LRS Worksite Audit 2

• Audit Title

Audit Overview

• Audit Team:

• Type of Activity observed

• Location:

• Date:

• Unit:

• Unit Operator:

• Unit Ops Tech:

• Transport Operator:

Activity Planning

• Toolbox meeting held with all crew attending

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Full description of the operation reviewed

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Tasks and responsibilities assigned and understood

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Environmental conditions assessed

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Simultaneous Operations considered (SIMOPS)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Risk Assessment reviewed (Job Hazard Analysis)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Permit to Work in place if restricted activity

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Lock out / Tag out in place if required (LOTO )

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Escape routes (clear, difined muster points, pickup access)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Emergency plans in place

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Comments:

Work Environment

• Physical barriers in place (cones and signs)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Walkways and escape routes clear

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Adequate lighting

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Ladders and work platforms adequate

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Add media

  Media

• Comments:

Personal Protective Equipment

• Head, Ears, Eyes, Respiratory, Gloves, Feet, Gear

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Comments:

Well being

• Fit for work (mind and body)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Working at a safe pace

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Comments:

Position of People

• Pinch points, striking against

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Line of Fire

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Falling on, off, between or into

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Overhead loads

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Comments:

Reactions

• Wind Direction (changing position)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Adjusting PPE

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Stopping Work ( Step back)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Leaks and Spills

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Comments:

Tools and Equipment

• Right for the job

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Used correctly

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• In a safe condition (hammer unions, hammer faces, hoses, etc)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Tools signed out (Work at height, sensitive equipment)

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Comments:

• Add media

  Media

Process Control

• Procedures adequate

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Procedures reviewed periodically

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

• Abnormal conditions flagged/ tagged/ recorded.

  Select Acceptable Not acceptable Not Applicable

  • Acceptable
  • Not acceptable
  • Not Applicable

Debrief with crew observed

• Agreements made:

• Actions agreed:

• Add media

  Media

• Safe to continue operation

• Recognition for good performance