Information
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Audit Title
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Last Name, First Name
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Conducted on
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Prepared by
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Location
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Personnel
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Business Unit
- AR Jurisdiction
- Business Development Services
- Customer Operations Support
- LA Jurisdiction
- MS Jurisdiction
- NO Jurisdiction
- Regulatory Services
- TX Jurisdiction
- Transmission
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Function/Entity
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Workgroup
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Job Title
Accountability
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1a. When was the last time you were coached or encouraged from a member of management on safety, that was not at a regularly scheduled safety meeting?
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1b. Can you describe the situation and was the coaching effective?
Safety Commitment
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2a. On a scale of 1-10, with 10 being the best, how committed are you to safety?
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2b. On a scale of 1-10, with 10 being the best, how committed is your leadership to safety?
Human Performance
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3a. On a scale of 1-10, with 10 being the best, how effective do you consider Human Performance to be?
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3a. On a scale of 1-10, with 10 being for each task, 5 being sometimes, and 1 being never, how often do you use Human Performance?
Conservative Decision Making
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4a. Prior to making a decision, do you think Likelihood or Consequences?
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4b. What factors do you consider when making a decision?
Close Calls / Good Catch Reporting
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5a. When is the last time you reported a Close Call / Good Catch? What was the CC/GC pertaining to?
Vehicle Inspection
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1. Are weekly vehicle inspections (for vehicles GVW >10,000 lbs) properly documented and present in the vehicle?
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17B.2
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2. Was the vehicle properly parked before the inspection?
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Was the vehicle backed in, or parked where the vehicle could pull through? 17A.13
If backing in was not applicable then N/A. -
3. Are tires in visibly good condition and look to be properly inflated?
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4. Are the wipers in good working condition?
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5. Are there any obstructions keeping the driver from seeing out of the windows or mirrors?
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6. Does the horn work?
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7. Is the driver using three points of contact for entering or exiting the vehicle?
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17A7
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8. Does the vehicle have a fire extinguisher?
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17A.18
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9. Are all inspection stickers and licenses visible and within date?
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17A2
Smith System Driving Keys
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10. Did the driver demonstrate the 5 Smith Driving Keys?
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11. Aim High in Steering?
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12. Get the Big Picture?
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13. Keep Your Eyes Moving?
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14. Leave Yourself an Out?
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15. Make Sure They See You?
General Driving Questions
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16. Did the driver yield appropriately in traffic, yield to pedestrians as well as slowing at all railroad crossings?
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17A12
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17. Did the driver scan their mirrors?
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18. Are the mirrors properly aligned?
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Ask the driver if he can see out of all the mirrors.
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19. Did the driver follow vehicles at a safe and appropriate distance?
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20. Did the driver maintain enough space in front of them while stopped at a red light or stop sign?
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approximate length of vehicle.
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21. Did the properly park their vehicle, if a stop was made during the inspection?
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With the flow of traffic, cone, flashers, and beacons as needed. 17A17, 17A2
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22. Were seat belts in place before departure and constantly in use?
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1H.4
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23. Did the driver utilize a hands free device for communication?
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1J.1-1J.5 outlines the use of cell phones and hands free devices while operating a motor vehicle.
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24. Did the driver keep their vehicle in the center of the lane?
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1H.1 & 1H.3
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25. Were the drivers lane changes minimized?
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1H.1 & 1H.3
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26. Did the driver remain focused while driving?
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1H.1 & 1H.3 No eating, shuffling through paper work, etc.
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27. Did the driver use turn signals properly?
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1H.1 & 1H.3
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28. Did the driver travel at or below the posted speed limit?
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17A.1-17A.3 Speed should be adjusted for weather conditions.
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29. Did the driver avoid backing whenever possible?
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17A.13
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30. If the drivers view was obstructed, was a spotter used to back the vehicle into a parking spot?
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17A.14
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31. Did the driver close their laptop before departure.
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1J.5
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32. Did the driver use flashers or beacons when impeding the flow of traffic?
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Should be used while patrolling lines or looking for an address.
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Comments
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Signiture