Information
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Work Order Number
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Conducted on
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Name and SESA
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Customer
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Location
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Work Order Title
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Site Name
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Customer Company Name
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Customer Contact Name
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Local Emergency Number
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Describe the work being completed:
At the vehicle
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Vehicle check applicable?
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1. 1. Is the vehicle documentation, and required markings present and valid?
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1. 2. Is the vehicle content secure and barriers in place?
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1. 3. Identify any other vehicle safety equipment (high-vis vests, accident triangle, first aid etc.)
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1. 4. Is the vehicle content organized?
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1. 5. Identify the general PPE available to the Auditee:
- Helmet
- Eye protection
- Hearing protection
- Respiratory protection
- Mechanical gloves
- Chemical gloves
- High visibility clothing
- Safety footwear
- Cold weather protection
- Other.
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1. 6. Identify the electrical PPE available to the Auditee:
- Electrical insulated gloves less 1000V
- Electrical insulated gloves greater 1000V
- Arc flash clothing Cat 0
- Arc flash face shield Cat 2
- Balaclava Cat 2
- Arc flash gloves Cat 2
- Arc flash clothing Cat 2
- Arc flash hood Cat 4
- Arc flash clothing Cat 4
- Other. Please give details below in 1.7
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1. 7. Details of other PPE available:
Planing for emergencies
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2. 1. Are the Fire & Medical emergency procedures well known?
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2. 2. Is the location identified for all devices that will isolate the electrical energy in the event of an emergency?
Documentation & Training
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3. 1. Is the Hazard & Risk Assessment complete?
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3. 2. Is the Work Plan Procedure complete and understood by everyone?
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3. 3. Is the team trained on the product they are working on?
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3. 4. Has team received safety training within the previous 12 months?
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3. 5. (If more than one person is carrying out the work) Is the person in charge identified on the documentation?
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3. 6. Explain the tasks being performed detailing key hazards and voltages?
Equipment Inspection
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Equipment and tools will be used?
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4. 1. Are the tools & equipment inspected?
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4. 2. Are the tools in good working order (Insulation not damaged, calibrated, etc.)?
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4. 3. Specific Tools - Leads have only 4mm exposed / Box cutters have auto retractable blades
Environment
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5. 1. Is the environment safe? Lighting adequate, guards in place, overhead hazards controlled, chemicals controlled, slip trip fall hazards removed?<br><br>
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5. 2. are the people wearing appropriate PPE for the hazards identified? (i.e. Mechanical gloves, hearing protection, etc.)
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5. 3. Are adequate measures in place to prevent unauthorized access to the work area?
Work at Heights
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Do the job require work at heights?
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6. 1. Does the access equipment used comply with Guidance-Document-Ladders? <br>
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6. 2. Is a safety harness used if required when working at height?
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6. 3. Are people working below protected?
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6. 4. Has scaffolding been inspected & tagged by a competent person?
Electrical De-energized Work (CONSIDERED ENERGIZED UNTIL ALL STEPS OF LOTO ARE COMPLETE)
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Do the job require work with Electrical equipment?
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7. 1. Is the presence of SF6 considered?
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7. 2. Is the LOTO checklist completed correctly?
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7. 3. Are all isolation devices locked out?
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7. 4. When there is more than one worker, does every worker have their locks in place?
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7. 5. Absence of voltage verified on all conductors, load and line side in every cabinet as they are opened?
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7. 6. Is a Hot Stick used for applying grounds and voltage measurement above 1000 volt?
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7. 8. Is the meter calibrated?
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7. 9. Is the Hot Stick (Fiberglass rod) certified?
Energized Testing
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Do the job require work with Electrical live equipment?
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8. 1. Is a safety watch person available in case of emergency (Mandatory >1000V)?
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8. 2. Is the correct arc flash PPE worn that is equal to or exceeds the hazard level?
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8. 3. Are unprotected persons outside the limited approach and arc flash boundary?
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8. 4. Is there an Electrical Rescue hook (Shepherd's hook) available if required?
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8. 5. Are insulated tools used?
Other Energy Sources & Hazardous substances (Gas, Chilled water, etc.)
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Do the Job require handling other Energy sources, hazardous material or substances?
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9. 1. Are all other sources of energy & hazardous substances identified
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9. 2. Are all the steps of the LOTO procedure for other energy sources followed?
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9. 3. Is the appropriate PPE worn to protect against the hazards present from hazardous substances & other energy sources?
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9. 4. Is a safety Data Sheet (SDS) available for any Hazardous Substances used?
Conclusions
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Record any non-compliances to procedures here:
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Record any good behaviours or practices observed here:
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