Information
-
Department
- Mixing
- Material Prep
- Tire Assembly
- Curing
- Finishing
- Warehouse
-
Document No.
-
Machine / Location
-
Conducted on
-
Prepared By:
- Bill Cassilly
- Pete Betts
- Robert Strickland
- Ray Powell
- Terry Weeden
- Stanley Manning
- Ken Midkiff
- Barry Poole
- Sony Shelton
- Ricky Houston
- Terry Hunsicker
- David Foster
- Name Not Listed
Daily Checklist
-
Was daily safety check completed?
5S Housekeeping
-
Aisles/Walkways kept clear?
-
Work area kept organized?
-
Housekeeping: spills, cords or other trips, trash/clutter, lighting, or Flammables
Personal Protective Equipment
-
All appropriate equipment or gear worn correctly?
-
PPE kept in good condition?
-
Machine Guarding
Ergonomics
-
-
In the job you are observing do you see the posture or motion that is indicated in the illustration above?
-
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?
-
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?
-
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?
-
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?
-
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?
-
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?
-
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?
-
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?
-
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?
-
Describe the job step where this posture or motion was observed.
Tools and Equipment
-
Appropriate tools or equipment being used?
-
Tools or equipment being used correctly?
-
Tools or equipment in good condition?
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
Safety procedures
-
Lock-out/Tag-out, Arc Flash, Hot Work Permit, Confined Space
-
Notes / Comments / Photos
-
Auditor signature
