Life safety rules gap analysis

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety devices and guards

• Has a machine guarding assessment been completed

  Yes

  No

  N/A

• Have guarding solutions been identified

  Yes

  No

  N/A

• Have guarding solutions been implemented

  Yes

  No

  N/A

• Are guarding solutions requiring visual inspections or functional testing being performed

  Yes

  No

  N/A

• Is a program to control bypass/set up keys in place

  Yes

  No

  N/A

• Are energy control procedures (loto) in place if guards or barriers must be bypassed or removed.

  Yes

  No

  N/A

• Have the review include all non-routine and non-production operations such as maintenance, equipment installation, contractors etc.

  Yes

  No

  N/A

Lock out tag out

• Is there a written energy control program implemented at the site

  Yes

  No

  N/A

• Have maintenance servicing or set up functions requiring energy control been identified

  Yes

  No

  N/A

• Are prescriptive procedures in place

  Yes

  No

  N/A

• Do the procedures include a requirement for 1 key/ 1 lock

  Yes

  No

  N/A

• Is there process to control bypass/set up keys in place

  Yes

  No

  N/A

• Are employees trained and required annually to demonstrate competency

  Yes

  No

  N/A

• Are authorized and affected employees trained

  Yes

  No

  N/A

• Have the review include all non-outline and non-production operations such as maintenance, equipment installation on tractors etc

  Yes

  No

  N/A

Electrical work/arc flash

• Is an electrical work program implemented at the site

  Yes

  No

  N/A

• Is there an electrical worth permit system in place

  Yes

  No

  N/A

• Do employees performing work on live or potentially live electrical equipment system have appropriate electrical training in accordance with nffpa 70e or equivalent.

  Yes

  No

  N/A

• Are CPR qualified individuals available

  Yes

  No

  N/A

• Have employees doing electrical work been provided with appropriate arc rated clothing and insulated tools

  Yes

  No

  N/A

• Has the site completed an arc flash study on electrical equipment and labeled the hazards

  Yes

  No

  N/A

• Have approach boundaries been established

  Yes

  No

  N/A

• Have the review include all non-routine and non-production operations such as maintenance equipment installation contractors etc.

  Yes

  No

  N/A

Fall protection

• Is there a fall protection program in place to assure compliance and is it routinely audited

  Yes

  No

  N/A

• Have areas and activities where work may be performed at elevations 4' without fall protection been identified

  Yes

  No

  N/A

• Are work platforms and/or elevated areas where work is performed protected by guard rails

  Yes

  No

  N/A

• Are fall arrest systems available for use

  Yes

  No

  N/A

• Have employees been trained in appropriate use of fall arrest systems

  Yes

  No

  N/A

• Are anchor points available with 5000 lb capacity

  Yes

  No

  N/A

• Is there a fall rescue program in place

  Yes

  No

  N/A

• Where ladders are used, is a ladder program in place and proper use understood

  Yes

  No

  N/A

• Have employees been properly trained and understood fall protection requirements

  Yes

  No

  N/A

• Are the appropriate quarts/controls/equipment available for use in elevated work situations

  Yes

  No

  N/A

• Are elevating options with engineered controls available, eq scissor lifts, work platforms, etc

  Yes

  No

  N/A

• Where aerial lifts, buckets or scissor lifts are used have available anchor points and fall arrest systems available for use

  Yes

  No

  N/A

• Have the review include all non-routine and non-production operations such as maintenance equipment e installation contractors etc.

  Yes

  No

  N/A

Confined space

• The the site have a written permits required confined space program

  Yes

  No

  N/A

• Have all confined spaces been evaluated and inventoried

  Yes

  No

  N/A

• Are permit required confined spaces labeled

  Yes

  No

  N/A

• If eaton employees are to enter confined spaces, does the site have properly trained confined space entry team

  Yes

  No

  N/A

• Do all confined space permits get approved and reviewed

  Yes

  No

  N/A

• Is monitoring equipment available calibrated maintained and monitoring for correct hazards

  Yes

  No

  N/A

• Is there a rescue team available and can entertain for rescue within 4 minutes unless non-entry rescue equipment is available

  Yes

  No

  N/A

• Can field personnel identify a confined space at a customer site

  Yes

  No

  N/A

• Have the review include all non-routine and non-production operations such as maintenance equipment installation contractors etc

  Yes

  No

  N/A

Powered industrial vehicles - seat belts

• All powered industrial vehicles manufactured affter to 1992 should have restraint systems

  Yes

  No

  N/A

• If industrial trucks do not have restraints have they been removed from service until modifications can be completed

  Yes

  No

  N/A

• Where restraint systems /seatbelts are in place and available, everyone operating or retiring should use restraints

  Yes

  No

  N/A

• Any person operating or riding in an aerial lift or scissor lift while moving horizontally wears a restraint/fall arrest system

  Yes

  No

  N/A

• Have the review include all non-routine and non-production operations such as maintenance equipment installation contractors etc.

  Yes

  No

  N/A