Laird - Weekly SSI

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Personnel

Part 1: Observation

• Is the work area floor free of debris and slippery conditions?

  Yes

  No

  N/A

• Is access to emergency exits, fire extinguishers, and other emergency equipment unobstructed?

  Yes

  No

  N/A

• Is all equipmemt in safe working condition and being used properly?

  Yes

  No

  N/A

• Are proper safeguards in place on machinery and equipment?

  Yes

  No

  N/A

• Are operators exposed to dangerous energy (electricity, compressed air, chemicals, stored energy, heat, etc.) during production or maintenance?

  Yes

  No

  N/A

• Are all employees wearing the required PPE?

  Yes

  No

  N/A

• Are all flexible cords and cables free of cracks, cuts, frays, and knots?

  Yes

  No

  N/A

• Were there any other hazards identified in your inspection?

  Yes

  No

  N/A

Part 2: Coaching

• Did you observe any unsafe behavior?

  Yes

  No

  N/A

• If so, what improvement actions were discussed?

• Did you observe any safe behaviors?

  Yes

  No

  N/A

• How was this positive behavior acknowledged and what feedback was given to the employee?