MDLZ - DSD GROUP

• Document No.

• Audit Title

• Branch Location

• Branch IBL Number

• Conducted on

  Date

• Prepared by

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.

HOUSEKEEPING CONDITIONS

• Is the area clean and orderly?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Any other housekeeping observations?

  Yes

  No

  N/A

• Please provide details on what you observed.

PERSONAL PROTECTIVE EQUIPMENT

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

  Safe

  At Risk

  N/A

• Any other personal protective equipment observations?

  Yes

  No

  N/A

• Please provide details on what you observed.

PICK LINE AREA

• Is the employee using proper material handling techniques?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Any other pick line area observations?

  Yes

  No

  N/A

• Please provide details on what you observed.

PALLET AND CART BUILDING

• Is the employee using proper material handling techniques?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Any other pallet and cart building observations?

  Yes

  No

  N/A

• Please provide details on what you observed.

STRETCHING

• Was pre-shift stretching completed today?

  Safe

  At Risk

  N/A

DRIVER WORK PRACTICES

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

  Safe

  At Risk

  N/A

• Is the employee using proper material handling techniques?

  Safe

  At Risk

  N/A

• Are proper driver methods being used?

  Safe

  At Risk

  N/A

• Are truck wheels chocked?

  Safe

  At Risk

  N/A

• Any other Driver work practice observations?

  Yes

  No

  N/A

• Please provide details on what you observed.

POWERED INDUSTRIAL TRUCKS

• Are pre-use inspections being completed?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• 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.)?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Any other powered industrial truck observations?

  Yes

  No

  N/A

• Please provide details on what you observed.

DOCK LOADING / UNLOADING

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

  Safe

  At Risk

  N/A

• Are key control methods being used?

  Safe

  At Risk

  N/A

• Are jack stands used on all decoupled trailers?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Are wheel chocks being used?

  Safe

  At Risk

  N/A

• Any other dock loading / unloading observations?

  Yes

  No

  N/A

• Please provide details on what you observed.

TRAINING

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

  Safe

  At Risk

  N/A

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

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

  Safe

  At Risk

  N/A

• Did the observation process include employee interactions?

  Yes

  No

  N/A

• Enter number of employees that were engaged.

• Were there any deficiencies noted?

  Yes

  No

  N/A

• Enter the number of deficiencies noted.

• 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?

  Yes

  No

  N/A

• Enter number of positive observations.

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