Milford HSE Field Audit

• Document No.

• Audit title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Foreman in charge

Reporting and Investigation Standard

• Does Employee have current and completed JSA

  Yes

  No

  N/A

• Does the employee have a current and completed HSE Site plan?

  Yes

  No

  N/A

• Dose the employee understand what a near loss / near hit is?

  Yes

  No

  N/A

• Have all injuries been reported?

  Yes

  No

  N/A

HSE 002 - Driving Standard

• Is the Milford vehicle parked in the appropriate area?

  Safe

  At Risk

  N/A

• Has the daily vehicle inspections sheet been properly filled out?

  Safe

  At Risk

  N/A

• Is the overall appearance of the vehicle clean, inside and out?

  Safe

  At Risk

  N/A

• Are all loads secure, both is the cab and bed of the truck?

  Safe

  At Risk

  N/A

HSE 003 - PPE

• Is hard hat in a clean and sanitary condition and with Milford logo?

  Safe

  At Risk

  N/A

• Are safety glasses ANSI / CSA approved and being worn properly ?

  Safe

  At Risk

  N/A

• Are FRC's / Coveralls in good condition without tears or overly dirty with grease or mud?

  Safe

  At Risk

  N/A

• Is employee wearing steel / composite toed boots?

  Safe

  At Risk

  N/A

• Is glove protecting adequate for work assigned?

  Safe

  At Risk

  N/A

• Does employee have a H2S monitor proper placed in the breathing zone and a adequate bump date?

  Safe

  At Risk

  N/A

HSE - 009 SSE (short service employee)

• Are SSE's properly identified by markings on hard hat?

  Safe

  At Risk

  N/A

• Are SSE's with a mentor?

  Yes

  No

  N/A

HSE 010 - Emergency Response and Preparedness

• Dose employee know where the muster point is?

  Yes

  No

  N/A

• Did the employee review the HSE Site Specific Emergency Plan with you upon arrival?

  Safe

  At Risk

  N/A

• Dose the employee know the PASS method when using a fire extinguisher?

  Yes

  No

  N/A

• Dose the employee have a current First Aid / CPR card?

  Safe

  At Risk

  N/A

HSE 011 - Hydrogen Sulfide

• Dose the employee know if there is H2S on location?

  Safe

  At Risk

  N/A

• Has the employee been trained in H2S and have a current card?

  Safe

  At Risk

  N/A

HSE 013 - Mechanical Lifting and Heavy Machinery

• Are lifting chains and straps properly marked with load limits?

  Safe

  At Risk

  N/A

• Are lifting chains and straps inspected?

  Safe

  At Risk

  N/A

• Dose equipment have certified lifting point?

  Safe

  At Risk

  N/A

• Dose the employee have his certification card to operate heavy equipment? if so upload a picture of the card.

  Safe

  At Risk

  N/A

• Is heavy equipment operator, operating with a spotter present and watching the dig?

  Safe

  At Risk

  N/A

HSE 017 - Electrical Safety

• Are extension cords, in good condition, and properly inspected?

  Safe

  At Risk

  N/A

• Are extension cords plugs adequate for Class I Div II environments?

  Safe

  At Risk

  N/A

HSE 018 - Scope of Work

• Can the employee adequately describe their scope of work?

  Safe

  At Risk

  N/A

• Is the employee preforming any job function that is beyond their scope of work in the area?

  Safe

  At Risk

  N/A

Other Stand Alone Categories / Questions

• Are hand-tools handles in good condition?

  Safe

  At Risk

  N/A

• Are tools properly stored in adequate condition?

  Safe

  At Risk

  N/A

• Dose the overall appearance of the location in good order and housekeeping?

  Safe

  At Risk

  N/A

• Do the employee have an adequate supply of water?

  Safe

  At Risk

  N/A

STOP WORK Authority

• can the employee adequately describe STOP WORK Authority?

  Safe

  At Risk

  N/A

Manual Lifting

• Observe the employee. Does the employee use proper ergonomic techniques while lifting?

  Safe

  At Risk

  N/A

Excavation

• Excavations, adjacent areas, and protective systems inspected by a<br>competent person daily before the start of work.

  Safe

  At Risk

  N/A

• Prior to excavation, was a line finder surveyed over the job?

  Yes

  No

  N/A

• Spoils, materials, and equipment set back at least two feet from the edge of<br>the excavation?

  Safe

  At Risk

  N/A

• Warning vests or other highly visible clothing provided and worn by all<br>employees exposed to public vehicular traffic

  Safe

  At Risk

  N/A

• Is the operator digging within three feet of any known lines or utilitys?

  Safe

  At Risk

  N/A

• Do all employees know not to enter the trench with the depth greater than four foot?

  Yes

  No

  N/A

• Signature of foreman or person in charge.

  Sign