FM Skokie Setup Observation

• Document No.

• Daily Safety Observation Checklist - Skokie Plant

• Value Stream / Dept / Machine

• Conducted on

  Date

• Prepared by

• Activity Observed

• Operator observed

Safe Behaviour

• Is the employee following prescribed standard work procedures, including required safety procedures?

  Yes

  No

  N/A

• Is the employee following required lockout of hazardous energies? This includes the requirement to lockout or to provide lockout equivalent protection during set-up and troubleshooting activities.

  Yes

  No

  N/A

• Can fingers be pinched?

  Yes

  No

  N/A

• If parts are stuck or misaligned in the equipment, is the employee using the approved tool to remove the parts?

  Yes

  No

  N/A

• For two person or multi-person work, are employees following the required safe work instructions?

  Yes

  No

  N/A

• Are signs posted that clearly communicate the required personal protective equipment to be used?

  Yes

  No

  N/A

• Is the employee wearing all the required personal protective equipment? For example: eye or hearing protection, safety shoes, gloves, etc

  Yes

  No

  N/A

• Is the employee using excessive force to push or pull an object?

  Yes

  No

  N/A

Safe conditions

• Are signs/labels (in local language) provided on equipment to warn of potential pinch points and other hazards?

  Yes

  No

  N/A

• Are non-movable barrier guards securely fastened to machines and designed yo prevent contact with pinch points and other hazards?

  Yes

  No

  N/A

• Ae movable barrier guards designed such that when they are opened all motion of the machine and its conveyors are stopped?

  Yes

  No

  N/A

• Are areas around equipment clean and free of trip hazards?

  Yes

  No

  N/A

Other

• Results from employee interview:

Set-up Employee Safety Questionnaire

• Valuestream

• Department

• Machine

• Do you have all the tools that you need? If not what do you do?

  Yes

  No

  N/A

• Are your tools in good shape? If not why?

  Yes

  No

  N/A

• Have you ever had a near miss?

  Yes

  No

  N/A

• Do you have any safety concerns? If yes are they addressed in a timely manner?

  Yes

  No

  N/A

• Do you ever have to use a lot of force when you do your job?

  Yes

  No

  N/A

• Do you have any issues with racks?

  Yes

  No

  N/A

• Do you have any issues with your die / mold truck?

  Yes

  No

  N/A

• Do you do any set-ups with two people? If yes, what are the risks?

  Yes

  No

  N/A

• Can you think of anything that would make your job safer?

  Yes

  No

  N/A

• What function is the most dangerous part of your job?

  Yes

  No

  N/A