ESPANOLA MILL JOB OBSERVATION

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• JOB OBSERVATION

• For Month of

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  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December

• Observation Time

  Date

• People Observed

• Job photo

  Media

PPE

• Hard Hat

  Safe

  At Risk

  N/A

• Safety Glasses

  Safe

  At Risk

  N/A

• Footwear

  Safe

  At Risk

  N/A

• Respiratory

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Hearing

  Safe

  At Risk

  N/A

• Hand

  Safe

  At Risk

  N/A

• Clothing

  Safe

  At Risk

  N/A

Body Mechanics

• Lifting

  Safe

  At Risk

  N/A

• Carrying

  Safe

  At Risk

  N/A

• Bending

  Safe

  At Risk

  N/A

• Twisting

  Safe

  At Risk

  N/A

• Reaching

  Safe

  At Risk

  N/A

• Position

  Safe

  At Risk

  N/A

• Balance

  Safe

  At Risk

  N/A

People

• Communication

  Safe

  At Risk

  N/A

• Line of Fire

  Safe

  At Risk

  N/A

• Pace

  Safe

  At Risk

  N/A

• Mind on Task

  Safe

  At Risk

  N/A

• Eyes on Task

  Safe

  At Risk

  N/A

• Hazard Response

  Safe

  At Risk

  N/A

• Working Blind

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

Tools & Equipment

• Condition

  Safe

  At Risk

  N/A

• Proper for Job

  Safe

  At Risk

  N/A

• Safety Devices

  Safe

  At Risk

  N/A

• Per-use Checklist

  Safe

  At Risk

  N/A

• Erected/Installed

  Safe

  At Risk

  N/A

• Storage

  Safe

  At Risk

  N/A

Lock & Tag

• Isolated

  Safe

  At Risk

  N/A

• Tested

  Safe

  At Risk

  N/A

• Locked

  Safe

  At Risk

  N/A

• Tagged

  Safe

  At Risk

  N/A

• Sealed

  Safe

  At Risk

  N/A

• Tried (i.e. jog)

  Safe

  At Risk

  N/A

Confined Space

• Permit Completed

  Safe

  At Risk

  N/A

• Observer Assigned

  Safe

  At Risk

  N/A

• S.A.R. Inside

  Safe

  At Risk

  N/A

• Ventilation

  Safe

  At Risk

  N/A

• G.F.C.I.

  Safe

  At Risk

  N/A

• Egress

  Safe

  At Risk

  N/A

Work Package

• Was the employee given a Work Order?

  Yes

  No

  N/A

• Was a Safety Checksheet completed for the job?

  Yes

  No

  N/A

• Does the worker have the required SOP for the job?

  Yes

  No

  N/A

General Comments

• Describe any practices and or conditions that deserve compliment or correction. If corrected please indicate action/follow-up taken.

• Comments

• Signature

  Sign

• Signature

  Sign