Job freeze

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Documentation

• Has a JHA been completed and is a copy available

  Yes

  No

  N/A

• Have all personnel signed on to the JHA

  Yes

  No

  N/A

• Was the JHA completed at the job site

  Yes

  No

  N/A

• Has the JHA been completed properly

  Yes

  No

  N/A

• Has the hierarchy of controls been used ? Have hazards been eliminated or are controls PPE and administration based

  Yes

  No

  N/A

• Has a work planning form been completed and signed off? Have all personnel signed the work planning form

  Yes

  No

  N/A

Employee knowledge

• Can the work group show a good understanding of the scope of work

  Yes

  No

  N/A

• Dose the work group show knowledge of the conditions and procedures on the permit to work

  Yes

  No

  N/A

Handling, Equipment

• Is the correct equipment being used for the task

  Yes

  No

  N/A

• Is a mechanical aid being used, if so is the operator competent and trained in its use

  Yes

  No

  N/A

PPE

• Is the correct PPE being used for the task

  Yes

  No

  N/A

• Is the PPE in good condition

  Yes

  No

  N/A

• Is the PPE being worn correctly

  Yes

  No

  N/A

Slips, Trips, Falls

• Is access to the area free from any potential slip,trip,fall hazards ?

  Yes

  No

  N/A

• Can the current weather conditions cause an STF Hazard ?

  Yes

  No

  N/A

House Keeping

• Is the work area tidy & organized ?

  Yes

  No

  N/A

• Has any equipment been placed in such a way to create a stored energy hazard ?

  Yes

  No

  N/A

• Is any equipment lying on the ground creating an STF Hazard ?

  Yes

  No

  N/A

Work at Heights

• Does the current task involve any working at heights ?

  Yes

  No

  N/A

• Are personnel trained in working at heights ?

  Yes

  No

  N/A

• Has all working at heights equipment been inspected and tagged (current) ?

  Yes

  No

  N/A

• Has the correct falls arrest equipment been selected for the job ?

  Yes

  No

  N/A

Barricade

• Is barricade required for this task ?

  Yes

  No

  N/A

• Does the barricade fully encompass the work zone ?

  Yes

  No

  N/A

• Is the barricaded area large enough to allow for any objects dropped from height?

  Yes

  No

  N/A

• Are there information tags on the barricade ?

  Yes

  No

  N/A

• Is the correct information on the barricade tags ?

  Yes

  No

  N/A

• Has the barricade register in the control room been filled out ?

  Yes

  No

  N/A

Comments

• Comments