FY14 Liebert Services Safety Performance Review Version 1.2.8

• 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?<br><br>Discuss this with the Associate…ask them what boxes they checked and why. You make the determination if they missed something. Are there hazards or potential hazards they missed? If so, ask them why they did not believe it was an issue. Help them ‘open up their eyes’ to all potential hazards.

  Yes

  No

  N/A

• Did the Service Engineer (SE) receive instructions regarding evacuation in the event of an emergency<br><br>Ask them…” what they would do right now if an alarm went off? Where would you go” Ask what the customer expects from them if an emergency occurs that is 1) associated with their work, and 2) not associated with their work.

  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?<br><br>Ask them where the SDSs are located on site. Make them show you…they must be able to demonstrate how to find an SDS (using MSDS Online, etc.).

  Yes

  No

  N/A

• Is there an ENP-company safety and environmental manual available on site?<br><br>The Answer is always ‘Yes.” Make sure they know how to find it.<br>

  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______<br><br>Have them explain the rule to you. They must call their manager if the job length exceeds the rule. Make sure they understand that their manager determines if they are allowed to work past the rule max, NOT them.

  Yes

  No

  N/A

TRAINING

• Is the Service Engineer (SE) certified in First Aid, CPR and AED? ​ <br><br> First Aid Expiration Date________ CPR Expiration Date________<br><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_________<br><br>Ask them to explain what they learned. What PPE are they wearing for the tasks they are performing this day? Evaluate and comment if you agree and disagree. <br>

  Yes

  No

  N/A

• Has the SE received Fall Protection training? Training Date_________<br><br>Ask them to tell you when it is acceptable to work on Elevated Lift devices or in confined spaces as long as they use a Fall Protection Harness?

  Yes

  No

  N/A

• Has the SE received LOTO training? Training Date_________<br><br>Ask them about the training…what did they learn?<br>

  Yes

  No

  N/A

• Has the SE received Arc Flash Training? Training Date__________<br><br>Have them explain the difference between and arc flash boundary and limited approach boundary. How do they determine which is the appropriate boundary for their work?

  Yes

  No

  N/A

• Has the SE received Confined Space Training? Training Date__________<br><br>Ask them when it is acceptable to work in a permit required confined space? Ask what they should do if the equipment appears to be located in a confined space? They should answer that they need to stop work and contact their manager.

  Yes

  No

  N/A

• Has the SE received Electrical Safety? Training Date__________

  Yes

  No

  N/A

• Has the SE received Fire Extinguisher? ​ Fire Extinguisher Training Date________<br><br>Do they know what the acronym “PASS” means? Have them tell you…it’s Pull, Aim, Squeeze and Sweep

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has SE received Back Safety Training? <br>Back Safety 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 Inspect their PPE bag. Do they have all necessary PPE? Anything damaged? The ONLY items allowed in their PPE bag are LOTO locks and tags, issued PPE, and their first aid kit. Sleeves should be in the bottom of the bag wrapped in or overlain by the arc flash coveralls, and the arc flash face shield attached to the hardhat (inside of the protective bag) on top. Safety Glasses should be in their protective case in a side pocket.

• Does the Service Engineer (SE) have company issued hard hat and safety glasses as required? ​ <br><br>Did they inspect their hard hat before using it? Have them show you how they do this. Did they clean their safety glasses? Are they scratched and need replacing?<br><br>

  Yes

  No

  N/A

• Is the SE wearing appropriate safety/work shoes? <br><br>Have they procured a pair of company standard shoes? Look the shoes over…do they have signs of significant wear? If so, replace them.<br>

  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?<br><br>If the associate is doing any wet cell work, they need to wear theses PPE. If they don’t have them, or don’t understand when to wear them…they need to be coached. Ask them what tasks they wear the orange arc flash apron for and why? Ask them if they still have the green chemical apron. If yes, confiscate it.

  Yes

  No

  N/A

• Has the SE demonstrated the proper inspection technique for electrical gloves and sleeves?<br><br>Have them demonstrate how to perform the flip rollup test. Do not allow them to do the twist test…it damages the gloves. See if they inspect the fingers, cuff, etc. .<br>

  Yes

  No

  N/A

• Are voltage insulating gloves marked with the current testing, MFG and or date placed in service?<br><br>Take a picture for your records. Verify that their Rubber Insulated glove Service Log is completed correctly.

  Yes

  No

  N/A

• Are voltage insulating sleeves marked with the current testing, MFG and or date placed in service?<br><br>Take a picture for your records

  Yes

  No

  N/A

• Are electrical gloves stored properly (flat and segregated from leather protectors and other PPE) ?<br><br>Are gloves stored in their protective bag…FLAT with nothing else in the bag? Do they have appropriate length bags for gloves? If not, get them a new glove bag

  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><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?<br><br>Do they have a balaclava? Does it appear that they have ever worn it? Ask them when they must wear their balaclava. Have them demonstrate how they inspect their Coveralls. Ask them if the coveralls they are wearing have been in an arc flash situation (which you should already know about). If so, replace the coveralls.

  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><br>Inspect the shield…is it scratched? If so, replace it.<br>

  Yes

  No

  N/A

• Does the SE have arc rated hearing protection?<br><br>Ask them when they are supposed to wear the hearing protection. ANSWER – whenever they are within the arc flash protection boundary, or when the customer’s site is noisy, such that they have to raise their voice beyond normal speaking volume to talk to anyone.

  Yes

  No

  N/A

• Do 3rd Party Service Providers working for our company have appropriate PPE including arc flash protection? ​ <br><br>If not, STOP them and ask why. Communicate this immediately to your manager and Safety. Ask them…” when they are supposed to wear the Arc Flash PPE?” When are you allowed to take them off?” <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><br>If they answer yes, you likely have a problem. Stop and ask them who authorized them to wear fall protection

  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?<br><br>If applicable, ask them to show you how they inspect their fall protection

  Yes

  No

  N/A

• Does the SE’s use retractable fall protection systems when working over 4 feet (1.2 m)? <br><br>If they are working on top of equipment, ask them how they are assuring that they won’t fall off? Do they have a spotter? If not, why not?<br>

  Yes

  No

  N/A

HOT WORK

• If job-required, has the Services Engineer (SE) obtained a Hot Work Permit?<br><br>Any metal welding, grinding, soldering, or brazing? If so, review the permit with the SE. Ask them about their assumptions. Have they removed all combustible items from a 10-foot (3 m) vicinity of the hot work area, and flammables at least 30 feet (9 m)? Have they covered / draped items that cannot be removed?

  Yes

  No

  N/A

• If hot work is required, did another Person perform the Fire Watch duties?<br><br>This IS required if hot work is preformed. Ask the fire watch SE what training they have had. They must answer Fire Extinguisher training

  Yes

  No

  N/A

• Did the Fire Watch attend their post for at least 60 minutes after hot work? <br><br>Ask them how long they must remain at the fire watch after the end of the hot work. Answer…either 60 minutes or longer if the customer requires it.

  Yes

  No

  N/A

ELECTRICAL SAFETY / LOTO

• Has the Service Engineer (SE) removed all jewelry before working on energized equipment? ​ <br><br>Look for rings, bracelets, watches, necklaces, ear rings, wallet chains, key carabiners, etc.<br><br>

  Yes

  No

  N/A

• Does the SE know what the Arc Flash, Limited Approach, Restricted Approach and Prohibited Approach Boundaries are for the task and do they understand their significance?<br><br>Ask the Service Engineer what arc flash and electrical protection is required. If they are uncertain, ask them where they would find this out? Liebert Only – TKO…entering 60 hz link, look for “ARC Flash Flow Charts.” The charts determine the correct PPE for various scenarios.

  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><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, hydraulic systems, etc.) been properly discharged, blocked or released?​ <br><br>Ask the associate how they know the system has been de-energized. Where did they go to identify all sources of energy? <br>

  Yes

  No

  N/A

• Have all energy sources (electrical & mechanical) been locked out and tagged?<br><br>Ask the associate to show you the locks and tags on all lockout points. Ask them…” how do they know that all sources of energy have been isolated…What they are doing today that requires LOTO?” FYI – red flag if they state NA. Liebert ONLY - CoHE procedures exist for almost all tasks. Ask them to show you where the CoHE instruction is for their task. Ask them what a Liebert HERT chart is, and how it is used to verify de-energized state. Have them show you the Liebert HERT table for the specific task being performed.

  Yes

  No

  N/A

• Require a demonstration of LOTO…did SE perform the procedure correctly?<br><br>Almost all work requires some form of CoHE. Verify that the CoHE steps were followed.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is all electrical test equipment calibrated and within current calibration date requirements?<br><br>Check calibration date. Take a photo of the calibration date for your records.

  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?<br><br>Determine if the associate inspects the extension cord prior to use. They should demonstrate that 1) the grounding pin is present, 2) the insulation is not compromised, and 3) the cord is free from kinks and creases.

  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?<br><br>If yes, ask if the Service Engineer discussed the One Line with the customer…have there been any changes since the One Line was created. This is critical in determining the proper arc flash protection (see flow charts discussion below).

  Yes

  No

  N/A

• Unless long tip probes are permitted by the business unit, are only short tip multimeter probes available for use?​ <br><br>Answer must be Yes or NA

  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?<br><br>Did the associate inspect their tools prior to use? Tools must not have any nicks, cuts, or peeled back insulation. If so, confiscate the tool and order replacements.

  Yes

  No

  N/A

LADDERS

• Have ladders been visually inspected prior to each use and are they in good condition? <br><br>Have them demonstrate how they evaluate issued or borrowed ladders before use. They should inspect rungs, stabilizers, rubber foot assemblies for damage.<br>

  Yes

  No

  N/A

• Are all SE ladders fiberglass and ANSI rated 1A (300 lbs/137 Kg) or 1AA (375 lbs/170 Kg)? OR EN Class 131(150 Kg / 330 lbs), or Class 1 (175 Kg/385 lbs) maximum or Country specific standard?<br><br>Ask the SE to show you how they know the ladder meets ENP requirements.<br>

  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? ​ <br><br>Extension ladders are unstable if their angle is greater or lesser than 4:1. Ask the SE to explain how to properly set up the ladder.

  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.<br><br>It is key that the associate lift properly. All of the above conditions must be met to assure a safe lift every time they lift any weight above 2.2 pounds (1 Kg).<br>

  Yes

  No

  N/A

• Did the Service Engineer (SE) create a “clear path” before lift and carry? <br><br>A clear path allows Service Engineers to keep load in front of them, and keep balance. <br>

  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?<br><br>If SEs are working with hands above their shoulders, their elbows will rise up away from their body. This creates stress on shoulder and upper back. This should be avoided. If they cannot avoid, break this activity up…do a little over shoulder or over head work, then stop and do something else to allow muscles to rest

  Yes

  No

  N/A

• If the company has established a maximum safe lifting limit, did the SE understand and conform to the policy limit? ​ <br><br>If applicable, ask them to tell you the company’s maximum safe lifting limit. Ask them what they would do if they believe that the load they need to lift is greater than the company’s policy limit.

  Yes

  No

  N/A

EXTERIOR VEHICLE CONDITION Report all damage to Fleet manager. Fill out an accident report for all damages and submit to Corp Safety​

• Is vehicle exterior clean and undamaged? <br><br>Check all exterior surfaces for dents, scratches, etc...<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• All exterior lights functional? <br><br>Have them demonstrate all functions…verify that all lights are working correctly. <br>

  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?<br><br>The vehicle should be in a condition that you would allow a customer to ride in.<br>

  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? <br><br>Auditors MUST verify that all paperwork is in the vehicle, and that all paperwork is up to date.

  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?<br><br>Make sure that no objects are in front of the cage (van only). The vehicle may not be used if the cage is not properly installed.

  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? <br><br>Ask them if they are required to perform any type of inspection? If so, how often? Do they document it? The answer is …monthly inspections are required. Ask them what they inspect? Answer – pin is in place, pressure arrow is in “green” region. Inspect the log…it must be completed monthly.

  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?<br><br>This should be in the PPE bag. Ask to see it – has it been opened? Inspect the contents…have expiration dates passed? If not, get them a new kit or appropriate refills. Do they have a drug test kit? Does the old kit have the yellow DHL shipping bag? If so, order a new kit.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

COOLING SEs

• Are Cooling SEs wearing goggles during spray or brush cleaning of coils either dry, or when using water or chemicals?<br><br>No spraying or brushing is allowed without goggles…NO exceptions.

  Yes

  No

  N/A

• Required flares, fire extinguishers, and roadway triangles in vehicle?

  Yes

  No

  N/A

• Red (acid) and Blue (base) chemicals segregated in vehicle?<br><br>Acids (red) and Bases (blue) are reactive. Store in different parts of the truck.<br>

  Yes

  No

  N/A

• Associate wearing #3 or #5 shade goggles when brazing or cutting metal?<br><br>Ask the associate which shades are required for soldering (3), brazing (3), or torch cutting (5). They must know the difference between No 3 and No 5 shades, and know when to use them.<br>

  Yes

  No

  N/A

• Does the Cooling CE have an Oxygen/ Acetylene Rig?<br><br>The Oxygen/ Acetylene rigs will be either blue or green.<br> <br>

  Yes

  No

  N/A

• Are the Oxygen and Acetylene rig equipped with flashback arrestors and check valves?<br><br>Have the Associate show you…the check valves must be installed at the torch end of the rig and flashback arrestor should be installed at the cylinder or regulator.<br>

  Yes

  No

  N/A

• Has the Cooling SE completed their quarterly Compressed Gas Cylinder Inspection form?

  Yes

  No

  N/A

BATTERY SAFETY

• Are SEs and Battery Specialists wearing gloves when making connection?<br><br>All battery work is energized. Associates must use insulating gloves and leather protectors at all times. When using tools, they must also wear the balaclava, arc flash coveralls, and arc face shield.

  Yes

  No

  N/A

• Associate checking for zero voltage each time before making connection?<br><br>Have the associate show you how they verify the string is not connected elsewhere. They must verify Zero volts before making any connection.

  Yes

  No

  N/A

• Associate wearing goggles when taking hydrometer readings?<br><br>Associates must wear ENP standard battery gear when working on all wet cells. This includes goggles, battery face shield, arc flash acid apron, rubber insulating gloves and leather protectors.

  Yes

  No

  N/A

• Associate wearing new orange arc flash apron for potential exposure to acid?<br><br>Ask them what tasks they wear the orange arc flash apron for and why? Ask them if they still have the green chemical apron. If yes, confiscate it.

  Yes

  No

  N/A

• Associate wearing chemical face shield (not arc flash) when working with electrolyte (acid)?

  Yes

  No

  N/A

• Does the Service Engineer ever transport batteries in their vehicle?

  Yes

  No

  N/A

• If yes, do they have the battery securing device?

  Yes

  No

  N/A

• Require the Associate to demonstrate how to use the battery securing device. Did they demonstrate correctly?

  Yes

  No

  N/A

RESPIRATORS Respirators are NOT issued to associates unless Egress Respirators (ONLY) are required on customer sites. IF this is the case, contact Corp Safety for assistance.

• Are company issued respirators maintained in a sanitary condition?<br><br>Ask the associate if they have a respirator. If they haven’t been issued that respirator from Corporate Safety…it must be confiscated…we do not permit voluntary use of respirators (except dust masks…see below). If issued, have them show you the respirator. It should be in a re-sealable bag. If they are using Filtering Face piece Respirators (i.e. Dust Masks) on a voluntary basis, they must have a copy of Appendix D of the OSHA respiratory standard with them at all times. Contact Safety Dept for assistance

  Yes

  No

  N/A

• Require Associate to perform per-use inspection. Conforms to standard?<br><br>Have them demonstrate their pre-use inspection. Check all rubber fittings. Check seals, if half or full face, perform negative pressure test with no cartridges applied. Have them explain why they check the respirator. Are associates who are permitted to wear a dust mask, half face or full face respirators clean shaven? They MUST shave everyday…no exception. No facial hair is allowed for anyone permitted to wear a respirator

  Yes

  No

  N/A

• Unused detachable cartridges are in sealed bag?<br><br>Any detachable cartridge not in its original sealed wrapping is considered to be used

  Yes

  No

  N/A

• Detachable cartridges are disposed of after use?

  Yes

  No

  N/A

• Demonstrate user seal checks? Did Associate perform negative and positive pressure test correctly?

  Yes

  No

  N/A

CONTROL OF HAZARDOUS ENERGY (CoHE) PROCEDURES

• Did the Associate check TKO to determine if there is a CoHE procedure?

  Yes

  No

  N/A

• Did the Associate use the Hazardous Energy Reference Tables (HERT)?

  Yes

  No

  N/A

• Were all CoHE and HERT documents accurate? If no, explain.

  Yes

  No

  N/A

LIEBERT SERVICES COMPANY VEHICLES

• Has the company vehicle been altered from its original state?

  Yes

  No

  N/A

• Installation of sound/ video or permanent GPS equipment?

  Yes

  No

  N/A

• Installation of trailer hitch?

  Yes

  No

  N/A

• The Service Engineer has not received a moving vehicle violation in the last 12 months?<br><br>Ask them if they have a clean driving record (i.e. Moving traffic violation). This does not include parking violations, toll violations, etc...

  Yes

  No

  N/A

• If they had a moving vehicle violation in the last 12 months, did they report it to their direct Manager?<br><br>If they had a clean driving record, mark "N/A"

  Yes

  No

  N/A

• Window tinting?

  Yes

  No

  N/A

• Any other alterations? If yes, explain.

  Yes

  No

  N/A

• Inspect the vehicle for GPS jammer. Does the Associate have one? GPS jammer are not allowed in company vehicles.

  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><br>

  Yes

  No

  N/A

SIGNATURES

• Auditor Signature

  Sign

• SE Signature

  Sign

• Service Manager

  Sign