Senior Leadership Workplace Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Project Info

• Senior Project Director / Manager:

• Name of JHSC HSE Rep / Worker Co-Chair:

• Project H&S Director / Manager / Coordinator:

• Project Phase:

• Number of Workers:

• Non-Routine or Critical Path Work being performed at time of inspection:

H&S Program Execution

• 1. Is the 2017 current policy and the monthly leading and lagging indicators posted?

  Yes

  No

  N/A

• 2. Date of last JHSC meeting (enter in notes section)? Are JHSC meeting minutes posted?

  Yes

  No

  N/A

• Any recommendations from the JHSC?

  Yes

  No

  N/A

• 3. Review a JSA and/or Work Permit (2) - Does the document reflect appropriate hazards and controls?

  Yes

  No

  N/A

• 4. Are workers trained for the task and credentials properly documented on the training matrix?

  Yes

  No

  N/A

• 5. Are StepBacks being performed prior to start of new tasks?

  Yes

  No

  N/A

• 6. Speak with workers (3) - can they explain "what is a Perfect Day"?

  Yes

  No

  N/A

• 7. Review Incident Reports (2) - has an investigation been conducted which identifies contributing factors and root causes?

  Yes

  No

  N/A

• 8. Are 80% of the BIPs being completed by Management/Leads/Supervisors?

  Yes

  No

  N/A

• 9. Are the Imminent Danger Forms (Care Cards) being completed as per the 1 per 5000 hours worked? Comments:<br>

  Yes

  No

  N/A

Area Inspected

• 1. Does area meet housekeeping standards?

  Yes

  No

  N/A

• 2. Are workers wearing required PPE?

  Yes

  No

  N/A

• 3. Are workers taking Ergonomics, Situational Awareness and Line of Sight into consideration while performing tasks?<br>

  Yes

  No

  N/A

• 4. Are emergency exits clear of obstructions to allow easy access in an emergency situation?

  Yes

  No

  N/A

• 5. Are fire extinguisher mounted, signed and easily accessible?

  Yes

  No

  N/A

• 6. Are pre-operational inspections being performed prior to using mobile equipment?

  Yes

  No

  N/A

Employees

• 1. Randomly interview an employee during the inspection to confirm transfer of H&S knowledge i.e Toolbox, CRCP's, etc. Add comments/concerns the worker may have in the notes section.

  Yes

  No

  N/A

• Enter the workers name:

  Yes

  No

  N/A

Inspection review

• Was an incentive award given during this inspection? Reason......

  Yes

  No

  N/A

• Executive Manager (Print and Sign Name)

  Sign

• Senior Project Director/Manager

  Sign

• Project H&S Director / Manager / Coordinator

  Sign