Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

WHAT ARE WE GOING TO DO?

  • TIME BRIEFING CONDUCTED:

  • Are the procedures and work scope understood?

  • Are there written Job Safety Analysis (JSA) for this activity?

  • If this job meets the definition of a high hazard job, then a JSA must be used in conjunction with this checklist for the Pre-job briefing.

  • JSA #'s :

  • Have the Foreman / lead-person and crew/team analyzed the work assignment for safety hazards?

  • Are the roles of the workers/task leader identified?

  • DAILY DISCUSSION:

WHAT IS THE WORST THING THAT COULD HAPPEN?

  • Have the safety hazards been identified and ways to control these hazards discussed for each task?

  • Have other safety considerations been identified and discussed?

  • Is there a significant potential for personnel injury?

  • Are Rescue plans in place: Means of contacting emergency agencies, a list of phone numbers, and a description of worksite locations? Police, Fire, emergency numbers posted?

  • Have there been additional discussions held about significant changes, which might affect safety, occurring during the course of the work being performed?

  • DAILY DISCUSSION:

WHAT ARE WE GOING TO DO,ESPECIALLY AT THOSE CRITICAL STEPS, TO MAKE SURE THAT A MISTAKE DOESN'T HAPPEN?

  • Insured that communication lines where clearly understood.

  • Insured that a work plan or procedure was in place? If YES list below or NO explain.

  • WorkPlan # or Reason for NO written plan?

  • Identified the barriers or defenses to be depended on?

  • Time Out (understood to mean STOP when unsure).

  • All procedures are to be followed as written or are to be revised first. (not to proceed if procedures are not accurate)

  • Identified the criteria for suspending work activities?

  • DAILY DISCUSSION:

WHAT ARE THE ERROR-LIKELY SITUATIONS?

  • Is there a potential for distractions and if yes, how will they be minimized?

  • Is this a first time job function being performed?

  • Is this the first working day after days off?

  • Are there other error precursors (task demands, work environment, individual capability, human nature?

  • Are procedures new or recently revised?

  • Are personnel familiar with the task?

  • Has time / schedule / out-of-service time been considered?

  • DAILY DISCUSSION:

WHAT ARE OUR SAFETY CONCERNS?

  • Clearance-boundaries have been walked down and discussed with the team members?

  • Adequate scaffolding / ladders / rigging available and in proper working order? (including all annual inspections)

  • Have all environmental, chemical and health related hazards been identified and appropriate actions taken?

  • PPE (hard hats, safety glasses, fall protection equipment, gloves hearing protection, face shields and Fire Retardant clothing) available for use as required?

  • High temperature extremes and potential employee exposure discussed?

  • Do you have any identified or potential Confined Spaces to enter and are proper precautions being taken? (Confined Space training required for entry)

  • DAILY DISCUSSION:

OPERATING EXPERIENCE (related industry events either internal or external)

  • Discussed applicable recent industry events and/or Lessons Learned?

  • DAILY DISCUSSION:

GENERAL

  • Are the performers task qualified to do the task and are they current?

  • Are the proper tools available to perform the task(s)?

  • Is inspected rigging equipment available and has the right equipment been selected to perform the task(s)?

  • Is proper flagging material available for use and application identified?

  • Have we considered housekeeping, area cleanliness, and posting requirements for the job?

  • Are aerial lifts, cranes, forklifts, bucket trucks and other such equipment being inspected and documented at least daily before use?

  • Are there any special requirements associated with this work activity?

  • Is there sensitive equipment in the area that needs to be considered before, during and/or after the work activity?

  • Are there limitations on radio and cell phone use before, during and/or after this work activity'

  • Have issues related to the environment been discussed? (weather, terrain, time-of-day, dust, noise, lighting etc.).

  • DAILY DISCUSSION:

  • ATTENDEES initial:

  • 3/12/2013 Frank Deller

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.