Graycor Post-Work Pre-Incident Review

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

ISSUE

• Enter date and time of this review.

  Date

• For any issues identified during this review, provide comments below the question, including any actions taken already.

• If a JSA was used in the Pre-task briefing, did it adequately cover all of the hazards and control measures?

  Yes

  No

  N/A

• If a JSA was not used in the Pre-task briefing, did the Pre-task briefing checklist cover all of the hazards and control measures?

  Yes

  No

  N/A

• If a JSA was not used in the Pre-task briefing, should a JSA be developed for this job?

  YES

  NO

  N/A

• Was the task accomplished with expected results?

  Yes

  No

  N/A

• Were there any unexpected occurrences during performance of the job?

  YES

  NO

  N/A

• Are there recommended changes to the work that could have improved the safety or efficiency of the work, i.e. PPE, work environment, tools, materials, equipment, etc.?

  YES

  NO

  N/A

• Was planning and scheduling optimized to reduce the potential for human error?

  Yes

  No

  N/A

• Was material on hand and staged prior to beginning job.

  Yes

  No

  N/A

• Did supervision provide the needed support and appropriate guidance when necessary?

  Yes

  No

  N/A

• Did you notice any human factor issues, improper or missing labels, or any significant physical hindrances to the performance of the work?

  YES

  NO

  N/A

• Did all workers have proper training needed or required to successfully and efficiently complete the the job?

  Yes

  No

  N/A

• Was the work area clean and housekeeping adequate before work began?

  Yes

  No

  N/A

• Is additional follow up required from this POST-JOB Review.<br>( if YES, then the Foreman/Supervisor/Lead Performer is responsible to provide this feedback to the responsible group for action. )

  YES

  NO

  N/A

• Did all involved with the work understand their individual responsibilities?

  Yes

  No

  N/A

• NEAR MISSES:

• INTERVENTIONS:

• LESSONS LEARNED:

• ATTENDEES:

  Sign

• 3/12/2013 Frank Deller