• Date Conducted:

  • Client/ Job Number:

  • Company Division::

  • Evaluation Conducted By:

  • Location:
  • Type of Project:

  • Personnel Present during Evaluation:

  • The purpose of this iAuditor document is to support the Company’s Section 0.16; which is titled a “Project Management Tool”. This platform will not fully duplicate all three phases of the MSWord form; nor is it intended to. The original form is designed and intended to provide Company personnel direction as it relates to the necessary information needed for a safe, responsible and incident free shift of work during a project. • During a shift of work, it is the responsibility of onsite supervision/ management to ensure that all employee(s) receive an appropriate safety orientation and that the orientation activities are documented according to the topics outlined within page #1 of Section 0.16. • During a shift of work, it is the responsibility of all involved employees to adhere to the requirements discussed and/or referenced within all information blocks supportive of all three phases of Section 0.16. This evaluation predominately supports the “Post Shift Evaluation” phase of the process; therefore, such is designed to grade and record the performance of (7) categories. Each category supports different components of activities which will be benchmarked for performance during the shift of work evaluated. Upon completion the evaluation; the information rated shall be shared for recognitions and/or lessons learned purposes. Compliance Focus: The protection of our Personnel, affiliated Assets, the Environment and the Brand of the Organization. Safety Mindset: Unsafe Condition leads to an Unsafe Acts which can result into a Near-Misses or worse an Incident!

1.0 Orientation Guidance Items Reviewed

  • 1.1 Adhering to the practice of No one is allowed to wear jewelry while on the worksite; i.e. rings, necklaces, piercings etc.

  • 1.2 Adhering to the practice of Cellular and/or other electronic devices are prohibited from the work area; unless authorized by location supervision/ facility management. (authorization must be documented)

  • 1.3 Adhering to the practice of Personnel required to wear respiratory equipment are clean shaven (in accordance with the chart on page (64) of Section 54 - Respiratory Protection Program).

  • 1.4 Adhering to the practice of reviewing site specific Emergency Evacuation Plan(s) to include type of signal, designated muster station and all clear instructions.

  • 1.5 Adhering to the practice of identifying the proper PPE for the task and that such is being utilized and maintained appropriately (head, eye, face, body, hands and foot protection applicable to the task) <br>

  • 1.6 Adhering to the practice of reviewing the location(s); Restrooms, Emergency Eye-wash, First-Aid, AEDs and Designated Smoking Area (all applicable).

  • 1.7 Adhering to the practice reminding personnel that all Incidents shall be reported immediately to onsite Management; to include but not limited to Injuries, Property Damage, Near-Misses, etc.

  • 1.8 Adhering to the practice of introducing for utilization the (S.H.I.N.E) BBS Program; to include the location of material and also the expectation of participation by all personnel associated with the project. <br>

  • 1.9 Adhering to the practice of reminding personnel that there shall be NO eating or drinking in work areas or areas where chemicals are Used or Stored. We expect you to police all trash that is a result from your daily activities- GOOD HOUSE KEEPING PRACTICES<br>

  • 1.10 Adhering to the practice of verifying Training and Competency - employees scheduled to perform work shall be up-to-date on “position related training” in accordance with their position affiliated TRAINING MATRIX.

  • 1.11 Adhering to the practice of reminding personnel of Safety and Compliance expectations (Ecoserv, LLC's Safety Culture)<br>Company Purpose-<br>Innovative and driven people providing superior environmental solutions<br><br>Core Values-<br>Safety is No Accident<br>Science Beyond Compliance<br>We are People of Character<br>One for All<br>No Status Quo<br><br>Safety Mission<br>Safety pays, accident cost. When you work safe, nothing is lost. <br>

  • 1.12 When applicable; review Client specific Safety Rules and KPI(s) (Key Performance Indicators).<br><br>

  • 1.13 Adhering to the practice of personnel maintaining a good Fit-for-Duty status - All personnel shall be physically conditioned, trained and prepared to carry out their specialized craft in the safest manner? (Check-in status?)

  • 1.14 Adhering to the practice of exercising Proper Work-Permits executed and documented, i.e. confined space, hot-work, LO/TO, etc.

2.0 Observation Checklist (All items listed shall have been verified and/or completed by the Person Leading Work (PLW) prior to the commencement of a Job-Related-Task)

  • 2.1 Safety Meeting and JSEA: information is accurate to the task

  • 2.2 Permits: are accurate; i.e. confined space, rescue, LO/TO hot-work, etc.

  • 2.3 Personnel: confirmation of readiness w/ credentials to preform task related duties

  • 2.4 Equipment Inspected: (hoses, PPE, rescue equipment, staging of work area, etc.)

  • 2.5 Release Protection: secondary containment & release prevention practices in place

  • 2.6 Communication Method: established and standardized across the operation & acknowledged by all affiliated

3.0 Job Performance Ratings

  • 3.1 Safety Observed

  • Comments:

  • 3.2 Environmental Consideration

  • Comments:

  • 3.3 Competency of Personnel<br>

  • Comments:

  • 3.4 Professionalism of Personnel

  • Comments:

  • 3.5 Performance of Equipment

  • Comments:

  • 3.6 Quality of Work

  • Comments:

  • 3.7 Support of Company Personnel

  • Comments:

  • 3.8 Hiring Client Input; If Applicable

  • Comments:

4.0 Safety Related Processes

  • 4.1 Any Management of Change

  • Proper Documents on File?

  • 4.2 Near-Miss Encounter

  • Proper Documents on File?

  • Any Injuries/ Illnesses Occurred

  • Proper Documents on File?

  • (S.H.I.N.E) Cards Completed

  • Proper Documents on File?

5.0 P.A.L.S. is an acronym for (PERFORMANCE, ACCOUNTABILITY, LIFE, & SYSTEMS = Safe and Sustainable). The program influences safe behavior alignment by the use of (14) icons and written guidance that correlates to all EHS Manual programs. “Core rules are/ were determined based off constant hazards; Supplementary Rules are/ were determined based off contextual hazards”.

  • Core Rules: Based on observance is compliance being achieved for all CORE Rules<br> 1. Confined Space<br>2. Heights (Working/ Ascending and Descending)<br>3. Safe Lifting Practices/ Suspended Loads (Line of Fire)<br>4. Transportation (Operator Shall-Plan Trips, Obey Laws and Cellular Usage is Prohibited)<br>5. Permitting Systems (Working and Regulating Requirements)<br>6. Energy Isolation

  • Select the number of rule categories applicable to your recognized deficiencies and provide a positive comment as to explain how compliance achievement can be obtained:

  • Compliance Achievement Comments:

  • Supplementary Rules: Based on observance is compliance being achieved for all SUPPLEMENTARY Rules<br>7. Hazardous Atmospheric Exposure (Chemical/ Gas Hazards)<br>8. Working around Heavy Equipment<br>9. Dropped Objects<br>10. Safety Barriers and Equipment Guards<br>11. Severe Weather<br>12. Proper Personal Protective Equipment Practices<br>13. Fit-for-Duty (Health Management)<br>14. Stop-Work-Authority (Associated with Every Rule)

  • Select the number of rule categories applicable to your recognized deficiencies and provide a positive comment as to explain how compliance achievement can be obtained:

  • Compliance Achievement Comments:


  • 6.1 Recommendations, Action Items and/or Observance Concerns:

  • 6.2 Positive Recognition(s):

  • Overall evaluation experience with safety of personnel and environmental consideration primarily in mind on a scale from 1-10 with (1) being the lesser value- Please assess:

  • Media and/ or Photographs

7.0 Acknowledgement Signatures

  • Person-In-Charge Signature:

  • Select date

  • Evaluator's Signature:

  • Select date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.