Jewelry Checklist.

• Audit Title

• Squadron

• Conducted on

  Date

• Inspector

• Location
  Address

• Supervisor

9.4. Jewelry Checklist

• Do workers remove rings (including silicone rings) when they perform activities that involve climbing, ascending or<br>descending, or where they could fall or jump from an elevated surface? AFI 91-203 para. 9.1.1.1

  Yes

  No

  N/A

• Do workers remove rings (including silicone rings) when performing materials handling activities? AFI 91-203 para. 9.1.1.2

  Yes

  No

  N/A

• Do workers remove rings (including silicone rings) when performing work that exposes them to moving machinery, rotating or revolving parts? AFI 91-203 para. 9.1.1.3

  Yes

  No

  N/A

• Do workers remove rings (including silicone rings) when performing work that exposes them to energized electrical circuits? AFi 91-203 para. 9.1.1.4

  Yes

  No

  N/A

• Is any jewelry that presents a potential for snagging, catching, pulling, tearing or loss evaluated and restricted if it presents a hazard to the worker or operation? AFI 91-203 para. 9.2

  Yes

  No

  N/A

• Report Routing

• Supervisor Signature:

  Sign

• Notification

  Action

  Info

  N/A

• Superintendent Signature:

  Sign

• Notification

  Action

  Info

  N/A

• Commander Signature:

  Sign

• Notification

  Action

  Info

  N/A

• Safety Office Signature:

  Sign

• Notification

  Action

  Info

  N/A

• Wing Commander Signature:

  Sign

• Notification

  Action

  Info

  N/A