Title Page

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  • Prepared by

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  • The reviewing team is expected to make recommendations for improvement whenever opportunities for enhancements and/or implementing best practices exist. This process is not simply a compliance review but a robust exercise for improving overall safety at the facility. Answer Yes or No and provide supporting comments for the below items; use back of sheet for comments and recommendations

  • 1) Are Weekly Toolbox talks / Safety Topics and Safety Alerts discussed with a copy of supporting documentation kept at the site or local office?

  • 2) Leaders and workers at this site have an effective Risk Assessment process in place. RA process is robust and the focus on eliminating risks first, whenever possible, before mitigating or reducing risks (pre-shift, pre-task, T-5, risks that kill, etc.)

  • 3) Documented lock-out/tag-out or isolation policy and machine specific lock-out/tag-out procedures or isolation rules in place. All authorized employees trained and evaluated (proficiency demonstration) in LOTO, as applicable

  • 4) A list of Close Proximity Maintenance (CPM) procedures specific to your facility has been created, as applicable. Personnel should be familiar with CPM as outlined on pg. 25 of the OMG LOTO policy

  • 5) Arc flash survey completed by a qualified person for this facility. Electrical labels warning of arc flash and containing required information installed on applicable electrical enclosures. Arc Flash PPE available and worn

  • 6) All employees who troubleshoot electrical systems, perform voltage testing, operate circuit breakers with covers off or are otherwise exposed to live or potentially live circuits are qualified and have been trained in NFPA 70E?

  • 7) All hazardous points on machinery are fully guarded and a system is in place for regular checks of guards. No machines are operated unless guards are replaced and secured

  • 8) 100% fall protective strategies fully implemented, trained and understood by workers. Elevated work activities have been reviewed with platforms erected in areas that are regularly accessed. Fall protective devices available and used to achieve 100% (Harnesses, beam straps, retractable lanyards, etc.)

  • 9) Pedestrian & Vehicle Segregation measures have been fully implemented at this site and these measures clearly provide direction regarding pedestrian walkways, traffic patterns, parking areas, prohibited conduct, cell phone use areas, signage, etc

  • 10) Mobile equipment and vehicles inspected as required and observations confirm units are safely operated at the site. All safety devices fully functional and utilized (i.e. cameras, b/u alarms, b/u radar, Greenroads, etc.), if equipped

  • 11) Housekeeping is excellent (not just good)

  • 12) Evidence that all employees are fully engaged in safety at this facility is present and noticeably visible during the site review

  • 13) All PPE is in place and in good condition (i.e., Hi Viz shirts, vest etc. are relatively clean)

  • 14) Evidence of seat belt use

  • 15) Evidence of 3 Points of Contact when climbing

  • The reviewing team should provide comments on both positive observations and any improvement recommendations as determined from your site review

  • Improvement recommendations can be made even where items are marked “Yes” if implementation will enhance the level of safety at the site or to implement an OMG, Divisional or Regional Best Practice. Any “No” items on the previous page should have a recommendation to address the issue.

  • Positive Observations and/or Best Practices identified during the site review (provide at least 3):

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  • Recommendations for Safety Improvement or Best Practices that should be implemented (provide at least 3):

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Overall Assessment

  • Overall Assessment

Notes:

Signatures:

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  • Site Supervisor:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.