S&C Employee Safety Review

• Audit No.

• Audit Title

• Date Performed

  Date

• Employee Audited

• Audit Location

• Location
  Address

• Performed by

JOB SPECIFIC INFORMATION AND DOCUMENTATION

• Does the S&C Field Service person have current One Line diagram for the electrical distribution?

  Yes

  No

  N/A

• Was a Tailgate Meeting form completed?

  Yes

  No

  N/A

• Was a Tailgate Meeting form fill out correctly?

  Yes

  No

  N/A

• Did the S&C Field Service personal obtain job site specific emergency evacuation instructions?

  Yes

  No

  N/A

• Does the S&C Field Service person know who the emergency contact is?

  Yes

  No

  N/A

• Does the S&C Field Service person know what the site specific emergency phone number is?

  Yes

  No

  N/A

• Was Method of Procedure used and followed by the S&C Field Service person, if required by the customer?

  Yes

  No

  N/A

• Does the S&C Field Service person know where the nearest hospital and burn center is?

  Yes

  No

  N/A

• Did the S&C Field Service person attend site-specific safety training, if required by the customer?

  Yes

  No

  N/A

• Is the S&C Field Service person able to produce hard or soft copy of the S&C Safety Manual?

  Yes

  No

  N/A

• Does the S&C Field Service personal know how long they are able to remain on site per the rest notification rule and how to calculate it?

  Yes

  No

  N/A

• Does the S&C Field Service person have the MSDSs available for the materials he has brought on site?

  Yes

  No

  N/A

• Did the S&C Field Service ask if there are other materials in thier work area and if so where to find the MSDSs for those materials?

  Yes

  No

  N/A

JOB SITE CONDITIONS

• Is the work site maintained in a safe and professional manner with no trash or refuge and tool and equipment in order?

  Yes

  No

  N/A

• Are cleaning agents, chemicals and other liquids identified and stored in proper containers?

  Yes

  No

  N/A

• Is there an adequate supply of drinking water?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT (PPE) INSPECTION

• Does the S&C Field Service person have all the PPE required for the tasks and work conditions?

  Yes

  No

  N/A

• Is the S&C Field Service person complying with the customer’s PPE requirements, if more stringent than S&C's or OSHA's?

  Yes

  No

  N/A

• Does the S&C Field Service person have a S&C issued safety glasses and hard hat, if required? ​ <br>

  Yes

  No

  N/A

• Is the S&C Field Service person have on safety work shoes, if required?

  Yes

  No

  N/A

• Are insulating rubber goods, gloves, sleeves, matts etc., marked with the date they were tested and placed in service?

  Yes

  No

  N/A

• Are insulating rubber goods, gloves, sleeves, matts etc., all within date ranges acceptable for use? If not, note each item individually in the corrective actions section.

  Yes

  No

  N/A

• Are electrical gloves, sleeves matts etc. stored in there own bags or container, with leather protectors removed, and are not kinked or folded?

  Yes

  No

  N/A

• Does the S&C Field Service person have all S&C issued Arc Flash clothing on for the tasks being performed? ​

  Yes

  No

  N/A

• Is the Arc Flash clothing in good condition? Free of holes, damage and significant wear and laundered correctly?

  Yes

  No

  N/A

• Are face shields in good condition, free of cracks or significant scratches, and is it stored in a protective bag to prevent damage?<br>

  Yes

  No

  N/A

• Does the S&C Field Service person have arc rated hearing protection?

  Yes

  No

  N/A

• Has the S&C Field Service person confirmed that any third party service providers working for S&C are in compliance with our safety requirements? ​ <br>

  Yes

  No

  N/A

ELECTRICAL SAFETY AND LOCK OUT TAG OUT

• Before beginning work, has the S&C Field Service personal removed all jewelry? ​ <br>

  Yes

  No

  N/A

• Can the S&C Field Service person explain the Arc Flash boundaries and what they mean?

  Yes

  No

  N/A

• Can the S&C Field Service person explain how to determine the Arc Flash values, should the labels be missing?

  Yes

  No

  N/A

• Has the the S&C Field Service person erected barricades or used barrier tape to establish Arc Flash boundies, if needed?<br>

  Yes

  No

  N/A

• Has the S&C Field Service person communicated LOTO requirements to the customer, if required?

  Yes

  No

  N/A

• Have all stored energy devices like, capacitors, batteries, springs, charging mechanisms, moving machinery parts, hydraulic systems, etc., been discharged, blocked or released?​

  Yes

  No

  N/A

• Have all the required energy sources, electrical & mechanical, been locked out and tagged?

  Yes

  No

  N/A

• Has all of the equipment in the zone of protection been tested for zero energy?​​​ <br>

  Yes

  No

  N/A

• Can the S&C Field Service person describe what a "Live - Dead - Live", and how to perform it?

  Yes

  No

  N/A

• Is all test equipment being used or in the possession ofthe S&C Field Service person calibrated, labeled and has a acceptable calibration date?

  Yes

  No

  N/A

• Are electrical panels covered when not being worked on?

  Yes

  No

  N/A

• Are extension cords in good condition?

  Yes

  No

  N/A

• Is the S&C Field Service person have, and if necessary are they using, a Ground Fault Circuit Interrupter (GFCI)?

  Yes

  No

  N/A

• Are all insulated tools present in good condition and free of nicks and in original condition?

  Yes

  No

  N/A

FALL PROTECTION

• If the work being performed requires fall protection, is the equipment available, has it been inspected prior to use, and is it being used correctly?

  Yes

  No

  N/A

HOT WORK

• If required, did the S&C Field Service person get a Hot Work Permit and have a Fire Watch person there and present 60 minutes after completion of the work?

  Yes

  No

  N/A

ERGONOMICS

• Can the the S&C Field Service person tell you and demonstrate proper lifting practicies? <br>1. Straight back<br>2. Test weight of a unknown object before attempting a lift<br>3. No twisting at the waist<br>4. Lift with legs<br>5. Feet staggered and apart to maintain their stability<br>6. Keep load close to body as possible.

  Yes

  No

  N/A

• Did the S&C Field Service person insure that there is a clear path before lifting and carrying items?

  Yes

  No

  N/A

• Can the S&C Field Service person tell you what maximum safe lifting limit policy is and it's limits? ​

  Yes

  No

  N/A

SAFETY TRAINING VERIFICATION

• Is the S&C Field Service person certified in First Aid, CPR and AED? ​ <br>First Aid Expiration Date________ CPR Expiration Date________<br>

  Yes

  No

  N/A

• If certified in First Aid and CPR, can the S&C Field Service person produce the training verification card?

  Yes

  No

  N/A

• Blood Borne Pathogens training completed? Date__________

  Yes

  No

  N/A

• Fall Protection training completed? Date_________

  Yes

  No

  N/A

• PPE training completed? Date_________

  Yes

  No

  N/A

• LOTO training completed? Date_________

  Yes

  No

  N/A

• Arc Flash training completed? Date__________

  Yes

  No

  N/A

• Confined Space training completed? Date__________

  Yes

  No

  N/A

• Basic Electrical Safety training completed? Date__________

  Yes

  No

  N/A

• Fire Prevengtion training? Date_________

  Yes

  No

  N/A

• Fire Extinguisher training? ​ Date________

  Yes

  No

  N/A

• Hazard Communication training? Date__________

  Yes

  No

  N/A

SUMARY OF AUDIT

• MAJOR NON CONFORMANCE - The employee was stopped from working and or removed from the job site. Immediate corrective actions are required.

  Yes

  No

  N/A

• MINOR NON CONFORMANCE- Critical requirements are being met in order to work safely. Minor issue that require follow up are noted.

  Yes

  No

  N/A

• CONFORMING - Meets all requirements and expectations. No follow up required.

  Yes

  No

  N/A

CORRECTIVE ACTIONS - STATE ISSSUE, CORRECTIVE ACTION, WHO IS RESPONSIBLE TO CORRECT, AND REQUIRED COMPLETION.

• 1.

  Yes

  No

  N/A

• 2.

  Yes

  No

  N/A

• 3.

  Yes

  No

  N/A

• 4.

  Yes

  No

  N/A

• 5.

  Yes

  No

  N/A

• 6.

  Yes

  No

  N/A

• 7.

  Yes

  No

  N/A

• 8

  Yes

  No

  N/A

• 9.

  Yes

  No

  N/A

SIGNATURES

• Field Service Persons Signature

  Sign

• Service Manager

  Sign

• Auditor Signature

  Sign