NASA GRC Test Facilities Maintenance Walkthrough Check Sheet

• Document No.

• Inspection Title

• Date/ Time of Inspection:

  Date
• Location: Building & Room(area):
  Address

• Person(s) Conducting Inspection:

• Employees Conducting Task/ PM:

• Description of Task being Performed:

Pre Task Planning/ JHA:

• Is a JHA required for the task?

  Yes

  No

• Is the JHA applicable or adequate?

  Yes

  No

• Has the JHA been reviewed by the Lead and signed by all the employees preforming the task?

  Yes

  No

Personal Protective Equipment:

• Is Lockout/ Tagout (single or group) required for the task?

  Yes

  No

• If multiple sources of energy have to be locked out was a GRC 787 form filled out?

  Yes

  No

• Was Lockout/Tagout (single or group) performed correctly?

  Yes

  No

• Is any PPE required for the task?

  Yes

  No

• Is the PPE being used in Good, Fair, or Poor condition and been inspected before use?

  Good

  Fair

  Poor

• Is the required and correct PPE being used by employees?

  Yes

  No

• If the required PPE is not be used what further PPE is needed?

Work Orders

• Is a copy of the Work Order at the job site?

  Yes

  No

• Does the work order have the correct Asset listed and is the PM tag on the equipment still readable.

  Yes

  No

• Notify the TFOME Maintenance Dept.

• Does the Work Order have the correct Location listed

  Yes

  No

• Does the work order have the correct Work type? (PM,PTI, or PGM)

  Yes

  No

• Are the Job Plan instructions being followed?

  Yes

  No

• If not, make sure any deviations are documented within the Work Log of the Work Order.

• Do the Job Plan instructions need to be updated?

  No

  Yes

• If so, make sure the appropriate updates are communicated to the TFOME Maintenance Dept.

• Do technicians understand why the work is being performed?

  Yes

  No

• Do technicians have the right tools to perform the task assigned?

  Yes

  No

• Did this task require spare parts, grease, or other materials?

  Yes

  No

  N/A

• Please document all materials used on the Work Order if not specified.

• Please make sure appropriate updates are communicated to the TFOME Maintenance Dept.