Information

  • Location
  • Conducted on

  • Name & SESA Number of first person audited:

  • Name & SESA Number of second person audited:

  • Name & SESA Number of third person audited:

  • Name & SESA Number of fourth person audited:

  • Name & SESA Number of fifth person audited:

  • Name of Contractor or Partner Company:

  • Customer Name:

  • SE Business

  • Auditors Names: Erik Melchior

  • Type of Auditors

  • Describe the work being completed:

At the vehicle

  • 1. 1. Is the vehicle documentation, and required markings present and valid?

  • 1. 2. Is the vehicle content secure and barriers in place?

  • 1. 3. Identify any other vehicle safety equipment (high-vis vests, accident triangle, first aid etc.)

  • 1. 4. Is the vehicle content organized?

  • 1. 5. Identify the general PPE available to the Auditee:

  • 1. 6. Identify the electrical PPE available to the Auditee:

  • 1. 7. Details of other PPE available:

  • 1. 8. Is all conductive objects (jewellery, belt buckle, glasses) removed or protected?

BEFORE STARTING WORK- PLANNING FOR EMERGENCIES

  • 2. 1. Is the Auditee aware of the Fire & Medical emergency procedures?

  • 2. 2. Has the Auditee confirmed with the customer the location of all devices that will isolate the electrical energy in the event of an emergency?

DOCUMENTATION & TRAINING

  • 3. 1. Has the Auditee completed a Hazard Assessment & Written Work Plan?

  • 3. 2. Has the Auditee completed a point of work risk assessment (Pre-job safety plan) every day?

  • 3. 3. Has the Auditee received training on the product they are working on?

  • 3. 4. Has the Auditee received safety training in the previous 12 months?

  • 3. 5. (If more than one person are carrying out work) Has the person in charge been identified on the documentation?

  • 3. 6. Explain the tasks being performed detailing key hazards and voltages?

INSPECT EQUIPMENT

  • 4. 1. Has the FE inspected his/her tools & equipment?

  • 4. 2. Are the tools in good working order (Insulation not damaged)

  • 4. 3. Specific Tools - Leads have only 4mm exposed / Box cutters have auto retractable blades

  • 5. 1. Is the environment safe? Lighting adequate, guards in place, overhead hazards controlled, chemicals controlled, slip trip fall hazards removed?

  • 5. 2. Is the employee wearing appropriate PPE for the hazards identified? (i.e. Mechanical gloves, hearing protection, etc.)

  • 5. 3. Are adequate measures in place to prevent unauthorized access to the work area?

WORKING AT HEIGHTS

  • 6. Working at heights<br><br>6. 1. Does the access equipment used comply with GSD 10-Guidance-Document-Ladders? <br>

  • 6. 2. Is a safety harness used if required when working at height?

  • 6. 3. Are people working below protected?

  • 6. 4. Has scaffolding been inspected & tagged by a competent person?

GENERAL WORK

  • 5. 1. Is the environment safe? Lighting adequate, guards in place, overhead hazards controlled, chemicals controlled, slip trip fall hazards removed?<br><br>

  • 5. 2. Is the employee wearing appropriate PPE for the hazards identified? (i.e. Mechanical gloves, hearing protection, etc.)

  • 5. 3. Are adequate measures in place to prevent unauthorized access to the work area?

ELECTRICAL DE-ENERGIZED WORK (CONSIDERED ENERGIZED UNTIL ALL STEPS OF LOTO ARE COMPLETE)

  • 7. 1. Is the presence of SF6 considered?

  • 7. 2. Is the LOTO checklist completed correctly?

  • 7. 3. Are all isolation devices locked out?

  • 7. 4. When there is more than one worker, does every worker have their locks in place?

  • 7. 5. Has the Auditee verified absence of voltage on all conductors, load and line side in every cabinet as they are opened? YES / NO / N/A

  • 7. 6. Is the appropriate meter for measuring less and more than 1000 volt used?

  • 7. 7. Is a Hot Stick used for applying grounds and voltage measurement above 1000 volt?

  • 7. 8. Is the meter calibrated annually if periodic calibration is required by the manufacturer?

ENERGIZED TESTING

  • 8. 1. Has the Auditee a safety watch person available in case of emergency (Mandatory >1000V)?

  • 8. 2. Is the Auditee wearing the correct arc flash PPE that is equal to or exceeds the hazard level?

  • 8. 3. Are unprotected persons outside the limited approach and arc flash boundary?

  • 8. 5. Are insulated tools used?

OTHER ENERGY SOURCES & HAZARDOUS SUBSTANCES (GAS, CHILLED WATER ETC.)

  • 9. 1. Are all other sources of energy & hazardous substances identified

  • 9. 2. Are all the steps of the LOTO procedure for other energy sources followed?

  • 9. 3. Is the appropriate PPE worn to protect against the hazards present from hazardous substances & other energy sources?

  • 9. 4. Is a safety Data Sheet (SDS) available for any Hazardous Substances used?

SAFETY MANAGEMENT & COMMUNICATION

  • 10. 1. When was the last safety audit by the Auditee's manager or delegate?

  • 10. 2. Describe the actions taken following the last audit:

  • 10. 3. How many times did the Auditee receive safety communication in the previous 12 months?

  • 10. 4. How does the Auditee access safety information?

  • 10. 5. Has the Auditee reported any near misses and safety improvement suggestions in the previous year?

  • 10. 6. If a near miss has been reported, is the Auditee satisfied with the preventative action taken?

  • 10. 7. What has prevented the Auditee from being fully compliant?

CONCLUSIONS

  • Record any non-compliances to procedures here:

  • Record any good behaviours or practices observed here:

  • Signed by

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.