One Page Safety Expectations Assessment- DRAFT

• Prepared by

• Conducted on

  Date

• Client / Site

• Location
  Address

• Personnel

• Document No.

CREW COMMUNICATOR MEETING

• Score: (0=They are not doing it / 1= Meets Expectations / 2= Exceeds Expectations)

• Was the meeting planned?

• Good Content?

• Involvement? Engagement?

• Related to current work?

• Expectations are clear?

• Notes/Comments:

HAZARD ANALYSIS PROCESS

• Score: (0=They are not doing it / 1= Meets Expectations / 2= Exceeds Expectations)

• Created and reviewed by the craft?

• One readily available for each operation?

• Specific (Not Generic). Pinch points, tie off points identified?

• Updates/change in conditions identified?

• Communicated with other crews in area, truck drivers, etc?

• Current? Relevant safety policies are in HA or attached?

  Yes

  No

• Are all riggers certified? Spotters identified for operations?

  Yes

  No

  N/A

• Notes/Comments:

WEEKLY SUPERVISOR SAFETY TRAINING MEETING

• Score: (0=They are not doing it / 1= Meets Expectations / 2= Exceeds Expectations)

• Is the meeting prepared ahead of time?

• Agenda?

• Quality training element?

• Weekly Safety Assessments reviewed?

• Trends Analyzed?

• Is it an expectation that all supervision must attend?

  Yes

  No

• How is management supporting the program?

• Do we have a good way to capture deficiencies?

  Yes

  No

  N/A

• How?

• Suggestions:

• Is recognition a part of the meeting?

  Yes

  No

• Notes/Comments:

CRAFT OWNERSHIP PROGRAM

• Score: (0=They are not doing it / 1= Meets Expectations / 2= Exceeds Expectations)

• Relayed back to the craft? (Successes, Outstanding Items)

• Indoctrinations ran by CVIS?

• Mass meeting is CVIS led?

• Is recognition planned ahead?

• Is it Visible?

• Do the crews know?

• Are they excited about it?

• How are the crews able to make suggestions?

• How is management supporting the program?

• Is CVIS an effective link?

  Yes

  No

• How?

• Comments:

• Notes/Comments:

RECOGNIZE CHANGE

• Score: (0=They are not doing it / 1= Meets Expectations / 2= Exceeds Expectations)

• Red Book or Mini HA available for each crew?

• Do the crews know the expectations?

• Are we utilizing this?

• Have we defined and communicated what a 'near hit' means?

  Yes

  No

• Is it clear to the crews how to report a near hit?

  Yes

  No

• Notes/Comments:

EXTREME ACCESS AND HOUSEKEEPING

• Score: (0=They are not doing it / 1= Meets Expectations / 2= Exceeds Expectations)

• Part of initial plan?

• Access clear of debris?

  Safe

  At Risk

  N/A

• Walk through ladders?

  Yes

  No

  N/A

• Ramps cut at right slope?

  Yes

  No

  N/A

• Is the small stuff tolerated? (i.e. cut offs, banding, nails protruding, etc.)

  Yes

  No

• Please describe:

• Is the lay down yard organized and accessible?

  Yes

  No

  N/A

• Are you proud to say this is YOUR job?

  Yes

  No

• Why?

• Why not?

• Does the crew enforce the plan?

  Yes

  No

• Notes/Comments:

• Completed by:

• Signature:

  Sign