Information
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Document No.
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FDT Observation Worksheet
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FD Thomas, Inc
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Conducted on
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Prepared by
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Project:
Location: (Select only one)
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Enclosure 1
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Enclosure 2
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Enclosure 3
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Enclosure 4
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Enclosure 5
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Enclosure 6
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Enclosure 7
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Enclosure 8
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Enclosure 9
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Enclosure 10
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Lay-down Yard
Use The Following Choices For The Observation
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EE = Exceeds Expectations. ME = Meets Expectations. NI = Needs Improvement.
Human Performance Tools
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01. Plan of the Day or Job Safety Analysis or Pre/Post Job Brief
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02. Self Checking (STAR {Stop-Think-Act-Review}, Flagging)
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03. Verification (Self or Peer Check)
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04. Questioning Attitude (Two Minute Rule / Crew discussion of the scope of the work for the day)
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05. Procedure Use and Adherence
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06. Communicate Effectively (3-Way, Phonetic Alphabet, Proper Radio Usage)
Hazard Recognition
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07. Line of Fire
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08. Barrier Tape or Rope / Correct Signage
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09. Hard Barricades
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10. Compressed Gas
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11. Electrical Cord(s)
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12. Hoses / Connections / Whip-checks / Pins
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13. Tools (good condition / inspected before use)
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14. Vehicle usage procedures (aerial lift / forklift or lull)
Housekeeping and Material Conditions
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15. Housekeeping (cleanliness)
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16. Combustibles (properly stored / secured, labeled)
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17. Work / Laydown Area (cleanliness, orderly)
Personnel Protective Equipment
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18. Head
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19. Hearing
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20. Eyes / Face
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21. Foot
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22. Hand
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23. Body (Coveralls, etc.)
Fall Protection
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24. Use of Fall Protection
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25. Ladder Use
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26. Dropped Objects
Lifting and Rigging
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27. Lift Area
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28. Operator
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29. Signal Person
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30. Load Control
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31. Softners
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32. Cribbing
Material Handling
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33. Lifting and Carrying
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34. Use of Spotter or Assistance
You must answer both of these questions
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Feedback Given to Crew or Individual
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Debriefed Supervision
