Title Page

  • Conducted on

  • Prepared by

  • Location
  • Employee Observed

P.R.E.P.

Positioning

  • Are employees positioning themselves out of the line of fire of moving vehicles and equipment?

  • Acknowledge the employees' proper positioning out of the line of fire and thank him/her for demonstrating Safe Behaviors!

  • Stop the unsafe act and counsel employees on proper positioning out of the line of fire.

  • Are employees performing tasks only in/on designated walking/working surfaces (NOT on rails, rollers, correlators, companion plates; vehicle tires, door frames, running boards, bumpers, tailgates)?

  • Stop the unsafe act and counsel employees on proper positioning only in/on designated walking/working surfaces.

  • Acknowledge the employee's proper positioning only in/on designated walking/working surfaces and thank him/her for demonstrating Safe Behaviors!

  • Are employees performing tasks in the wash tunnel only when it is safe to do so (when tunnel equipment has been deenergized and locked out)?

  • Acknowledge the employee's safe act of performing work only when it is safe to do so and thank him/her for demonstrating Safe Behaviors!

  • Stop the unsafe act and counsel employees on deenergizing moving equipment before performing work in the wash tunnel.

Resourcefulness

  • Are employees using mechanical aids (dollies, carts, pallet jacks, etc.) or soliciting the help of fellow employees where practical to lift and/or transport heavy items (trash, debris, cases of chemical, etc.)?

  • Acknowledge employee's proper selection and use of available mechanical aids and thank him/her for demonstrating Safe Behaviors!

  • Stop the unsafe act and counsel employees on proper selection and use of available mechanical aids.

  • Are employees selecting the right tool (hand and power tools, cleaning tools, etc.) for the job at hand (routine maintenance, site cleaning, etc.)?

  • Acknowledge the employee's selection of the right tool for the job at hand and thank him/her for demonstrating Safe Behaviors!

  • Stop the unsafe act and counsel employees on selecting the right tool for the job at hand.

  • Where appropriate, are employees using available resources (written policies and/or procedures, operator manuals or manufacturer's instructions) to safely complete the task at hand?

  • Acknowledge the employee's use of available resources to safely complete the task at hand and thank him/her for demonstrating Safe Behaviors!

  • Stop the unsafe act and counsel employees on using available resources.

Eyes on Task

  • Are employees establishing eye contact with operators of vehicles while on site, or, if operating a vehicle themselves, with pedestrians who may be in the line of fire while on site?

  • Acknowledge the employee's safe act of establishing eye contact with operators of vehicles and with pedestrians while operating a vehicle on site and thank him/her for demonstrating Safe Behaviors!

  • Stop the unsafe act and counsel the employees on the importance of establishing eye contact with operators of vehicles and with pedestrians while operating a vehicle on site.

  • Are employees placing their hands and feet only places where they can visually confirm that it is safe to do so (i.e. - NOT into trash cans, vacuum separator canisters, under customer vehicle seats or into seat/door pockets)?

  • Acknowledge the employee's proper placement of hands and feet only in places where they can visually confirm that it is safe to do so and thank him/her for demonstrating Safe Behaviors!

  • Stop the unsafe act and counsel employees on the importance of placing hands and feet only where they can visually confirm that it is safe to do so (e.g. - contaminated sharps, bodily fluids, other potentially infectious materials [OPIM]).

Protective Equipment

  • Are employees wearing footwear that has been designated as non-slip?

  • Acknowledge the employee's compliance with the non-slip footwear requirement and thank him/her for demonstrating Safe Behaviors!

  • Counsel employees on the importance of non-slip footwear, and inform them of their options on how to obtain a pair (Shoes for Crews, local retail outlets, etc.).

  • Are employees donning required personal protective equipment, PPE (hearing protection, gloves, goggles, etc.), where and when required (designated high noise areas, when handling chemicals, etc.)?

  • Acknowledge the employee's proper selection and use of required PPE and thank him/her for demonstrating Safe Behaviors!

  • Stop the unsafe act and counsel employees on the importance of wearing required PPE.

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.