Title Page
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Conducted on
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Completed by
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Location
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Job/Task Number
Safety Check Questions
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Have you and Your Team members been inducted
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Liaise with site contact and complete induction before continuing
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Do you have a Risk Assessment and Method Statement (RAMS) for the task
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Stop Work and Contact Management for Instruction
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Do the RAMS capture all serious hazards and control measures to form a suitable and sufficient safe system of work for the task
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Can additional Hazard control measures be put into place to reduce risk to an acceptable level
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Stop Work and Contact Management for Instruction
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Document hazard, who is at risk and how and control measures to reduce risk to an acceptable level
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Please include pictures of Hazard to be controlled where possible
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Can you confirm that NO neutral conductors (LV 4-wire system with secondary power source) will be lifted?
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Stop Work and Contact Management for Instruction
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Has this task been Categorised as per the Eaton JSR criteria OR have you worked on this equipment before
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Assess the job against categorisation guide and allocated catergory number.
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What Category
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Category 1 and 2 indicate possible non routine or higher risk activities. Please review RAMS and confirm any of the following that are NOT true.
- RAMS cover all routine and non routine tasks
- All LOTO points have been identified
- All Customer EHS requirements will be adhered to
- Adequate ARC Flash controls are in place
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Stop Work and Contact Management for Instruction
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Confirm that you are aware of the site emergency response provision. This should include - First aid (including site Automatic External Defibrilator), fire, evacuation and raising the alarm as a minimum
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Liaise with Site Contact to make yourself aware of the emergency response provision on site before continuing.
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Do you and the work party have all safety equipment including personal individual LOTO equipment and PPE to continue the task safely and to meet Eaton, customer and legally required standards
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Stop Work and Contact Management for Instruction
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Have adjacent live parts, cabinets and panels been identified and warning signage attached and any required barriers been erected
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Put required signage and barriers in place before continuing or stop work and contact Management for instruction
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If lone working have you identified a safety person to be available for hazardous tasks (Examples of hazardous tasks are live works/testing and proving dead)
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Stop works until a safety person has been identified for hazardous tasks
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Document who is the saftey person for the lone working tasks
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Have you completed a walk through of the overall and individual tasks, identified all isolation points and reviewed any LOTO plan (where required) during a pre-start team meeting with site contact and team members.
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Complete Team Meeting before proceeding
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Team Leader should confirm that all reasonably practicable safety controls are in place and the task is now safe to start
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All team members should sign only if the below is TRUE. You have reviewed the RAMS, attended the pre start meeting and understand the hazards and controls to be put in place. You are competent to carry out your set task and have all the PPE, safety equipment and tools to complete the task safely. You have and will use personal LOTO equipment to ensure you are protected from hazardous energy sources.
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Team Member 1
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Team Member 2
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Team Member 3
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Team Member 4
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Team Member 5
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Team Member 6
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Team Member 7
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Team Member 8
