Fatal Risk - Stored Energy

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Is a contractor being audited?

  YES

  NO

• Which contractor company?

  Select

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

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

  YES

  NO

• Has a workplace exam been conducted?

  Yes

  No

  N/A

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

  YES

  NO

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

  YES

  NO

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

  YES

  NO

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

  YES

  NO

• 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, AtRisk, or NA (Not Applicable or not observed). See Assessment below for definitions. If something is marked AtRisk, 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 energy isolation?

  Controlled

  At Risk

  N/A

Energy Isolation/LOTOTO

• Have all energy sources been identified, isolated, and de-energized?

  Controlled

  At Risk

  N/A

• Have all isolation points been accounted for?

  Controlled

  At Risk

  N/A

• Are the workers using the appropriate locks/tags for the task performed?

  Controlled

  At Risk

  N/A

• Have locks, tags, and other isolation devices been installed so they cannot be bypassed or defeated?

  Controlled

  At Risk

  N/A

• Have all required employees locked out?

  Controlled

  At Risk

  N/A

• Has the tryout step been completed?

  Controlled

  At Risk

  N/A

• Has "Zero Energy" been verified?

  Controlled

  At Risk

  N/A

Guards, Barriers, and Barricades

• Are guards, barriers, and barricades properly installed to protect personnel from uncontrolled energy release?

  Controlled

  At Risk

  N/A

• Are deadman switches, emergency stops, and pull cords confirmed as functional prior to work commencing?

  Controlled

  At Risk

  N/A

• Does the work plan address reinstallation of guards, barriers, and barricades prior to return to service?

  Controlled

  At Risk

  N/A

• CONTROLLED The presence of this control is verified and effective

• ATRISK This control is missing or ineffective

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