Harbor - Entergy Transmission Contractor Safety Program - Employee Questionnaire

• Audit Title (Employee Name)

• Compliance inspection associated with this employee questionnaire

• Conducted on

  Date

• Prepared by

• Location
  Address

Employee Questions about Safety Specialist

• 1. How many times has your Safety Specialist visited your site in the past month?

  0

  1-2

  3-5

  6+

• 2. How long does your Safety Specialist usually stay on site?

  less than 3 hrs

  more than 3 hrs but not all day

  All Day

• 3. Can you describe the last situation your Safety Specialist coached you on and did you consider it to be an effective coaching moment?

  Yes

  No

• 4. Is your Safety Specialist on site for critical tasks or evaluations?

  Every Time

  Most of the Time

  Sometimes

  Rarely

Employee Questions about General Foreman

• 5. How many times has your General Foreman visited your job site in the past month?

  0

  1-2

  3-5

  6+

• 6. How long does your General Foreman typically stay on the job site?

  less than 3 hrs

  more than 3 hrs but not all day

  All Day

• 7. Can you describe the last situation your General Foreman coached you on and did you consider it to be an effective coaching moment?

  Yes

  No

• 8. Is your General Foreman on site for critical tasks or evaluations?

  Every Time

  Most of the Time

  Sometimes

  Rarely

Employee Questions about Entergy Management

• 9. How many times has and Entergy Safety Specialist visited your job site in the past month?

  0

  1-2

  3-5

  6+

• 10. How long does the Entergy Safety Specialist typically stay on the job site?

  less than 3 hrs

  more than 3 hrs but not all day

  All Day

• 11. Can you describe the last situation an Entergy Safety Specialist coached you on and did you consider it to be an effective coaching moment?

  Yes

  No

• 12. How many times has your Entergy OC visited your job site in the past month?

  0

  1-2

  3-5

  6+

• 13. How long does the Entergy OC typically stay on the job site?

  less than 3 hrs

  more than 3 hrs but not all day

  All Day

• 14. Can you describe the last situation your Entergy OC coached you on and did you consider it to be an effective coaching moment?

  Yes

  No

• 15. Is your Entergy OC on site for critical tasks or evolutions?

  Every Time

  Most of the Time

  Sometimes

  Rarely

Employee Questions

• 16. How many times in the past month has someone on the crew utilized their stop work authority due to an unsafe act/condition?

  0

  1-2

  3-5

  6+

• 17. How many times in he past month did you participate in the creation of a HA/JSA?

  0

  1-2

  3-5

  6+

• 18. How many times in the past month have you received coaching or on the job training?

  0

  1-2

  3-5

  6+

• 19. When was the last time you had formal skills training, can you describe the training, and it's effectiveness?

  <1 month

  1-3 months

  >3 months

Supervisor Questions

• 20. Have you been provided the necessary personnel and equipment to safely perform the job.

  Yes

  No

• 21. Do you feel the most recent visit from the Safety Specialist (Highlines or Entergy) was effective?

  Yes

  No

• 22. How often do you use the HU tools during coaching opportunities?

  Every Time

  Most of the Time

  Sometimes

  Rarely

• 23. When was the last time you had formal leadership training, can you describe the training, and it's effectiveness?

  <1 month

  1-3 months

  >3 months

• Final Comments from Employee Questionnaire

• Signature

  Sign

• Employee Signature

  Sign