SAI OBS GEMBA WALK CHECKLIST

Daily Checklist

• Was daily safety check completed?

  Yes

  No

  N/A

5S Housekeeping

• Aisles/Walkways kept clear?

  Safe

  At Risk

  N/A

• Work area kept organized?

  Safe

  At Risk

  N/A

• Housekeeping: spills, cords or other trips, trash/clutter, lighting, or Flammables

Personal Protective Equipment

• All appropriate equipment or gear worn correctly?

  Safe

  At Risk

  N/A

• PPE kept in good condition?

  Safe

  At Risk

  N/A

• Machine Guarding

  Safe

  At Risk

  N/A

Ergonomics

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

• 

• In the job you are observing do you see the posture or motion that is indicated in the illustration above?

  No

  Yes

• Describe the job step where this posture or motion was observed.

Tools and Equipment

• Appropriate tools or equipment being used?

  Safe

  At Risk

  N/A

• Tools or equipment being used correctly?

  Safe

  At Risk

  N/A

• Tools or equipment in good condition?

  Safe

  At Risk

  N/A

Safe behaviors observed-actions taken to encourage safe behavior

Unsafe behaviors observed-action taken to correct and prevent recurrence

Line of fire. Is the worker in the line of fire?

• Grinding or drilling operations creating flying objects or particles - goggles/face-shield. Heavy equipment movement in the area - operator aware of pedestrian? Around rigging operations - hand in pinch point not under equipment? Working in front of live electrical panel - NFPA70E PPE

• Grinding, drilling or other operation that would cause flying debris

  Safe

  At Risk

  N/A

Safety procedures

• Lock-out/Tag-out, Arc Flash, Hot Work Permit, Confined Space

  Safe

  At Risk

  N/A

• Notes / Comments / Photos

  Media

• Auditor signature

  Sign