Information
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FDT Observation Worksheet. Capital Restoration Project
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FD Thomas, Inc
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Conducted on
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Prepared by:
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Prepared by:
Location: (Select only one)
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Job Site or Job Number
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Level or Area
Use The Following Choices For The Observation (NI - Requires a comment)
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EE = Exceeds Expectations. ME = Meets Expectations. NI = Needs Improvement.
Human Performance Tools
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Plan of the Day or Job Safety Analysis or Pre/Post Job Brief
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Crew discussion of the scope of the work for the day)
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Procedure Use and Adherence
Hazard Recognition
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Line of Fire
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Barrier Tape or Rope / Signage
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Hard Barricades / Signage
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Compressed Gas or Bottles (either flammable or non-flammable)
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Electrical Cord(s) / Inspected / Good Condition
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Air Hoses / Connections / Whip-checks / Pins
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Tools (good condition / inspected before use)
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Ventilation
Housekeeping and Material Conditions
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General Housekeeping (cleanliness)
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Combustibles (properly stored / secured, labeled)
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Work Area (cleanliness, orderly, hazmat controlled)
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Lay-down yard (clean, uncluttered, easy access)
Personnel Protective Equipment
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Head
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Hearing
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Eyes / Face
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Foot
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Hand
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Respirator(s)
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Body (Coveralls, etc.)
Fall Protection
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Use of Fall Protection
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Properly worn / adjusted
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Properly anchored while in use
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Ladder Use
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Scaffold Use (mobile or permanent)
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Dropped Object Control
Lifting and Rigging / Mechanical Material Handling
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Vehicle usage procedures (aerial lift / forklift or lull)
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Operator
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Signal Person
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Use of Spotter
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Lift Area
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Load Control
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Softners
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Cribbing
Manual Material Handling
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Lifting and Carrying
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Using assistance as needed
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Using mechanical assistance (hand-truck, dolly, etc..)
You must answer both of these questions
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Feedback Given to Crew or Individual
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Debriefed Supervision
