Gulf Transport Task Observation Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Observed Employee

• Employee Name:

1.0 PPE

• 1.1 Head Protection

  Safe

  At Risk

  N/A

• 1.2 Eye/Face Protection

  Safe

  At Risk

  N/A

• 1.3 Hand/Foot Protection

  Safe

  At Risk

  N/A

• 1.3.1 Impact resistant gloves

  Yes

  No

  N/A

• 1.3.2 Leather gloves

  Yes

  No

  N/A

• 1.3.3 Chemical gloves

  Yes

  No

  N/A

• 1.3.4 Steel toe boots

  Yes

  No

  N/A

• 1.3.5 Chemical boots

  Yes

  No

  N/A

• 1.4 Hearing Protection

  Safe

  At Risk

  N/A

• 1.5 Clothing

  Safe

  At Risk

  N/A

• 1.6 Respirator

  Safe

  At Risk

  N/A

• 1.7 High visibility striping/vest

  Safe

  At Risk

  N/A

2.0 Manual Lifting

• 2.1 Correct body position

  Safe

  At Risk

  N/A

• 2.2 Help for heavy items

  Safe

  At Risk

  N/A

• 2.3 Hand placement

  Safe

  At Risk

  N/A

• 2.4 Weight known

  Safe

  At Risk

  N/A

• 2.5 Use of equipment

  Safe

  At Risk

  N/A

3.0 Line of Fire

• 3.1 Hand/Body position

  Safe

  At Risk

  N/A

• 3.2 Overhead hazards

  Safe

  At Risk

  N/A

• 3.3 Rotating equipment

  Safe

  At Risk

  N/A

• 3.4 Eyes on work or path

  Safe

  At Risk

  N/A

• 3.5 Pinch points/ sharp edges identified & protected

  Safe

  At Risk

  N/A

4.0 Housekeeping

• 4.1 Trash/Debris

  Safe

  At Risk

  N/A

• 4.2 Cord/lead control

  Safe

  At Risk

  N/A

• 4.3 Protruding items

  Safe

  At Risk

  N/A

• 4.4 Correct barricades

  Safe

  At Risk

  N/A

• 4.5 Tool storage

  Safe

  At Risk

  N/A

5.0 Walking/Working Surfaces

• 5.1 Trip hazard

  Safe

  At Risk

  N/A

• 5.2 Fall to below

  Safe

  At Risk

  N/A

• 5.3 Fall from same level

  Safe

  At Risk

  N/A

• 5.4 Fall arrest equipment use

  Safe

  At Risk

  N/A

• 5.5 Handrail meets OSHA requirements

  Safe

  At Risk

  N/A

6.0 Tool Use

• 6.1 Correct tool

  Safe

  At Risk

  N/A

• Type of tool:

• 6.2 Used correctly

  Safe

  At Risk

  N/A

• 6.3 Material secured

  Safe

  At Risk

  N/A

• 6.4 Guards in place

  Safe

  At Risk

  N/A

• 6.5 GFCI used

  Safe

  At Risk

  N/A

7.0 Equipment/Vehicle Use

• 7.1 Seat belt use

  Safe

  At Risk

  N/A

• 7.2 Vehicle inspection

  Safe

  At Risk

  N/A

• 7.3 Operating speed

  Safe

  At Risk

  N/A

• 7.4 Backing

  Safe

  At Risk

  N/A

8.0 Adjacent Work

• 8.1 Equipment startup

  Safe

  At Risk

  N/A

• 8.2 Vehicle traffic

  Safe

  At Risk

  N/A

• 8.3 Work scope known

  Safe

  At Risk

  N/A

• 8.4 Excavations

  Safe

  At Risk

  N/A

• 8.5 Crane/Hoist use

  Safe

  At Risk

  N/A

• 8.6 Rail car movements

  Safe

  At Risk

  N/A

• 8.7 Chemical exposure

  Safe

  At Risk

  N/A

9.0 Procedure/Task

• 9.1 Loading

  Safe

  At Risk

  N/A

• 9.2 Unloading

  Safe

  At Risk

  N/A

• 9.3 Driving

  Safe

  At Risk

  N/A

• 9.4 Other

  Safe

  At Risk

  N/A

• Describe procedure/task:

10.0 Job Planning

• 10.1 JSA available

  Yes

  No

  N/A

• 10.2 Employee knowledge of JSA content

  Safe

  At Risk

  N/A

• 10.2.1 Employee involved in writing JSA

  Yes

  No

  N/A

• 10.3 Critical items checklist available

  Yes

  No

  N/A

• 10.4 Critical items checklist used properly

  Safe

  At Risk

  N/A

11.0 Other

• Item # - What is positive or at risk? / Corrective action or recommendation?

• Item # - What is positive or at risk? / Corrective action or recommendation?

• Item # - What is positive or at risk? / Corrective action or recommendation?

• Item # - What is positive or at risk? / Corrective action or recommendation?

• Observed employee signature:

  Sign

• Inspection completed by:

  Sign