Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Untitled Page
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Job Observations
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Observer:
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Task:
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Plant/Area:
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Date/Time:
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Supervisor(s):
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Operator(s):
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Intervene
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Ergonomics/Body Use and Position
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Lifting with legs/knees rather than back
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Full body turn rather than twisting
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Smooth motions
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Walking/Working
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Eyes in direction of travel
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Not walking backwards
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Not rushing
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Ladders and Climbing
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Using ladders or steps
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Using handrail if walking up and down steps
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Not climbing on equipment
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Both hands free when climbing
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Ladder tied off
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One person on ladder at a time
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Inspected daily
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Using 3 points of contact
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Stable surface/Secure Positon
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Working on a stable surface
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Is footing secure
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Working away from edge or opening
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Not working directly below robot
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Pinch Points
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Body parts clear of moving machinery
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Body parts clear of magnet wheels
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Tight space/sharp or hot surfaces
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Body parts not in close proximity
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Personal Protective Equipment (PPE)
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Hard hat used and in good condition
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Face shield used and in good condition
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Safety glasses used and in good condition
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Safety boots used and in good condition
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FR clothing used and in good condition
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Proper clothing used and in good condition
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Proper gloves used for task and in good conditon
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Respirator storage used when not in use
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Respirator used and in good conditon
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Clean shaved when wearing respirator
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Proper respirator cartidge used and in good condition
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Hearing protection used and in good condition
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Fall Protection
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Harness and lanyard used properly and in good condition
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Inspection current
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Fall Hazard Assessment accurate
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Anchorage point adequate
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Harness and lanyard tied off properly
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100% tie off being maintained above 4 feet
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Scaffold rosettes not being used for tie off
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Harness and lanyard off ground when not in use
Tools and Equipment
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Not Appicable
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Intervene
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Is the right tool/equipment used correctly
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Is tool/equipment in good condition
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Are generators away from workers
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Are tools/objects/equipment safe from being dropped
Robot
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Inspection current
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Exposed electrical parts
LOTO
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Is equipment deenergized
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All energy isolated, disconnected, blanked.etc
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Are tags filled out correctly
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Are locks on equipment
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Are procedures followed
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Was verification adequate and done
Electrical
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Are GFCI's used and placed at outlet source
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Have GFCI's been tested
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Are all cords out of water
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Have electrical cords been inspected
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Are electrical cords free of damage
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Are cords routed properly ouyt of walkways
Confined Space Attendant
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Attendant in place with no collateral tasks
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Aware of method for communicating with entrants
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Has continuous monitoring documented
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Knows rescue plan requirements and how to summon
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Is not breaking the plane of the space
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Has monitor inside of the confined space
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Accurate logs kept for entrants into and out of space
Confined Space Entry Supervisor
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Any confined space has been checked before entry
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Has form posted at confined space entrance
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Ensures permit is properly filled out/logs kept/monitoring
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Resue team in place before entry
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Ensures attendant is relieved when asked
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Air movers/blowers are in place
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Ensures customer confined space form is adequate
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Attendant is in place prior to entry
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Is all emission equipment away from entrance of space
Scaffolding
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Scaffold has been inspected each shift/day
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Scaffold tags are in place and accurate
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Items are not stacked where dropped objects can occur
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Requirements followed that are listed on scaffold tag
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Not signed off by a Gecko Employee
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Swing gates remain closed when not in use
Barricades and Tags
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Are all sides barricaded
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Barricade covers entire area of need
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Are tags on all 4sides
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Are tags filled out correctly
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Is all equipment captured in barricade
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Is falling water staying within barricade
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Correct color being used
Job Safety Analysis/Hazard Assessment/Permits
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All permits obtained from customer
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Permits properly filled out
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Permit signed by everyone as needed
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Permits properly communicated
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Area evaluated properly
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Following procedures indicated on JSA
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Knows information on JSA form (Ask employee)
Hazard Communication
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All chemical containers labeled
Environmental
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All customer environmental concerns met
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Water not piling up in work area
Vehicle Truck/Rental
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Are seat belts being worn
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Is it being driven at safe speed
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Is driver alert/looking in direction of travel
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Is load being carried correctly
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Inspection current on vehicle
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Cargo secured properly
JLG/AWP
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Worker has proper training to use it
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Daily inspection sheet complete and current
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Equipment on stable/level surface
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Employee 100% tied off while in it
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Spotter used in congested areas
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Workers not standing on handrails
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Worker at controls while lift is in use
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Exiting lift while elevated remaining tied off
CUSTOMER NOTES (Has customer provided safe work environment?)
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Notes
SUPERVISOR NOTES (Unsafe Acts and Behaviors)
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Notes
OPERATORS NOTES (Unsafe Acts and Behaviors)
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Notes
