FY 14 Global Services Safety Performance Review Version 1.1

• Audit Title

• Client / Site

• Location
  Address

• Prepared by

• Conducted on

  Date

Auditor's Name & Title/Position

Personnel Being Audited

Activity or Operation

I. JOB SITE DOCUMENTATION FY 14 ver. 1.1

• A. Was an EHS Survey / Project Safety Tailgate Meeting / Job Site Risk Assessment conducted? Is the form properly filled up and available on site?

  Yes

  No

  N/A

• B. Did the Service Engineer (SE) receive instructions regarding evacuation in the event of an emergency?

  Yes

  No

  N/A

• C. Does the SE undestand his responsibilities in case of fire?

  Yes

  No

  N/A

• D. Does the SE know the onsite emergency phone number?

  Yes

  No

  N/A

• E. Does the SE know who the emergency contact is?

  Yes

  No

  N/A

• F. Does the SE know where the nearest hospital or burn center is?

  Yes

  No

  N/A

• G. If required by the Customer, did the SE use a Method of Procedure?

  Yes

  No

  N/A

• H. If provided by the Customer, did the SE attend any site-specific training? List down coverage of the training

  Yes

  No

  N/A

• I. Are SDSs available for the materials being used on site?

  Yes

  No

  N/A

• J. Is there an ENP-company safety and environmental manual available on site?

  Yes

  No

  N/A

• K. Is the SE familiar with the Company work/rest notification rule? How many hours will be onsite ______? How many hours travel time _______?

  Yes

  No

  N/A

II. TRAINING

• A. Is the Service Engineer (SE) certified in First Aid, CPR and AED?<br> First Aid Expiration Date ________________________<br> CPR Expiration Date ___________________________

  Yes

  No

  N/A

• B. Is the SE carrying his current First Aid and CPR card, if required?

  Yes

  No

  N/A

• C. Has the SE received Bloodborne Pathogens Training? Training Date ___________________

  Yes

  No

  N/A

• D. Has the SE received PPE Training? Training Date. _______________________

  Yes

  No

  N/A

• E. Has the SE received Fall Protection Training? Training Date __________________________

  Yes

  No

  N/A

• F. Has the SE received LOTO Training? Training Date __________________________

  Yes

  No

  N/A

• G. Has the SE received Arc Flash Training? Training Date _________________________

  Yes

  No

  N/A

• H. Has the SE received Confined Space Training? Training Date _______________________

  Yes

  No

  N/A

• I. Has the SE received Electrical Safety? Training Date ________________________

  Yes

  No

  N/A

• J. Has the SE received Fire Extinguisher Training? Training Date ______________________

  Yes

  No

  N/A

• K. Has the SE received Fire Prevention Training? Training Date ________________________

  Yes

  No

  N/A

• L. Has the SE received Hazard Communication Training? Training Date _______________________

  Yes

  No

  N/A

• M. Has the SE received Defensive Driving / Drive Safe Training? Training Date ___________________

  Yes

  No

  N/A

• N. Has the SE received Back Safety Training? Training Date _____________________

  Yes

  No

  N/A

III. JOB SITE CONDITIONS

• A. Is the work site clean of trash and maintained in an orderly manner?

  Yes

  No

  N/A

• B. Is sufficient drinking water available?

  Yes

  No

  N/A

• C. Are chemicals/combustible liquids identified and stored properly?

  Safe

  At Risk

  N/A

IV. PERSONAL PROTECTIVE EQUIPMENT

• 5.1. Unsafe or damaged harness or equipment?

  Safe

  At Risk

  N/A

• 5.2. Incompatible hooks/equipment?

  Safe

  At Risk

  N/A

• 5.3. Unlabelled or does not meet AS?

  Safe

  At Risk

  N/A

• 5.4. Unsafe or uncertified anchor points?

  Safe

  At Risk

  N/A

• 5.5. Lack of inspection protocol for equipment?

  Safe

  At Risk

  N/A

• 5.6. Lack of or inadequate formal training for operators?

  Safe

  At Risk

  N/A

6. Ladders

• 6.1. Unsafe or damaged ladders?

  Safe

  At Risk

  N/A

• 6.2. Unsafe positioning of ladders?

  Safe

  At Risk

  N/A

• 6.3. Ladder not properly secured?

  Safe

  At Risk

  N/A

• 6.4. Ladder unsuitable for job? (e.g. metal ladder used for electrical work)

  Safe

  At Risk

  N/A

7. Hazardous Manual Tasks

2. TRAINING

2. TRAINING

• Add media

  Media

• Add media

  Media

• 7.1. Lack of identification hazardous manual tasks?

  Safe

  At Risk

  N/A

• 7.2. Lack of assessment of hazardous manual tasks?

  Safe

  At Risk

  N/A

• 7.3. Inadequate risk controls? (examples: no job rotation, lighter loads, trolleys, lifting equipment, etc)

  Safe

  At Risk

  N/A

• 7.4. Lack of training in risk controls and safe lifting/ team lifting techniques?

  Safe

  At Risk

  N/A

8. Hazardous Chemical (including fuel and oil)

• 8.1. Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)

  Safe

  At Risk

  N/A

• 8.2. Incompatible chemicals stored near each other?

  Safe

  At Risk

  N/A

• 8.3. Inadequate spill containment equipment?

  Safe

  At Risk

  N/A

• 8.4. Safety Data Sheets not accessible on site?

  Safe

  At Risk

  N/A

• 8.5. Lack of emergency procedures for injury/spills/fire etc?

  Safe

  At Risk

  N/A

• 8.6. Excessive quantities stored on site or in vehicles?

  Safe

  At Risk

  N/A

• 8.7. Insufficient ventilation?

  Safe

  At Risk

  N/A

• 8.8. Insufficient, or incorrect, PPE?

  Safe

  At Risk

  N/A

• 8.9. Unsuitable storage containers? (unlabeled or stored in food containers)

  Safe

  At Risk

  N/A

9. Emergency Response

• 9.1. Lack of, or no emergency plans for site?

  Safe

  At Risk

  N/A

• 9.2. Emergency procedures not displayed at site?

  Safe

  At Risk

  N/A

• 9.3. Lack of training and rehearsal of emergency plans?

  Safe

  At Risk

  N/A

• 9.4. Lack of, or inadequate first aid kits aid equipment for site?

  Safe

  At Risk

  N/A

• 9.5. Insufficient access to formally trained First Aiders for all shifts?

  Safe

  At Risk

  N/A

• 9.6. Unsuitable or inadequate communication equipment?

  Safe

  At Risk

  N/A

10. Traffic Management

• 10.1. Lack of, or inadequate, Traffic Management Plan (TMP) in place?

  Safe

  At Risk

  N/A

• 10.2. Lack of training in TMP for all persons on site? <br>(contractors and visitors)

  Safe

  At Risk

  N/A

• 10.3. Inadequate controls for TMP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)

  Safe

  At Risk

  N/A

11. Personal Protective Equipment (PPE)

• 11.1. Lack of, or inadequate PPE (including sun protection)

  Safe

  At Risk

  N/A

• 11.2. Lack of system to issue, inspect, replace and monitor PPE?

  Safe

  At Risk

  N/A

• 11.3. Lack of training in safe use, clean-up and inspection of PPE?

  Safe

  At Risk

  N/A

12. Work Environment

• 12.1. Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)

  Safe

  At Risk

  N/A

• 12.2. Insufficient lighting?

  Safe

  At Risk

  N/A

• 12.3. Inadequate housekeeping?

  Safe

  At Risk

  N/A

• 12.4. Lack of, or inadequate noise/ vibration control?

  Safe

  At Risk

  N/A

13. Electrical Hazards

• 13.1. Unsafe electrical leads? (damaged, out of test date or untested)

  Safe

  At Risk

  N/A

• 13.2. Lack of RCD protection?

  Safe

  At Risk

  N/A

• 13.3. Contact with underground assets?

  Safe

  At Risk

  N/A

• 13.4. Contact with overhead electrical lines?

  Safe

  At Risk

  N/A

• 13.5. Overloading outlets?

  Safe

  At Risk

  N/A

• 13.6. Leads placed on ground or on metal structures?

  Safe

  At Risk

  N/A

• 13.7. Electrical equipment near water?

  Safe

  At Risk

  N/A

• 13.8. Electrical equipment near flammables?

  Safe

  At Risk

  N/A

• 13.9. Electrical equipment near chemicals that could cause damage?

  Safe

  At Risk

  N/A

• 13.10. Electrical leads that may be damaged from contact with moving machinery parts?

  Safe

  At Risk

  N/A

• 13.11. Electrical leads on work surfaces?

  Safe

  At Risk

  N/A

• 13.12. Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?

  Safe

  At Risk

  N/A

14. Environmental Hazards

• 14.1. Lack of/or inadequate Environmental Management plan (EMP)?

  Safe

  At Risk

  N/A

• 14.2. Lack of/or inadequate, dust suppression system?

  Safe

  At Risk

  N/A

• 14.3. Lack of/or inadequate systems to prevent contaminants entering stormwater drains?

  Safe

  At Risk

  N/A

• 14.4. Lack of water re-use systems?

  Safe

  At Risk

  N/A

15. Administrative Procedures

• 15.1. Lack of/or inadequate Site Safety Plan?

  Safe

  At Risk

  N/A

• 15.2. Failure to obtain permits (Council, EPA, WHS, also Hot Works, Confined Space etc)

  Safe

  At Risk

  N/A

• 15.3. Lack of, or inadequate, induction for workers, contractors, visitors?

  Safe

  At Risk

  N/A

• 15.4. Lack or, or inadequate, supervisory arrangements?

  Safe

  At Risk

  N/A

• 15.5. Lack of/or inadequate training, licenses, skills, experience?

  Safe

  At Risk

  N/A

• 15.6. Lack of/or inadequate Safe Work Method Statements (SWSM) for high- risk work?

  Safe

  At Risk

  N/A

• 15.7. Lack of, or inadequate system to review SWMS as needed?

  Safe

  At Risk

  N/A

• 15.8. Lack of/or inadequate incident notification procedures?

  Safe

  At Risk

  N/A

• 15.9. Lack of, or inadequate, routine inspections, monitoring, audits?

  Safe

  At Risk

  N/A

• 15.10. Lack of/or inadequate consultative arrangements?

  Safe

  At Risk

  N/A

Corrective Actions

• Enter any corrective actions that will be undertaken

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• On site representative

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• Auditor's signature

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