completion of task?

  Yes

  No

  N/A

• Are EMO's covered with in the work zone?

  Yes

  No

  N/A

• Are spotters being used in congested areas and potential areas of interference been identified and accounted for?

  Yes

  No

  N/A

• Are slip rings being used properly? (Blue & Green)

  Yes

  No

  N/A

• Is 5's being implemented? (before, during and after)

  Yes

  No

  N/A

• Has the information been properly passed down from the morning work permit meeting?

  Yes

  No

  N/A

• Have proper actions been taken to minimize risk to critical tools as shown on the Big Board?

  Yes

  No

  N/A

• Have proper actions been taken to minimize risk to critical tools?

  Yes

  No

  N/A

Environmental

• Are chemical containers properly labeled?

  Yes

  No

  N/A

• Are storm drains protected from potential work run-off?

  Yes

  No

  N/A

• Is potential waste addressed for proper disposal? (recycling bins, waste bins or DSC)

  Yes

  No

  N/A