EHS Internal Audit - ROS Service & Installation - EMEA - Rev 05/08/2024

• Site conducted

• Conducted on

  Date

• Prepared by

• Location
  Address

• Field Service Engineer

• Equipment

• Others people present at audit

• Tasks performed

• Documentations

• Document number

• Are there any follow-ups to the previous evaluation?

  Yes

  No

• list which ones

6.1.1 General

• Was maintenance or installation planned with the customer?

  Yes

  No

  N/A

• Have arrangements been made with the customer for the management of waste generated by Varian during maintenance or installation activity?

  Yes

  No

6.1.2. Hazard identification

• Is Customer's Safety Plan present?

  Yes

  No

• Is Customer's Emergency response present?

  Yes

  No

• If there are other companies in the ward, did the Customer manage the interference risks?

  Yes

  Partial

  No

  N/A

7.1 Resources

• Does maintenance or installation activity require more than one FSE?

  Yes

  No

• Specify the procedure

• Does maintenance or installation activity require support from one or more suppliers?

  Yes

  No

• Indicate the list of suppliers

7.3 Awareness

EHS aspects

Worker(s)

• FSE name:

• If required, does the FSE have suitability for the job certificate (health check)?

  Yes

  No

  N/A

• Certificate due date

  Date

• If required, is the FSE authorized to work in the presence of an electrical risk?

  Yes

  No

  N/A

• If required, does the FSE have the radiation safety training certificate?

  Yes

  No

  N/A

• Is the FSE aware of Customer's Safety Plan?

  Yes

  No

  N/A

• If required, does the FSE have emergency training certificate?

  Yes

  No

  N/A

• Is the FSE aware of EHS procedures?

  Yes

  No

  N/A

• Does FSE have the lock-out, tag-out?

  Yes

  No

  N/A

• Are tools in good condition (visually checked for damage, DVM , cables ...)?

  Yes

  No

  N/A

• Does FSE have the necessary PPE with him/her to perform the required tasks?

  Yes

  No

  N/A

• PPE and dosimeters present

  Select Safety shoes EN 345 (S1P) Mechanical gloves EN 388 Chemical/biological gloves EN 374 (nitrile) Chemical gloves EN 374 abc (polyethylene) Electrical safety gloves Electrical safety kit Safety glasses EN 166 Semi-Mask EN 149 - FFP2 Semi-Mask with filters EN 149 - A2P2 Ear plug EN 352.2 Helmet EN 397 High-Visibility Vest EN 471 Dosimeter whole body Dosimeter extremity EPD Other None

  • Safety shoes EN 345 (S1P)
  • Mechanical gloves EN 388
  • Chemical/biological gloves EN 374 (nitrile)
  • Chemical gloves EN 374 abc (polyethylene)
  • Electrical safety gloves
  • Electrical safety kit
  • Safety glasses EN 166
  • Semi-Mask EN 149 - FFP2
  • Semi-Mask with filters EN 149 - A2P2
  • Ear plug EN 352.2
  • Helmet EN 397
  • High-Visibility Vest EN 471
  • Dosimeter whole body
  • Dosimeter extremity
  • EPD
  • Other
  • None

• Other PPE worn

• EPD calibration date

  Date

• Does the FSE have the latest procedures, iSIR updated?

  Yes

  No

  N/A

• Does the FSE know that he has to report incidents, near misses, and good observations using myCority and to the Site Manager?

  Yes

  No

  N/A

7.4 Communication

• Is the maintenance or installation plan present in Unity?

  Yes

  No

  N/A

8.1 Operational planning and control

• Task assessed:

• Risks present

  Select Electrical risk Using ladder Chemical risk Mechanical risk Radiation safety Biological hazard Slip, trip and fall Manual handling heavy parts Lifting and lowering and carrying operations None of the above

  • Electrical risk
  • Using ladder
  • Chemical risk
  • Mechanical risk
  • Radiation safety
  • Biological hazard
  • Slip, trip and fall
  • Manual handling heavy parts
  • Lifting and lowering and carrying operations
  • None of the above

• Does FSE know how to handle Chemical / SDS-Location?

  Yes

  Partial

  No

  N/A

• Is the lock-out and tag-out equipment at hand and does it demonstrate how to use it?

  Yes

  Partial

  No

  N/A

• Does FSE follow the electrical safety procedure?

  Yes

  Partial

  No

  N/A

• Does FSE properly verify the ladder before using it?

  Yes

  Partial

  No

  N/A

• Does FSE use the ladder safely?

  Yes

  Partial

  No

  N/A

• Are equipment parts (e.i. Couch or MLC or collimator) clean (no Blood Borne Pathogens are present)?

  Yes

  Partial

  No

  N/A

• Disinfectant to clean is present

  Select Disinfectant ZETA 3 SOFT Other disinfectant

  • Disinfectant ZETA 3 SOFT
  • Other disinfectant

• Disinfectant to clean is present

  Select Disinfectant ZETA 3 SOFT Other disinfectant

  • Disinfectant ZETA 3 SOFT
  • Other disinfectant

• PPE and dosimeters worn

  Select Safety shoes EN 345 (S1P) Mechanical gloves EN 388 Chemical/biological gloves EN 374 (nitrile) Chemical gloves EN 374 abc (polyethylene) Electrical safety gloves Electrical safety kit Safety glasses EN 166 Semi-Mask EN 149 - FFP2 Semi-Mask with filters EN 149 - A2P2 Ear plug EN 352.2 Helmet EN 397 High-Visibility Vest EN 471 Dosimeter whole body Dosimeter extremity EPD Other None

  • Safety shoes EN 345 (S1P)
  • Mechanical gloves EN 388
  • Chemical/biological gloves EN 374 (nitrile)
  • Chemical gloves EN 374 abc (polyethylene)
  • Electrical safety gloves
  • Electrical safety kit
  • Safety glasses EN 166
  • Semi-Mask EN 149 - FFP2
  • Semi-Mask with filters EN 149 - A2P2
  • Ear plug EN 352.2
  • Helmet EN 397
  • High-Visibility Vest EN 471
  • Dosimeter whole body
  • Dosimeter extremity
  • EPD
  • Other
  • None

• Other PPE worn

• EPD calibration date

  Date

8.2 Emergency preparedness and response

• Is the FSE aware of Customer's Emergency Response?

  Yes

  No

  N/A

• List any findings / comments / corrective actions

• Number of health and safety non-conformities

• Number of environmental non-conformities

• Overall conclusion

• Auditor Signature

  Sign

• Audidee(s) Signature

  Sign

• Audidee(s) Signature

  Sign

• Audidee(s) Signature

  Sign

• Other person present at audit

  Sign