FY16 Liebert Services- Global Safety Performance Review Version 1.0

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

FY15 Top Deficiencies

• Does the SE have two pairs of insulating gloves? (one in use, one in sealed plastic bag)

• If permitted (or required) by local law, does the SE have a hands free device?

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

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

• Is all required Arc Flash ATPV calcm2 clothing free of holes damage and significant wear?

JOB SITE DOCUMENTATION FY16 V 1.0

• Was a EHS Survey / Project Safety Tailgate Meeting / Job Site Risk Assessment conducted? Is the form properly filled and available onsite? Have all involved Service Engineers (SE) participated in the EHS Survey/ Tailgate Meeting?

  Yes

  No

  N/A

• Does the SE know what to do in the event of an emergency situation (evacuation routes, muster points, etc.)?

  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 medical facility is?

  Yes

  No

  N/A

• Did the SE receive/ inquire about any site specific procedures?

  Yes

  No

  N/A

• Can the SE demonstrate access to (M)SDSs?

  Yes

  No

  N/A

• Can the SE demonstrate access to the ENP-company safety and environmental manual?

  Yes

  No

  N/A

• Is the SE familiar with the Company work / rest notification rule?

  Yes

  No

  N/A

• If the Service Division has established a maximum safe lifting limit, did the SE understand and conform to the policy limit?

  Yes

  No

  N/A

TRAINING

• Has the SE received technical training related to the unit/equipment he is working on?

  Yes

  No

  N/A

• Has the SE received Arc Flash Training? Training Date__________

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has the SE been offered the Hepatitis B Vaccination?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has the SE received Confined Space Training? Training Date__________

  Yes

  No

  N/A

• 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

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

  Yes

  No

  N/A

• Has the SE received Electrical Safety? Training Date__________

  Yes

  No

  N/A

• Has the SE received Fall Protection training? Training Date_________

  Yes

  No

  N/A

• Has the SE received Fire Prevention and Hot Work 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 the SE received LOTO training? Training Date_________

  Yes

  No

  N/A

• Has the SE received PPE training? Training Date_________

  Yes

  No

  N/A

JOB SITE CONDITIONS

• Any conditions that present hazards at the jobsite (asbestos, hydrogen sulfide, lead, etc.), have been accounted for?<br><br>

  Yes

  No

  N/A

• Is there sufficient ventilation on site to carry out the work being performed (e.g. generator testing, load banks, hot work, etc.)?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Have unsafe conditions been communicated to the Customer and conditions resolved before work begins?

  Yes

  No

  N/A

• Are chemicals/combustible liquids identified ,stored properly and protected from accidental release?

  Yes

  No

  N/A

• Is the SE familiar with the fire suppression system? (e.g. Halon, FM 200, etc...)

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

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

  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 the appropriate PPE for the task being performed (electrolyte work, hot work, refrigerant, brazing/cutting, generator testing, batteries, etc.)?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does the SE have two pairs of insulating gloves? (one in use, one in sealed plastic bag)

  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 Sleeves stored unfolded and separate from other PPE?

  Yes

  No

  N/A

• Does the SE have all required Arc Flash ATPV cal/cm2 (Westex label) clothing and are 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 the appropriate hearing protection for the task?

  Yes

  No

  N/A

FALL PROTECTION

• If work in areas requiring fall protection are identified as a job requirement, 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 certified for use as fall protection devices and tie offs?

  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 the required amount of time after hot work was completed?

  Yes

  No

  N/A

ELECTRICAL SAFETY / LOTO

• Is the SE qualified to perform electrical work?

  Yes

  No

  N/A

• Has the SE removed all jewelry prior to beginning work?

  Yes

  No

  N/A

• Are prescription safety glasses non-conductive?

  Yes

  No

  N/A

• Does the SE know and understand the significance of the Approach Boundaries?

  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, 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

• When removing or installing panels on equipment, is correct PPE being used?

  Yes

  No

  N/A

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

  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

• Is the SE using insulated shielding 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

• Does SE have a company issued Lockout/Tagout Kit?

  Yes

  No

  N/A

• Unless long tip probes are permitted by the business unit, are only short tip multimeter probes available for use and company supplied?​

  Yes

  No

  N/A

• Does the SE only have required company issued/approved 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

DOCUMENTATION

• Does the SE have a valid Driver's license?

  Yes

  No

  N/A

• Does the SE have a current vehicle registration?

  Yes

  No

  N/A

• Does the SE have a current insurance and accident reporting documents?

  Yes

  No

  N/A

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

  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, organized 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

• 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

• If permitted (or required) by local law, does the SE have a hands free device?

  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 or other equipment as required by local law?

  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 or repeated non-compliance, 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

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A