Information
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Document No.
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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
OBSERVATION INFORMATION
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Observation Date and Time
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Location:
- 9800 (S) - PREP / LEAD
- 9800 (S) PREP / BEAD BLAST
- 9800 (S) PAINT
- 9800 (S) SCAFFOLD LAY DOWN
- 9200 (E) COOLING TOWER
- 9010 (W) PIPE RACK
- 9010 (C) PIPE RACK
- 9010 (E) PIPE RACK
- 1000 AREA
- 2000 AREA
- 3000 AREA
PPE
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1.1 HEAD PROTECTION
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1.2 EYE AND FACE PROTECTION
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1.3 HAND AND FOOT PROTECTION
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1.4 HEARING PROTECTION
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1.5 CLOTHING
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1.6 RESPIRATOR
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1.7 FACE SHIELD
LIFTING
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2.1 CORRECT BODY POSITION
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2.2 HELP FOR HEAVY ITEMS
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2.3 HAND PLACEMENT
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2.4 WEIGHT KNOWN
HAZARDS
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3.1 HAND AND BODY POSITION
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3.2 OVERHEAD HAZARDS
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3.3 ROTATING EQUIPMENT
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3.4 EYES ON WORK OR PATH
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3.5 PINCH POINTS/ SHARP EDGES IDENTIFIED AND PROTECTED
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3.6 FUMES, ODORS, ATMOSPHERE
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3.7 NOISE LEVEL
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3.8. HEAT OR COLD EXPOSURE
WORK AREA
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4.1 TRASH AND DEBRIS
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4.2 CORD/ LEAD CONTROL
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4.3 PROTRUDING ITEMS
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4.4 CORRECT BARRICADES
ELEVATED / PLATFORM SAFETY
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5.1 TRIP HAZARDS
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5.2 FALL ARREST EQUIPMENT USED
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5.3 CORRECT LADDER AND PLACEMENT
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5.4. GATES, TOE BOARDS, NETS
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5.5 CRANES, LIFTS, PULLEYS
TOOLS AND EQUIPMENT
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6.1 CORRECT TOOL FOR JOB
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6.2 TOOL OR EQUIPMENT USED CORRECTLY
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6.3 MATERIALS SECURED
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6.4 PROPER GUARDS IN PLACE
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6.5 GFCI USED
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6.6 SPILL RESPONSE, CONTAINMENT, ABATEMENT MATERIALS
ROLLING STOCK / FORKLIFT / CRANES
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7.1 SEATBELT OR RESTRAINTS
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7.2 SPOTTER IN LINE OF SIGHT
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7.3 EQUIPMENT USED PROPERLY (USE OF HORN, SIGNALS, ETC.)
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7.4 CORRECT BACKING IN WORK AREA, SPOTTERS AND HORN USE
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7.5 LOAD SECURED, ROPES, LANYARDS AND CONTROLS
ADJACENT WORK
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8.1 EQUIPMENT STARTUP
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8.2 VEHICLE TRAFFIC
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8.3 SCOPE OF WORK KNOWN
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8.4 EXCAVATIONS / PITS / OPENINGS
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8.5 CRANE OR HOIST USE
PROCEDURES
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9.1 SPILL RESPONSE
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9.2 CONFINED SPACE
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9.3 CLIMBING (SCAFFOLD / LADDERS)
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Add media
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Image Information:
ACTIONS OR COUNSELING
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OBSERVATION RATING
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OBSERVATION REMARKS
OBSERVER / INSPECTOR
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