NCIG - PTO - Work On Or Near Water

• Audit Title/Client/Date (reverse order)

• Prepared by

• Location
  Address

• Personnel

EVALUATION

• Are all activities performed in compliance with an accepted JSEA that is still adequate for the current tasks & conditions?

  Yes

  No

  N/A

• Do all persons appear to understand the requirements of the JSEA & have signed off?

  Yes

  No

  N/A

• Were workers never alone?

  Yes

  No

  N/A

• Did workers wear a life jacket or were they suitably prevented from falling into or contact with the water?

  Yes

  No

  N/A

• Was there evidence that emergency response protocols have been documented, rehearsed, & communicated to all persons in the work group?

  Yes

  No

  N/A

• Are there any other risks or issues associated with the activities observed?

  Yes

  No

  N/A

• Location of Observation

• COMMENTS & RECOMMENDATIONS

• Comments & recommendations to be actioned by

• Signature of observer

  Sign