Information
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Picture of the PFI JSA
PFI JSA
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Is there a JSA available at the job site.
Specific job location & brief job location
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Is there a building name and number
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Is the Area of the building in which the equipment that is subject of the JSA is listed
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Is the type of work that is being done to the equipment listed
Equipment to be worked on
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Does this section include specifics about the equipment that is being worked on
Company name and signatures
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Is there a company name
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Is there a supervisor's signature
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If not is there a name and phone number
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Is there a PFI Production Mangers signature
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If not is there a name and phone number
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Is there a PFI Project Managers Signature
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If not is there a name and phone number
Print/Sign
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Is there a name of the person who filled of the PFI JSA
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Is there "today's date" this is the start date of the form
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Is there a project end date on the form
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Is there a form expiration date ( 30-day maximum from the inception/today's date )
Location of:
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Medical Treatment Facility
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Eye Wash Station
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Evacuation Point
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Fire Extinguisher
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M.S.D.S
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First Aid Kit
Personal Protective Equipment
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Hard Hat
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Safety Glasses
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Gloves
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Foot Protection
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Fall Protection
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Face Shield/Goggles
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Hearing Protcetion
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Respiratory Protection
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Fire Retardant Suit
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High Voltage Protection
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Other
Production/Used Equipment
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Is this Ina production area
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Will there be food production near the work area while work is being done?
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Will any used equipment be introduced to this area in this project? Explain in box how it has been prepared so that it will not contaminate the area.
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Will any chemicals and/or paints be used? ( please indicate in the box provided)
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Was MSDS given to the PM prior to the use to ensure chemical are on the approved list.
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Is there enclosed space work that requires a permit
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Is there. Hot work permit required
Preparation: equipment, material staging, removal of trash & old equipment - suggestions for section
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Sequence of steps-<br>Establish outside work area
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What are the food safety and of human hazards-<br>Contamination
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Steps to eliminate/ reduce human and/or food safety hazards<br>-Keep contained<br>- use designated trash and recycling containers<br>- follow GMP's, no smoking, no tobacco, no chewing gum, ect.<br>- keep equipment and. Tools in good condition ( off ground, protected, away from building ect.)<br><br>
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Sequence of steps<br>-Trash<br>
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What are the food safety and of human hazards<br>- Trash could be mistakenly put in production bins therefore contaminating bins<br>-Trash could pile up, blow away, spread, provide opportunity for contamination, attract pest
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Steps to eliminate/ reduce human and/or food safety hazards<br>-use designated trash and recycling containers, not product bins<br>- make arrangements with PFI to remove trash at appropriate intervals ( daily, every other day, ect.)
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Sequence of steps<br>-Contractors break room<br>
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What are the food safety and of human hazards<br>-Contamination
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Steps to eliminate/ reduce human and/or food safety hazards<br>-Designated break room including proper smoking arrangements ( receptacles, signs)<br>-Eating area, restroom, hand washing- not at work station
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Sequence of steps <br>-Staging area
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What are the food safety and of human hazards<br>-contamination<br>-Pest Activity
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Steps to eliminate/ reduce human and/or food safety hazards<br>- keep equipment in good condition-off ground, on pallets, protected away from building ect. <br>- no eating, drinking, smoking in area
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Was all points of perpetration hit
Traffic Flow: human & forklift route, in and out
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Sequence of steps<br>- people traffic into building
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What are the food safety and of human hazards<br>- pest activity<br>-contamination
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Steps to eliminate/ reduce human and/or food safety hazards<br>-Designate specific travel routs and times <br>-Include where contractors will wash hands, use hand sanitizer and if RTE use footpath and smocks<br>-Follow GMP's <br>-Keep doors shut
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Sequence of steps<br>- move Equipment in/out of the building
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What are the food safety and of human hazards<br>- pest activity<br>- contamination
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Steps to eliminate/ reduce human and/or food safety hazards<br>- make prior arrangements with production when and which routs to move equipment<br>- doors open at a minimum<br>- station person to watch for pest when door is open<br>- remove all packaging material outside-look for pest evidence<br>- inspect equipment prior to entering building<br>- remove dust and debris from equipment <br>- if RTE, equipment must be cleaned prior to entering building<br>- designate area for removed equipment to be stored, off the ground, away from product, remove gross soil
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Sequence of steps<br>- bring tools into building
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What are the food safety and of human hazards<br>-contamination
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Steps to eliminate/ reduce human and/or food safety hazards<br>- inspect tools, tools bags, totes, tool boxes for debris<br>- if RTE, clean tools and containers prior to entering the building
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Was all points of traffic flow hit
Job Steps
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Sequence of steps<br>- install barrier or curtain if cutting, welding, grinding in any area, or any job in RTE area
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What are the food safety and of human hazards<br>- bacteria contamination <br>- foreign material into product flow
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Steps to eliminate/ reduce human and/or food safety hazards<br>- discuss site and location with food safety<br>- install curtain during production down time, and when no product is present<br>- if other equipment will be at risk, cover or protect other equipment first<br>- use metal detectable zip ties<br>- inspect barriers/ curtains daily for gaps, tears
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Sequence of steps<br>- job
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What are the food safety and of human hazards<br>- contamination<br>- pest harborage
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Steps to eliminate/ reduce human and/or food safety hazards<br>- area is protected by curtain<br>- use sticky mat as entering and exiting job area <br>- contractors are following GMP's, washing hands, using designed routes to eliminate contamination <br>- equipment has been inspected for foreign material prior to entering building. <br>- if RTE, clean equipment prior to entering<br>- keep equipment off of the ground<br>- tools are being inspected for debris prior to entering building<br>- if RTE, clean tools prior to entering<br>- keep tools off of ground<br>- close conduit<br>- close holes in walls and equipment <br>- place all screws and bolts in place
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Was all points of job sets hit
Completion: clean up, removal of tools, curtain tear down & project turn over
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Sequence of steps<br>- remove curtain or barrier
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What are the food safety and of human hazards<br>- debris could fall in production flow
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Steps to eliminate/ reduce human and/or food safety hazards<br>- remove curtain or barrier prior to sanitation of new line and surrounding lines ( make prior arrangements with production )<br>- remove curtain when production is down and no product is present<br>- make sure to remove plastic stuck to ceiling, floor, ect.<br>- plug holes
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Sequence of steps<br>- clean project area, all staging areas, break areas, work areas
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What are the food safety and of human hazards<br>- contamination
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Steps to eliminate/ reduce human and/or food safety hazards<br>- areas will be kept clean regularly <br>- keep area free of debris, dust, screws, bolts, ect.<br>- clean area immediately after project or phase has finished
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Was all points of completion hit
Contractors signature
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Has everyone from the company signed the sheet.
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative
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Auditor's signature
