Jeld Wen - Checklist A - Observation Checklist - duplicate

• Job Position / Process

• Department

• Date

  Date

• Shift

• Observer(s)

• Employee(s) Observed

• Location
  Address

• INSTRUCTIONS
  ________________
  
  1. Answer all the questions below.
  2. Add photos and notes by clicking on the paperclip icon.
  3. To add a Corrective Measure (specifically if response is NO) click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.

Personal Protective Equipment (PPE)

• Required eye protection used

  Yes

  No

  N/A

• Required body protection used

  Yes

  No

  N/A

• Required hearing protection used

  Yes

  No

  N/A

• Required gloves used

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Surroundings

• Area is free of objects that could impede the process

  Yes

  No

  N/A

• Area is free from objects that could hit, fall or strike

  Yes

  No

  N/A

• Safeguards prevent access to pinch point or mechanical hazards

  Yes

  No

  N/A

• Area is clear of slip, trip or fall hazards

  Yes

  No

  N/A

• Correct tools used and properly stored

  Yes

  No

  N/A

• Forklift travel/operation creates no hazard

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Ergonomics

• Compliance Lift/Carry - Push/Pull load limits

  Yes

  No

  N/A

• Does the employee bend at the knees, not the back when lifting

  Yes

  No

  N/A

• Does the employee keep the object close to body when lifting

  Yes

  No

  N/A

• Back twisting or bending 45 degrees (+) avoided while lifting

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Safe Work Instructions

• Click "Add Step"

Step

• JSA : Were the Safe work instructions followed?

  Yes

  No

  N/A

• Modify JSA?

  Yes

  No

  N/A

Additional Details

• Time Spent Observing

• Comments or other safe or unsafe observations ( use back of form if needed)

• Number of work cycles observed

Completion

• Click "Add Observer"

Observer

• Name & Signature

  Sign