Information

  • PREPARED BY:

  • Date

  • MANUFACTURING LINE

  • LOCATION / AREA

  • NAME OF EQUIPMENT

  • JOB DESCRIPTION (DESCRIBE SPECIFIC TASK)

  • NAME OF ADDITIONAL OBSERVERS

  • NUMBER OF IMERYS EMPLOYEES OBSERVED

  • NUMBER OF CONTRACTORS OBSERVED

  • Additional comments

RISK ANALYSIS

  • PICTURE OF THE SYSTEM / EQUIPMENT DURING THE INSPECTION

  • Was a pre-job safety assessment properly completed for the job being observed?

  • Was the equipment locked out and tagged as required by the site LOTO procedure?

  • Was the appropriate personal protective equipment being used to protect against electrical?

  • Are live conductors property insulated to prevent accidental contact.?

  • Have overhead power lines been de-energized and guarded properly?

  • Is the electrical equipment labeled to identify the voltage / amperage?

  • Were all extension cords observed in use for less than 90 days?

  • Has a ground continuity measurement been conducted and within the last 12 months?

  • Arc Flash Protection - Are flash protection boundaries identified and protected if an arc flash hazard exist?

  • Are there at least two individuals working on the equipment when arc flash clothing is required (Level 2 or greater)?

  • Does the list include all electrical issues identified this observation?

SAFETY VISIT CARD - CHECKLIST

SAFETY VISIT CARD

  • CHECKLIST # 1 - MARK ALL BEHAVIOURS THAT APPLY

  • CHECKLIST # 2 - MARK ALL BEHAVIOURS THAT APPLY

  • CHECKLIST # 3 - MARK ALL BEHAVIOURS THAT APPLY

HAZARDS & RISK ASSESMENT

ASSESMENT

  • Select the level of risk: Low, Medium, High

  • Is there a way to do the job/task "Better" and/or "Safer"?

  • Feedback Given:

  • Follow Up Action required ? (if any, submit action plan)

ENDING TIME

  • ENDING TIME

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.