EHS Internal Audit - ROS Service & Installation - EMEA - Rev 24/02/2025

• Site conducted

• Conducted on

  Date

• Prepared by

• Location
  Address

• Name of Field Service or Installation Engineer(s) (hereafter FE)

• Equipment

• Others people present at audit

• Tasks performed by FE during di inspection

• Documentation assessed during the audit

• Document number

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

  Yes

  No

• Which ones

6.1.1 General

• 1. Has the maintenance or installation been planned with the customer?

  Yes

  No

  N/A

• 2. Is there an agreement with the customer for proper handling of waste generated by Varian during maintenance or installation activity?

  Yes

  No

6.1.2. Hazard identification

• 1. Is the Customer Health & Safety documentation present?

  Yes

  No

• 2. Is Customer's Emergency response present?

  Yes

  No

• 2. If personnel from other companies are present, has the risks of interference been managed by the customer?

  Yes

  Partial

  No

  N/A

6.1.3 Site hazard verification

• 1. Are conditions for workers and pedestrian safe?

  Yes

  Partial

  No

  N/A

• 2. Is there a customer manager present (supervisor, health physicist, physician etc.)?

  Yes

  Partial

  No

  N/A

• 3. Is access to the Bunker (vault) safe?

  Yes

  Partial

  No

  N/A

• 4. Are toilets available and in good condition?

  Yes

  Partial

  No

  N/A

• 5. Are the environmental conditions acceptable (temperature, light, humidity, noise, dust, etc.)?

  Yes

  Partial

  No

  N/A

• 6. Is the Customer's safety signage present?

  Yes

  Partial

  No

  N/A

• 7. Is the bunker (except for working materials) tidy? Does it present no slip, trip or fall hazards?

  Yes

  Partial

  No

  N/A

• 8. Is the equipment clean? Particularly on the couch and/or collimator, are there no biological fluids present?

  Yes

  Partial

  No

  N/A

7.1 Resources

• 1. Does the maintenance or installation activity that the FE is performing require more than one person?

  Yes

  No

• Specify the procedure

• 2. Does the maintenance or installation activity that the FE is performing require the support of a qualified supplier?

  Yes

  No

• Specify the procedure

7.3 Awareness

EHS aspects

Worker(s)

• FE name:

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

  Yes

  No

  N/A

• 2. If required, does FE have with him the Company badge with photo?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 4. Is FE aware of the Customer's emergency procedures?

  Yes

  Partial

  No

  N/A

• 5. Is the FE aware of EHS procedures and know where they are located?

  Yes

  Partial

  No

  N/A

• 6. Does FE know how to proper handle Chemical and know where SDSs are located?

  Yes

  No

  N/A

• 7. Does the FE know that he has to report any incidents, near misses, and good observation using myCority?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 9. Does FE have the lock-out, tag-out?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 11. Does FE have all required PPE to perform the planned activities?

  Yes

  No

  N/A

• Indicate the PPE 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 PPE not listed above No PPE are required for this specific task

  • 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 PPE not listed above
  • No PPE are required for this specific task

• Other PPE not listed above

• 12. Are the available PPE in good condition?

  Yes

  Partial

  No

  N/A
Radiation safety (if within the scope of the audit)

• 13. If required, does FE have with him the suitability to work as category B radiation worker?

  Yes

  No

  N/A

• 14. If required, does the FE have the radiation safety training certificate?

  Yes

  No

  N/A

• 15. Is FE aware of the proper handling of replaced activated components (RMT0604G10)?

  Yes

  Partial

  No

  N/A

• 16. Does FE wear dosimeter(s) as required?

  Yes

  No

  N/A

• Which ones

  Select Whole boby Extremety EPD (Electronic Personal Dosimeter)

  • Whole boby
  • Extremety
  • EPD (Electronic Personal Dosimeter)

• EPD last calibration date

  Date
Company car (if within the scope of the audit)

• 17) Is the FSE aware of Company Car coverage / maintenance (company car only)? Select from the drop-down menu the checks performed

  Select Winter tyres Summer tyres High visibility vest Maintenance Emergency triangle Failed

  • Winter tyres
  • Summer tyres
  • High visibility vest
  • Maintenance
  • Emergency triangle
  • Failed

• 18) Is the First aid kit present?

  Yes

  No

• Due date

  Date

• 19) If present, are pressurized cans (WD 40, Triflow, compressed air, etc) stored properly by FSE?

  Yes

  Partial

  No

  N/A
Evaluation of the effectiveness of EHS training (if within the scope of the audit)

• 1. Hands-on test on the correct use of category 3 PPE. Select at least one from the drop-down menu

  Select Electrical safety gloves Half-mask (with filters A2P2)

  • Electrical safety gloves
  • Half-mask (with filters A2P2)

• Did the FSE properly check the electric safety gloves before using them?

  Pass

  Fail

  N/A

• Did the FSE wear the half mask (with A2P2 filters) correctly before using it?

  Pass

  Fail

  N/A

• 2. Interview the FSE on one or more of these specific risks: e.g., electrical hazard, use of a ladder, chemical hazard, or other hazards present during the audit.

8.1 Operational planning and control

• Task performed by FE:

• 1. What risks does the FE face during this specific task? Select them form the drop-down menu

  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 Interference risks Other risks not listed 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
  • Interference risks
  • Other risks not listed above

• Does FE know how to handle properly Chemical?

  Yes

  Partial

  No

  N/A

• Does the FE demonstrate how to use the LOTO correctly?

  Yes

  Partial

  No

  N/A

• Does the FE follow the electrical safety procedure during this task?

  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

• Does the FE check for biological fluids in the couch or collimator before starting activities?

  Yes

  Partial

  No

  N/A

• Indicate the risk(s) present not listed above

• 2. What PPE does the FE wear during this specific task? Select them from the drop-down menu

  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 PPE not listed above No PPE are required for this specific task

  • 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 PPE not listed above
  • No PPE are required for this specific task

• Other PPE worn by FE not listed above

• 3. Notes

• 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