FY 14 Global Services Safety Performance Review Version 1.1

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

JOB SITE DOCUMENTATION FY14 V 1.1

• Was a EHS Survey / Project Safety Tailgate Meeting / Job Site Risk Assessment conducted? Is the form properly filled and available onsite?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does the SE understand his responsibilities in case of fire?

  Yes

  No

  N/A

• Does the SE know the onsite emergency phone number?

  Yes

  No

  N/A

• Does the SE know who the emergency contact is?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• If provided by the customer, did the SE attend site-specific safety training?

  Yes

  No

  N/A

• Are (M)SDSs available for the materials being used on site?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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

TRAINING

• Is the Service Engineer (SE) certified in First Aid, CPR and AED? ​ <br> First Aid Expiration Date________ CPR Expiration Date________<br>

  Yes

  No

  N/A

• Is the SE’s carrying their current First Aid and CPR card, if required?

  Yes

  No

  N/A

• Has the SE received Blood Borne Pathogens training? Training Date__________

  Yes

  No

  N/A

• Has the SE received PPE training? Training Date_________

  Yes

  No

  N/A

• Has the SE received Fall Protection training? Training Date_________

  Yes

  No

  N/A

• Has the SE received LOTO training? Training Date_________

  Yes

  No

  N/A

• Has the SE received Arc Flash Training? Training Date__________

  Yes

  No

  N/A

• Has the SE received Confined Space Training? Training Date__________

  Yes

  No

  N/A

• Has the SE received Electrical Safety? Training Date__________

  Yes

  No

  N/A

• Has the SE received Fire Extinguisher? ​ <br> Fire Extinguisher Training Date________

  Yes

  No

  N/A

• Has the SE received Fire Prevengtion training? Fire Prevention Training Date_________

  Yes

  No

  N/A

• Has SE received Hazard Communication Training?<br> Hazard Communication Training Date__________

  Yes

  No

  N/A

• Has SE received Defensive Driving / Drive Safe Training? <br>Defensive Driving / Drive Safe Training Date___________

  Yes

  No

  N/A

• Has SE received Back Safety Training? <br>Back Safety Training Training Date_________

  Yes

  No

  N/A

JOB SITE CONDITIONS

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

  Yes

  No

  N/A

• Is sufficient drinking water available?

  Yes

  No

  N/A

• Are chemicals/combustible liquids identified and stored properly?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Does the Service Engineer (SE) have company issued hard hat and<br>safety glasses as required? ​ <br>

  Yes

  No

  N/A

• Is the SE wearing appropriate safety/work shoes?

  Yes

  No

  N/A

• Is the SE conforming to customer’s required specific PPE requirements?

  Yes

  No

  N/A

• Does the SE have an acid faceshield and apron, if required?

  Yes

  No

  N/A

• Has the SE demonstrated the proper inspection technique for electrical gloves and sleeves?

  Yes

  No

  N/A

• Are voltage insulating gloves marked with the current testing, MFG and or date placed in service?

  Yes

  No

  N/A

• Are voltage insulating sleeves marked with the current testing, MFG and or date placed in service?

  Yes

  No

  N/A

• Are electrical gloves stored properly (flat and segregated from leather protectors and other PPE) ?

  Yes

  No

  N/A

• Are Electrical Sleeves stored unfolded and separate from other PPE?

  Yes

  No

  N/A

• Does the SE have all required Arc Flash ATPV cal/cm2 (Westex labeled for current orders) clothing and are <br>they wearing the appropriate Arc Flash ATPV cal/cm2 for all tasks? ​

  Yes

  No

  N/A

• Is all required Arc Flash ATPV cal/cm2 clothing free of holes, damage and significant wear?

  Yes

  No

  N/A

• Does the SE have Arc rated face shield and is it in good condition, free of cracks and significant scratches, and stored in protective bag?<br>

  Yes

  No

  N/A

• Does the SE have arc rated hearing protection?

  Yes

  No

  N/A

• Do 3rd Party Service Providers working for our company have appropriate<br>PPE including arc flash protection? ​ <br>

  Yes

  No

  N/A

FALL PROTECTION

• If work in areas requiring fall protection are identified as a job requirement,<br>is the Service Engineer (SE) authorized to wear fall protection?​ <br>

  Yes

  No

  N/A

• If the work being performed requires fall protection, is the equipment available,has it been inspected prior to use, and is it being used correctly?

  Yes

  No

  N/A

• Does the SE’s use retractable fall protection systems when working over 4 feet (1.2 m)?

  Yes

  No

  N/A

HOT WORK

• If job-required, has the Services Engineer (SE) obtained a Hot Work Permit?

  Yes

  No

  N/A

• If hot work is required, did another Person perform the Fire Watch duties?

  Yes

  No

  N/A

• Did the Fire Watch attend their post for at least 60 minutes after hot work?

  Yes

  No

  N/A

ELECTRICAL SAFETY / LOTO

• Has the Service Engineer (SE) removed all jewelry before working on<br>energized equipment? ​ <br>

  Yes

  No

  N/A

• Does the SE know what the Arc Flash, Limited Approach, Restricted Approach<br>and Prohibited Approach Boundaries are for the task and do they understand their significance?

  Yes

  No

  N/A

• Has the CE calculated and or selected the correct safe work boundary (limited or arc flash)?

  Yes

  No

  N/A

• If required, has the safe work boundary been delineated using a safety barricade or tape?<br>

  Yes

  No

  N/A

• Has the SE coordinated with the customer to perform LOTO?

  Yes

  No

  N/A

• Have stored energy sources (capacitors, batteries, springs, charging mechanisms, moving machinery parts,<br>hydraulic systems, etc.) been properly discharged, blocked or released?​

  Yes

  No

  N/A

• Have all energy sources (electrical & mechanical) been locked out and tagged?

  Yes

  No

  N/A

• Require a demonstration of LOTO…did SE perform the procedure correctly?

  Yes

  No

  N/A

• Has the SE tested the circuit / component being worked on to verify that it is at a zero energy<br>state (de-energized) using a company approved voltage detector?​​​ <br>

  Yes

  No

  N/A

• Is all electrical test equipment calibrated and within current calibration date requirements?

  Yes

  No

  N/A

• Require a demonstration of "Live - Dead - Live", and was the demonstration preformed correctly?

  Yes

  No

  N/A

• Are electrical panels covered when not being worked on?

  Yes

  No

  N/A

• Is the SE using insulated battery mats if required?

  Yes

  No

  N/A

• Are extension cords in good condition and properly rated?

  Yes

  No

  N/A

• Does the SE have a Ground Fault Circuit Interrupter (GFCI)?

  Yes

  No

  N/A

• Has SE requested a current One Line diagram for the electrical distribution, from the Customer?

  Yes

  No

  N/A

• Unless long tip probes are permitted by the business unit, are only <br>short tip multimeter probes available for use?​

  Yes

  No

  N/A

• Does the SE only have required company issued insulated tools?

  Yes

  No

  N/A

• Are all insulated tools in good condition and free of nicks and unmodified?

  Yes

  No

  N/A

LADDERS

• Have ladders been visually inspected prior to each use and are they in good condition?

  Yes

  No

  N/A

• Are all SE ladders fiberglass and ANSI rated 1A (300 lbs/137 Kg) or 1AA (375 lbs/170 Kg)? OR<br>EN Class 131(150 Kg / 330 lbs), or Class 1 (175 Kg/385 lbs) maximum or Country specific standard?

  Yes

  No

  N/A

• Are customer ladders to be used by the SE, properly rated for electrical use / load and in good condition free of damage, defects and repairs.

  Yes

  No

  N/A

• If in use, have extension ladders been positioned so that the ratio of ladder height to distance from the wall / building is no greater than 4:1? ​

  Yes

  No

  N/A

ERGONOMICS

• Proper Lifting – Back Straight; tested weight of unknown object before attempting to lift; No twisting at the hips; Lifting with Legs & buttocks; Feet offset for stability; Hug load to body.

  Yes

  No

  N/A

• Did the Service Engineer (SE) create a “clear path” before lift and carry?

  Yes

  No

  N/A

• When the SE transports their equipment to the job site are they limiting the weight and distance they carry or are they using material handling devices?

  Yes

  No

  N/A

• Has the SE reduced the stresses of overhead work by reducing the duration of time, weight and effort?

  Yes

  No

  N/A

• If the company has established a maximum safe lifting limit, did the SE<br>understand and conform to the policy limit? ​

  Yes

  No

  N/A

EXTERIOR VEHICLE CONDITION

• Is vehicle exterior clean and undamaged?

  Yes

  No

  N/A

• Is the windshield in good condition (no cracks, stars)?

  Yes

  No

  N/A

• Vehicle not leaking fluids (water, oil, antifreeze, fuel, etc.)?

  Yes

  No

  N/A

• All exterior lights functional?

  Yes

  No

  N/A

• Outside mirrors attached and adjustable?

  Yes

  No

  N/A

• Are tires in good condition?

  Yes

  No

  N/A

INTERIOR VEHICLE CONDITION

• Is vehicle interior clean and undamaged?

  Yes

  No

  N/A

• Are dashboard gauges functioning and warning lights out?

  Yes

  No

  N/A

• Does vehicle’s horn sound?

  Yes

  No

  N/A

• Are all interior lights functioning?

  Yes

  No

  N/A

• Are the insurance, registration, and accident report forms, drivers license current and readily available?

  Yes

  No

  N/A

• If applicable, are vehicle inspection records up to date?

  Yes

  No

  N/A

• Is the vehicle safety shield/cage installed and all required materials stored behind?

  Yes

  No

  N/A

• If compressed gas cylinders are present, are they properly secured?

  Yes

  No

  N/A

• Are seat belts and rear view mirror in good condition?

  Yes

  No

  N/A

VEHICLE SAFETY EQUIPMENT

• If required, is vehicle equipped with an appropriate Fire Extinguisher?

  Yes

  No

  N/A

• If yes to A, is the monthly inspection record complete?

  Yes

  No

  N/A

• Is the first aid kit completely stocked with required, unexpired supplies?

  Yes

  No

  N/A

• Is there a flashlight in the vehicle or in the SE’s toolkit?

  Yes

  No

  N/A

• Are flashlights used in the workplace conforming with electrical safety best practices (arc rated, non conductive) and provided by the company?

  Yes

  No

  N/A

• Does the Service Engineer (SE) have a current First Aid Kit?

  Yes

  No

  N/A

• If required, is the vehicle equipped with Reflective Safety Triangles?

  Yes

  No

  N/A

CORRECTIVE ACTIONS

• 1.

  Yes

  No

  N/A

• 2.

  Yes

  No

  N/A

• 3.

  Yes

  No

  N/A

• 4.

  Yes

  No

  N/A

• 5.

  Yes

  No

  N/A

AUDIT SUMMARY

• COMPLIANT- All requirements are being met.

  Yes

  No

  N/A

• MINOR NON COMPLIANCE- Some requirements are not being met – work is still performed safely.

  Yes

  No

  N/A

• MAJOR NON COMPLIANCE - Significant issues not addressed, work must not proceed until resolved.

  Yes

  No

  N/A

• Is follow up necessary? If YES by whom? <br>

  Yes

  No

  N/A

SIGNATURES

• Auditor Signature

  Sign

• SE Signature

  Sign

• Service Manager

  Sign