Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Is a contractor being audit?

  • Which contractor company?

Prework Aspects

  • Foundational aspects applicable to all Fatal Risks that address: housekeeping, workplace exams, FLRA, training confirmation, emergency protocols.

  • Is the work area housekeeping in good order? (i.e., clear walkways and organized tools/materials)

  • Has a workplace exam been conducted?

  • Have all hazards been identified, corrected, or communicated?

  • Has the employee conducted a Field Level Risk Assessment (FLRA) or Team Risk Assessment (TRA)?

  • Has the employee received training? (i.e., task training, procedure or guidelines)

  • Can the employee explain the proper emergency shut down, summoning for help and evacuation procedures? 

Critical Controls - Rotating Equipment

  • Critical Controls: Actions and conditions that must be in place and functioning 100% of the time, without fail, to protect people when working in potentially significant risk situations.

    Instructions: For each critical control, select Controlled, At Risk, or NA (Not Applicable or Not Observed). See the Assessment below for definitions. If something is marked At Risk, immediately Pause the work until the missing protections are put in place. Write the corrective action taken in the notes box below

Competency

  • Has the worker been trained and authorized, and does the worker understand the components of working around rotating equipment?

Guarding and Safety Devices

  • Is guarding and/or a barrier present and meets the standard?

  • If an authorized bypass needs to occur, has communication been made to all affected personnel?

  • Is the exclusion zone demarcated with the hazard and precautionary actions identified?

  • Is there an authorized process in place for removal of guards, when necessary, in order to perform live testing?

  • Is the emergency shut-off device visible, accessible, and properly maintained?

  • If removed, have all guards and safety systems been restored when the work is completed?

  • Is worker clear of potential line of fire situations?

  • Are there designated covered walkways under conveyor belts?

  • Are barricades in place where there is the potential for falling objects?

Block Against Movement

  • Have individuals performed effective mechanical blocking?

  • Are the mechanical blocks approved and safe for use?

  • Are jacks and blocks designed, adequate, and positioned correctly for the task?

  • During maintenance, are the articulation and bed locks in place to block against movement?

Assessment

  • CONTROLLED The presence of this control is verified and effective

  • AT RISK This control is missing or ineffective

  • NA / NO Not Applicable to this exposure situation or Not Observed

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.