Information

  • Document No.

  • PSC Observation Worksheet

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

Location: (Select only one)

  • Turbine building

  • Aux building

  • Containment

  • Control Room

  • Fab Shop

  • Outside

  • Intake

  • Switch yard

  • Pri / Sec Lab

  • Training Center

  • Other

Use The Following Choices For The Observation

  • EE = Exceeds Expectations. ME = Meets Expectations. NI = Needs Improvement. UN = Un-satisfactory

Human Performance Tools

  • 01. STA (Safety Task Assignment) or Pre/Post Job Brief

  • 02. Self Checking (STAR, Flagging)

  • 03. Verification (Peer Check, CV, IV)

  • 04. Questioning Attitude (Two Min Rule, QV&V)

  • 05. Procedure Use and Adherence

  • 06. Communicate Effectively (3-Way, Phonetic Alphabet)

Hazard Recognition

  • 07. Line of Fire

  • 08. Barrier Tape / Rope

  • 09. Barricades

  • 10. Compressed Gas

  • 11. Electrical Cord(s)

  • 12. Hoses / Connections

  • 13. Tools

  • 14. Vehicles

Housekeeping and Material Conditions

  • 15. Housekeeping

  • 16. Combustibles

  • 17. Work / Laydown Area

Personnel Protective Equipment

  • 18. Head

  • 19. Hearing

  • 20. Eyes / Face

  • 21. Foot

  • 22. Hand

  • 23. Body (Coveralls, etc.)

Rad Worker Practices

  • 24. Rad Worker Practices

  • 25. Dosimeters Use

  • 26. RWP Knowledge / Adherence

  • 27. Contamination Control

  • 28. ALARA

  • 29. Use of Rad Monitors

Foreign Material Exclusion

  • 30. Boundaries / Barriers

  • 31. FME Log / Monitor

  • 32. FME Monitor

  • 33. Work Practices

Lifting and Rigging

  • 34. Softners

  • 35. Cribbing

  • 36. Lift Area

  • 37. Operator

  • 38. Signal Person

  • 39. Load Control

Material Handling

  • 40. Lifting and Carrying

  • 41. Use of Spotter

Fall Protection

  • 42. Use of Fall Protection

  • 43. Ladder Use

  • 44. Dropped Objects

You must answer both of these questions

  • Feedback Given to Crew or Individual

  • Debriefed Supervision

Number and Comments: (NI = Requires a comment)

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