Title Page
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Site conducted
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GM Location
- Factory Zero
- Flint Assembly
- Lansing Delta Township
- Lansing Grand River
- Romulus
- Wentzville
- Springhill
- Arlington Assembly
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Date
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Company Name
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Auditor's Name
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Auditors Title
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Factory/ Shop/ System
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Name of Worker
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Construction SCM Compliance?
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Is the SCM Board to the common layout and was updated at the start of the shift?
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Describe issues with the safety board
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Are the PTP's for the day listed on the SCM Board along with SFMEA Score?
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Describe Issues
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PTP/ SW/ SOP/ WEP Compliance?
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Can workers explain the Worker Safety Engagement Process and Purpose?
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Describe Issues:
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Does worker understand the Safe Work Zone (SWZ) technique?
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Describe Issues
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Did they have input prior to start of work?
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Comments:
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Can the worker explain Management of change?
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Comments:
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Are PTP's Being utilized for tasks being performed?
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Comments:
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Common Safety/Awareness (Is there Compliance?)
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Does the employee know the emergency procedures?
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Comments
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If you could be hurt on this job how could it happen? How can you prevent it?
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Mobile Device Policy
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Are Workers following the Mobile Device Policy? (Not walking and talking, using mobile equipment while looking at mobile equipment)
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Comments
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PPE's
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Are proper PPE's per GM's policy and their Pre-Task Plan being utilized?
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Comments
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Do all workers have appropriate footwear for the task the are performing? (Substantial footwear at minimum)
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Comments
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Working Alone/Isolations (Is there compliance with working alone or in isolated areas?)
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Who is the workers communication Contact?
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Comments
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Who is the worker's communication contact?
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Does the worker have a minimum frequency for check in? (Every 30 min)
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Comments
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Does the worker have a means to communicate in case of emergency?
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Comments
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Lockout Energy Control
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Do locks and tags correctly identified with employee name, company, and contact number?
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Comments
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Can the employee explain the lockout process and proper testing after lockout?
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Comments
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Do workers know their company's process for removing locks on equipment or lockbox, after work has been completed?
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Comments
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Is SCS-MPS being used?
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Can the worker show where the Safety instructions for the Tasks are listed on the SCS-MPS placard?
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Comments
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Does the person know what to do when performing a task that is not listed on the SCS-MPS placard?
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Comments
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Aerial Lifts
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Does the ground person know how to lower the lift in case of emergency?
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Comments
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Has the Daily Inspection been completed for the lift?
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Comments
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Is the work area barricaded?
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Comments
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Powered Industrial Vehicles (Is there Compliance with Power Industrial Vehicles?)
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Does the worker understand what an Orange Crush Zone is and the requirements are to enter?
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Comments
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Does The Worker Understand the two foot rule and explain "Wait for the Wave"?
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Comments
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Was the daily pre-op check completed?
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Comments
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Mobile Equipment being used for intended purpose?
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Comments
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Does operator have valid license?
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Comments
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Are Service Vehicles parked on slopes, are wheel securing devices present to prevent the vehicle from rolling?
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Comments
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Rigging and Lifting (Is there compliance with Rigging and Lifting?)
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Do all lifting hooks have undamaged safety latches?
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Comments
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Is the lift area properly barricaded?
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Comments
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Scaffolding (Is all scaffolding compliant?)
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Do all scaffolds have Green, Yellow or Red Tags and has been inspected daily by a competent person?
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Comments
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If Green Tagged are handrails, mid-rails and toe boards around all sides and no openings in the planking?
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Comments
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Is the Scaffolding anchored on mudsills or baseplates?
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Comments
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Use of Drones
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Does the operator have a Remote Pilot Certificate from the Federal Aviation Administration or other regulatory agency with jurisdiction over use of a drone?
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Comment
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Can the operator explain how they are ensuring a continuous visual line of sight is maintained at all times during operation?
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Comments
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Welding / Hotwork
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Does the dedicated Fire Watch understand their duties?
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Comments
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Are fire retardant blankets and fire extinguishers present in the work area along with fire watch?
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Comments
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Permits posted in the area?
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Comments
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Is the permit area identified and is the permit valid for today's date and time?
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Comments
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Is the area free from combustible materials?
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Comments
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Barricades
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Are proper barricades in place and access gates to the area closed?
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Comments
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Is the access opening or gate closed?
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Comments
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Does the worker know the hazards present that require the area to be barricaded?
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Comments
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Is the proper signage posted (Caution/Danger, Name of Contractor, Contact name and phone number)?
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Comments
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Chemical Control
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Does the worker know where eye wash stations/emergency showers are located?
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Comments
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Have workers received Hazard communication training and understand the hazards of the products they are using?
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Comments
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Does the worker know where to find the Safety Data Sheets for the chemicals?
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Comments
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Are all containers labeled with product name and appropriate hazard warnings such as GHS pictograms?
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Comments
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Are all containers stored in an upright and closed position?
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Comments
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Does the worker know what to do in the event of a spill or an exposure?
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Comments
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Confined Space
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Does the Entry Permit or Pre-Task Plan have a rescue plan?
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Comments
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Is emergency rescue equipment located in close proximity to the Confined Space entry point?
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Comments
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Was security notified of the entry?
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Comments
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Does the space have appropriate signage?
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Comments
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Does the attendant know where the phone is located and the number to call?
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Comments
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Can the entrant and attendant explain the task and if the reviewed with a supervisor?
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Comments
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Does the entrant and the attendant understand their roles and the rescue plan?
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Comments
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Cranes
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Do crane operator have their operators certificate on them
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Comments
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Has the operator completed the daily crane inspection log?
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Comments
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Are outriggers fully extended on outrigger pads or firm ground?
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Comments
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Electrical Safety
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Are workers utilizing all necessary Arc Flash protection, insulated tools, and required PPE noted on the sticker?
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Comments
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Is the electrical equipment in good condition (no damage) and being used properly?
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Comments
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Are GFCI's present with all extension and corded power tools (magnetic drills excluded)?
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Comments
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Fall Hazard Control
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Are all workers exposed to fall hazards 6' (2 meters) or higher for Construction or 4' (1.2 meters) or higher for General Industry using a full body harnesses, appropriate lanyards and anchorage points?
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Comments
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Can the employee explain the daily inspection of their equipment?
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Comments
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Is the employee working on an approved work surface and is is it posted with a load rating?
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Comments
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If the employee working on a ladder?
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Is the ladder in good condition?
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Comments
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Is the ladder properly set up w/ the spreader arms locked?
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Comments
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If aerial lift is being used, is a competent ground person in position and do they know their responsibilities?
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Comments
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Are workers on extension ladder?
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Are at least three rungs above the landing?
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Is the extension ladder angled at a 4:1? (For every 4 feet in height the base is back 1 foot)
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Housekeeping
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Is the area clean, organized and are aisles, walkways, exits and stairs free of obstructions?
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Comments
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Are ladders and portable equipment stored properly?
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Comments
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Is material stored in a safe an organized manner?
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Comments
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Does the work area have liquids on the floor?
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Comments
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Are there trip hazards?
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Comments
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Finger Focus
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Are guards present on all Rotating Spindle Tools?
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Comments
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Does the employee know what to do if a guard is missing?
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Comments
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Are Guards present on lifting devices to avoid pinched fingers?
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Comments
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Working Surfaces
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Are walking working surfaces clear of debris, clutter, fluids and trip hazards?
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Comments
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Does the employee know who to contact to get fluids cleaned up?
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Comments
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Are Ladders in good working condition? (no damage, no build up on rungs, no missing rungs, bolts, etc.)
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Comments
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Additional Comments