HBT FO Field Visit Assessment Form Rev00

• Name of Business/SBE name:

• Conducted on

  Date

• Name & EID of employee

• Scope of visit

  Sales Support

  Product Training

  Product Demo

  Other

• Field visit site

  Under construction

  Operational Manufacturing Unit

  Commercial Building

  Other

• Duration of visit

  Select 1 day < 1 Week < 1 Month < 3 Month < 6 Month < 1 Year > 1 year

  • 1 day
  • < 1 Week
  • < 1 Month
  • < 3 Month
  • < 6 Month
  • < 1 Year
  • > 1 year
• Location
  Address

• INSTRUCTIONS
  1. The Quick Field visit Assessment Tool must be completed during visit to the operational or under construction sites.
  2. Report your safety observations to customer representative.
  3. If there is any High risk or immediate danger regarding safety, they do not continue with the job, leave the site and inform their manager immediately.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.

Other Information

• Field Visit Purpose /Project Title (Name of customer/dealer + Purpose of visit)

• Brief task description (List the details about scope of work at customer site)

Quick Field Assessment Tool

• Visit to Customer office for office work <br><br>Understand & follow the customers site specific rules & regulations.<br>Know the Emergency response plan<br>Know the safe assembly area & emergency exit.<br>Report any safety observations<br>Follow & adhere to the HSE Cardinal rules.

  ✔

  ✖

  N/A

• Driving on Company Business <br><br>Plan your Journey<br>Follow the Driving safety norms<br>Check the condition of vehicle & its tyres before travelling <br>Follow the speed limit <br>Do not operate the vehicle unless authorized

  ✔

  ✖

  N/A

• Ergonomics <br><br>Follow the basic Principals of ergonomics while seating or travelling or handling the material if any.<br>Do not suddenly bend or twist from back to avoid back injury.<br>Stretch and walk around regularly; do not remain sedentary.

  ✔

  ✖

  N/A

• Potential Hazards - Spot the hazard on field /Site *(Ensures necessary actions/controls before proceeding)

• Slips, Trips, and Falls

  ✔

  ✖

  N/A

• Hot or Cold Surface

  ✔

  ✖

  N/A

• Poor Lighting or visibility

  ✔

  ✖

  N/A

• Moving Equipment

  ✔

  ✖

  N/A

• Unprotected floor

  ✔

  ✖

  N/A

• Severe weather condition

  ✔

  ✖

  N/A

• Uneven surface

  ✔

  ✖

  N/A

• Simultaneous Operations

  ✔

  ✖

  N/A

• Suspended load

  ✔

  ✖

  N/A

• Mobile Plant/Equipment

  ✔

  ✖

  N/A

• Opening on floor

  ✔

  ✖

  N/A

• Other

  ✔

  ✖

  N/A

• Please specify hazard observed

• Identified PPE

• Hard hat

  ✔

  ✖

  N/A

• Eye protection

  ✔

  ✖

  N/A

• Face shield

  ✔

  ✖

  N/A

• Welding mask

  ✔

  ✖

  N/A

• Respirator

  ✔

  ✖

  N/A

• Dust mask

  ✔

  ✖

  N/A

• Ear protection

  ✔

  ✖

  N/A

• Safety footwear

  ✔

  ✖

  N/A

• Gloves

  ✔

  ✖

  N/A

• Protective clothing

  ✔

  ✖

  N/A

• Harness

  ✔

  ✖

  N/A

• Other

  ✔

  ✖

  N/A

• Please specify hazard observed

Completion

• Inspector Sign Off

  Sign