Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Location
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Job number:
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Job Site or Title:
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Specific location of observation: (i.e. Lay-down yard, BSL, ? Bridge, ? Building)
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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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Plan of the Day or Job Safety Analysis or Pre/Post Job Brief
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Verification (Self or Peer Check)
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Crew discussion of the scope of the work assigned for the day
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Procedure adherence and use
Hazard Recognition
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Line of Fire
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Hard Barricades (concrete abutments, plywood, Cor-ply, etc)
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Barrier Tape or Rope / Correct Signage
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Compressed Gas or Bottles (either flammable or non-flammable)
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Electrical Cord(s) / inspected / good condition / correct inspection color coded
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Air hoses / Connections / Whip-checks / Pins
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Ventilation (fresh and dust collection)
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Tools (good condition / inspected before use / calibrated)
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Vehicle usage procedures (aerial lift / forklift or lull)
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 (orderly and controlled)
Personnel Protective Equipment
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Head / Hard Hat
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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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Body (coveralls, etc)
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Respirator(s)
Fall Protection
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Correct equipment for the work and currently inspected
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Ladder usage / setup
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Scaffold usage (mobile or permanent) and current inspection
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Dropped Object Control
Manual Material Handling
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Lifting and Carring
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Using assistance as needed
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Using manual mechanical assistance (hand-trucks, dollys, pallet jack, etc)
Lifting and Rigging / Mechanical Material Handling
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Operator
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Signal Person
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Use of Spotter(s)
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Lift area
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Load control
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Softners
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Cribbing
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Lay-down yard (clean, uncluttered, easy access)
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You Must Answer Both Of These Questions
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Was feedback given to the crew or individual as soon as or during the observation
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Was supervision debriefed while the observation was being conducted
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Comments: ( NI = Requires a comment)
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Comment 1:
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Comment 2:
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Comment 3:
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Comment 4:
