EYE Program

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• How long have you worked for us?

• What do you like to do outside of work?

Engagement

• Do you feel like part of the team?

  Safe

  At Risk

  N/A

• Do you feel too rushed to do things the right way?

  Safe

  At Risk

  N/A

• Have you been trained to recognize the hazards?

  Safe

  At Risk

  N/A

• Have you been provided the proper tools and direction to complete your task?

  Safe

  At Risk

  N/A

• Conversation

People's Positions

• Align

  Safe

  At Risk

  N/A

• Over exertion (get help)

  Safe

  At Risk

  N/A

• Line of fire (pinch points)

  Safe

  At Risk

  N/A

• Over reaching

  Safe

  At Risk

  N/A

• Repetition

  Safe

  At Risk

  N/A

Attention to work

• Eyes on task

  Safe

  At Risk

  N/A

• Pace

  Safe

  At Risk

  N/A

• Aware of surroundings

  Safe

  At Risk

  N/A

• Mind on task

  Safe

  At Risk

  N/A

Communication

• JHA (warns about potential hazards)

  Safe

  At Risk

  N/A

• Task coordination between parties involved

  Safe

  At Risk

  N/A

• Plan

  Safe

  At Risk

  N/A

• Recognize changes

  Safe

  At Risk

  N/A

Using PPE

• In use

  Safe

  At Risk

  N/A

• Good condition

  Safe

  At Risk

  N/A

• Right type

  Safe

  At Risk

  N/A

Executing Work

• Selecting the right tool

  Safe

  At Risk

  N/A

• Using the tool properly

  Safe

  At Risk

  N/A

• Verify that the tool is in good condition

  Safe

  At Risk

  N/A

• Follow all policies

  Yes

  No

  N/A

• Use correct access

  Safe

  At Risk

  N/A

• Work safely

  Safe

  At Risk

  N/A

Working Conditions

• Footing

  Safe

  At Risk

  N/A

• Clean and free of clutter

  Safe

  At Risk

  N/A

• Tools and equipment are where they belong

  Safe

  At Risk

  N/A

• Guards and barriers

  Safe

  At Risk

  N/A

• Work plan design

  Safe

  At Risk

  N/A

• Ambient conditions

  Safe

  At Risk

  N/A