Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Field Engineer
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Equipment
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Others people present at audit
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Tasks performed
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Documentations
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Document number
1) EHS Documents
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a) The Safety doc is present and signed by Varian and Customer (PSC, POS, DUVRI)
- DUVRI
- Informativa rischi introdotti ex art 26
- Riunioni di cooperazione e coordinamento ex art.26
- Coordinamento delle misure di radioprotezione ex art 112 -113 d.gls 101/2020
- PSC
- POS
- Altra documentazione H&S predisposta dal committente
- None of the above
2) Site
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a) The condition of workers and pedestrian are safe (construction site only)
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b) Customer officer is present (supervisor, health physicist, doctor ect.)
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c) The Bunker (vault) access is safe (construction site only)
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d) Toilet/restroom are present and in good condition
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e) The environmental conditions are acceptable (temperature, light, humidity, noise, dust, etc)
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f) Customer safety signs are present
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g) The Bunker (with the exception of working material) is clear and the machine is cleaned
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h) At the equipment the safety signs, stickers are present
3) Interference risks
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a) In the Bunker no other workers are present. Exceptions are mentioned in PSC o DUVRI
- Only Varian personnel is present
- Presence of personnel from other companies
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List H&S documents to manage the interferences present
- DUVRI
- Verbali riunione di cooperazione e coordinamento
- EHS-03-P05-M10-Rev 01 Verbale di coordinamento
- None of the above
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b) Demarcation & access control to Controlled Areas, safety signs are present (Area should clearly indicate Varian is in control & FSE must approve any access)<br>
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List the safety signs present
- No access sign at bunker entrance (corridor)
- Radiation safety sign at bunker entrance (corridor)
- Safety sign at console area
- At least one of the above is missing
4) Worker(s)
- Worker(s)
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Field Engineer name:
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a) The field engineer has the updated EHS procedures
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The field engineer is aware of EHS procedures
- EHS-03-P01-Sorveglianza sanitaria e radioprotezione
- EHS-03-P04-D01-Materiale di consumo e attrezzature di lavoro
- EHS-03-P04-Acquisti
- EHS-03-P05-Gestione delle attività in appalto
- EHS-03-P07-Gestione rifiuti
- EHS-03-P09-Travel Risk
- EHS-03-P08-Near Miss
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b) The field engineer has the lock-out, tag-out
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c) The field engineer has his own Varian badge with photo
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d) The tools are in good condition (visually checked for damage, DVM , cables ...)
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e) The PPE is available
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List of PPE available
- Safety shoes EN 345 (S1P)
- Electrical safety gloves CEI-EN 60903 Class 00
- Mechanical gloves EN 388
- Chemical/biological gloves EN 374 (nitrile)
- Chemical gloves EN 374 abc (polyethylene)
- Safety glasses EN 166
- Semi-Mask EN 149 - FFP2
- Semi-Mask with filters EN 149 - A2P2
- Ear plug EN 352.2
- Helmet
- Dosimeter whole body
- Dosimeter extremity
- Surgical mask
- See Brachytherapy
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PPE are in good condition
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f) The field engineer has the Customer emergency procedures
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g) The field engineer has the latest procedures, I-SIR updated
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h) The Field engineer knows how to handle the broken parts replaced (EHS-03-P07)
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i) The Field engineer knows how to handle activated component replaced (RMT0604G10 ex L12192 and EHS-03-P07)
5) Task assessed
- Task assessed
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Task assessed:
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Risks present
- Electrical risk
- Using ladder
- Chemical risk
- Mechanical risk
- Radiation safety
- Biological hazard
- None of the above
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The field engineer knows how to handle Chemical / SDS-Location
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The lock-out, tag-out equipment at hand and demonstrates how to use it
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The Field engineer follows the electrical safety procedure
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Field engineer correctly verified the ladder before use
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Field engineer uses the ladder safely
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Machine parts (e.i. Couch or MLC or collimator) are clean (no Blood Borne Pathogens are present)
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Disinfectant to clean is present
- Disinfectant ZETA 3 SOFT
- Other disinfectant
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Disinfectant to clean is present
- Disinfectant ZETA 3 SOFT
- Other disinfectant
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Disinfectant to clean is present
- Disinfectant ZETA 3 SOFT
- Other disinfectant
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PPE and dosimeters worn
- Safety shoes EN 345 (S1P)
- Electrical safety gloves CEI-EN 60903 Class 00
- Mechanical gloves EN 388
- Chemical/biological gloves EN 374 (nitrile)
- Chemical gloves EN 374 abc (polyethylene)
- Safety glasses EN 166
- Semi-Mask EN 149 - FFP2
- Semi-Mask with filters EN 149 - A2P2
- Ear plug EN 352.2
- Helmet
- Dosimeter whole body
- Dosimeter extremity
- Surgical mask
- See Brachytherapy
7) Environment
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a) If necessary, there is a temporary place to stock the wastes
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b) Check correct management with the customer of used lead batteries disposal
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c) If present, check correct storage of SF6 tanks in the Varian warehouse at customer site (Customer is responsible of the correct SF6 storage)
8) Company car
- Company car
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a) Employee is aware of Company Car coverage / maintenance (company car only)
- Winter tyres
- Summer tyres
- High visibility vest
- Maintenance
- Emergency triangle
- Failed
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b) First aid kit expired date check
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c) If supplied to Field Engineer, check the pressurized cans are correctly stored (WD 40, Triflow, compressed air, etc)
09) Evaluation of EHS training effectiveness (Chemical Risk, Electrical Risk, Ladder use and PPE)
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a) Practice activity
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Category 3 PPE check
- FE correclty checked electrical safety gloves before using them
- FE correctly worn half-mask (with filters A2P2) before using it
- FE correctly worn single use earplugs before using them
- Failed at least one of the above
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b) Interview (Electrical risk, using ladder, chemical risk, other risks)
10) Findings -Comments- Corrective Actions / Overall conclusion
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List any findings / comments / corrective actions
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Overall conclusion
11) Signature
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Auditor Signature
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Audidee(s) Signature
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Other person present at audit
