FMSO Berm Management

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Names of Auditors

• Name(s) of Employees and Supervisor being audited.

Employee Competencies (only affected employees should be audited)

• Employees can describe the consequences for not having an adequate berm.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe their responsibility to inspect berms each time they drive on a road.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe how to report a deficient berm.

  Yes

  No

  N/A

• Completion Date:

• Employees know that a berm must be at a minimum axle height to the largest vehicle that travels the road.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe events that would create the need for a berm. (To keep vehicles from leaving the roadway and overturning during: loss of consciousness, distracted driving, fatigued driving, erratic driving)

  Yes

  No

  N/A

• Completion Date:

Supervisor Competencies

• Supervisors can describe how they trust but verify the following for their employees:

• Employees can describe the consequences for not having an adequate berm.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe their responsibility to inspect berms each time they drive on a road.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe how to report a deficient berm.

  Yes

  No

  N/A

• Completion Date:

• Employees know that a berm must be at a minimum axle height to the largest vehicle that travels the road.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe events that would create the need for a berm. (To keep vehicles from leaving the roadway and overturning during: loss of consciousness, distracted driving, fatigued driving, erratic driving)

  Yes

  No

  N/A

• Completion Date:

• Supervisors can relate at least one instance when they observed or had reported to them a deficient berm.

  Yes

  No

  N/A

• Completion Date:

• Supervisors can describe a time when they directed the correction of a deficient berm.

  Yes

  No

  N/A

• Completion Date:

Observation of Work Practices

• Berms or guardrails are in place on all roadways.

  Yes

  No

  N/A

• Completion Date:

• Berms or guardrails are adequate to stop vehicles on the roadway.

  Yes

  No

  N/A

• Completion Date:

• Auditor(s) Signature

  Sign

• Revision 1.0 iCloud posted document is the controlled copy. 07/03/13