Audit

PURPOSE: To encourage leaders to perform routine safety observations of the work environment and actively engage with their employees regarding safe and/or unsafe behaviors and conditions. These engagement activities will provide coaching and listening opportunities to improve our overall safety program.
KEY OBSERVATION POINTS

1. A safety observation should take 10-15 minutes.
2. List the positive and improvement opportunities found.
3. Provide coaching and feedback on observations noted.
4. Develop corrective actions, document on action register and track through closure.
5. Retain observations for 12 months.
OBSERVATION SEVERITY RATING INFORMATION
A - A condition or practice likely to immediately cause loss of life. TAKE IMMEDIATELY CORRECTIVE ACTION.
B - A condition or practice likely to cause at least a Lost-Time Incident (LTI) or require Medical Treatment (MT).
C - A condition or practice likely to only cause a First-Aid Case (FA) injury or recoverable damage.
1.0 HOUSEKEEPING CONDITIONS

1.1 Is progressive clean-up being followed to maintain the work area clean and orderly?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 1.1 observations?

Was the situation corrected on the spot?

1.2 Are walking and working surfaces free of any slip/trip/fall hazards (i.e. electrical cords, broken pallet pieces, straps, liquids, etc.)?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 1.2 observations?

Was the situation corrected on the spot?

1.3 Is the area free of leaning materials (load bars, skids, dock plates, etc.)?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 1.3 observations?

Was the situation corrected on the spot?

1.4 Any other housekeeping observations?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 1.4 observations?

Was the situation corrected on the spot?

2.0 PERSONAL PROTECTIVE EQUIPMENT

2.1 Are employees wearing the appropriate personal protective equipment (i.e. safety glasses, protected toe shoes, gloves, etc.)?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 2.1 observations?

Was the situation corrected on the spot?

2.2 Any other personal protective equipment observations?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 2.2 observations?

Was the situation corrected on the spot?

3.0 PICK LINE AREA

3.1 Is the employee using proper material handling techniques?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 3.1 observations?

Was the situation corrected on the spot?

3.2 Are pick pallet locations maintained at a height that can be safely accessed?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 3.2 observations?

Was the situation corrected on the spot?

3.3 Is the pick path maintained in good condition and free of trip hazards?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 3.3 observations?

Was the situation corrected on the spot?

3.4 Any other pick line area observations?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 3.4 observations?
A - A condition or practice likely to immediately cause loss of life. TAKE IMMEDIATELY CORRECTIVE ACTION.
B - A condition or practice like to cause at least a Lost-Time Incident (LTI) or require Medical Treatment (MT).
C - A condition or practice likely to only cause a First-Aid Case (FA) injury or recoverable damage.

Was the situation corrected on the spot?

4.0 PALLET AND CART BUILDING

4.1 Is the employee using proper material handling techniques?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 4.1 observations?

Was the situation corrected on the spot?

4.2 Are flex belts appropriately positioned to carts/pallets to safely build orders?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 4.2 observations?

Was the situation corrected on the spot?

4.3 Any other pallet and cart building observations?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 4.3 observations?

Was the situation corrected on the spot?

5. 0 STRETCHING

5.1 Was pre-shift stretching completed today?

Please provide details on what you observed or discussion with employee(s).

Select Severity Rating for 5.1 observations?

Was the situation corrected on the spot?

6.0 DRIVER WORK PRACTICES

6.1 Were Pre/Post Trip inspections conducted correctly and deficiencies documented in ZONAR system?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 6.1 observations?

Was the situation corrected on the spot?

6.2 Are 3 points of contact being used when entering and exiting the truck?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 6.2 observations?

Was the situation corrected on the spot?

6.3 Is the employee using proper material handling techniques (proper lifting/lowering/bending, pushing vs pulling, etc.)?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 6.3 observations?

Was the situation corrected on the spot?

6.4 Are proper driver methods being used?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 6.4 observations?

Was the situation corrected on the spot?

6.5 Was that delivery unit secured (cab locked, wheels chocked, trailer door locked when away from unit) while making deliveries?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 6.4 observations?

Was the situation corrected on the spot?

6.5 Did the employee raise and lower the trailer door in a safe manner?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 6.5 observations?

Was the situation corrected on the spot?

6.6 Did the employee use and store the portable dock plate in a safe manner?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 6.6 observations?

Was the situation corrected on the spot?

6.7 Any other Driver work practice observations?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 6.7 observations?

Was the situation corrected on the spot?

7.0 POWERED INDUSTRIAL TRUCKS

7.1 Are pre-use inspections being completed?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 7.1 observations?
A

Was the situation corrected on the spot?

7.2 Are forklift operators wearing seatbelts? Give instant feedback (positive or negative).

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 7.2 observations?

Was the situation corrected on the spot?

7.3 Are powered industrial truck operators operating in a safe manner (i.e. safe speed, using horns at blind corners/intersections, maintaining clear view in the direction of travel, etc.)?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 7.3 observations?

Was the situation corrected on the spot?

7.4 Are powered industrial truck units parked with attachments lowered to the ground and the units shut down?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 7.4 observations?

Was the situation corrected on the spot?

7.5 Any other powered industrial truck observations?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 7.5 observations?

Was the situation corrected on the spot?

8.0 DOCK LOADING / UNLOADING

8.1 Are dock doors/screens in closed position when not in use?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 8.1 observations?

Was the situation corrected on the spot?

8.2 Are key control methods being used?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 8.2 observations?

Was the situation corrected on the spot?

8.3 Are jack stands used on all decoupled trailers?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 8.3 observations?

Was the situation corrected on the spot?

8.4 Are orange cones used to designate an active load / unload process?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 8.4 observations?

Was the situation corrected on the spot?

8.5 Are wheel chocks being used?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 8.5 observations?

Was the situation corrected on the spot?

8.6 Any other dock loading / unloading observations?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 8.6 observations?

Was the situation corrected on the spot?

9.0 TRAINING

9.1 Do you feel you have received sufficient safety training for your job?

Please provide details on what you observed (include any feedback given to the employee).

Select Severity Rating for 9.1 observations?

Was the situation corrected on the spot?

GENERAL QUESTIONS TO ASK WHEN ENGAGING EMPLOYEES

1. How would you evacuate and where would you go in an emergency situation.
2. Do you have any suggestions to make this branch a safer place to work?
3. What are you personally working on to improve your safety and that of your co-workers?
OBSERVATION SUMMARY - THIS SECTION MUST BE FULLY COMPLETED

Do you feel this observation should be considered a SAFE or AT RISK observation?

Did the observation process include employee interactions?

Enter number of employees that were engaged.

Were there any deficiencies noted?

Enter the number of deficiencies that were found.

Please provide details on what you observed (include feedback given to the employee).

If an opportunity was observed, what will the employee be working on?

Were there any positive findings observed?

Enter number of positive findings observations.

Please provide details on what you observed (include feedback given to the employee).

Was an operational change made as a result of this observation?

Please provide details on the operational change that was made.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.