TFOME Safety & Health, NASA GRC Maintenance, and/or SOR Inspections

• Document No.

• Inspection Title

• Date/ Time of Inspection:

  Date
• Location: Building & Room(area):
  Address

• Person(s) Conducting Inspection:

Type of Inspection:

• Is the inspection a "Task/ Process" Audit?

  Yes

  No

• Task or Process being evaluated:

• Employee(s) being evaluated or observed:

Pre Task Planning/ JHA:

• Is a JHA required for the task?

  Yes

  No

  N/A

• Is the JHA applicable or adequate?

  Yes

  No

  N/A

• Has the JHA been reviewed by the Lead and signed by all the employees preforming the task?

  Yes

  No

  N/A

• Yes

  No

  N/A

Hazard Identification and Mitigation:

• Have electrical hazards been identified and mitigated?

  Yes

  No

  N/A

• Have slip, trip, or fall hazards been identified and mitigated?

  Yes

  No

  N/A

• Have eye, face, and body hazards been identified and mitigated?

  Yes

  No

  N/A

• Have chemical use (Hazcom) hazards been identified and mitigated?

  Yes

  No

  N/A

• Have machine guarding issues been identified and mitigated?

  Yes

  No

  N/A

• Have hot or cold hazards been identified and mitigated?

  Yes

  No

  N/A

• Have caught in (pinch points) or struck by hazards been identified and mitigated?

  Yes

  No

  N/A

• Have overhead or falling object hazards been identified and mitigated?

  Yes

  No

  N/A

• Are hand tools and/or power tools being used to complete the task?

  Yes

  No

  N/A

• Are the tools being used to complete the job the correct tool for the job?

  Yes

  No

  N/A

• Are all the tools guards in place and are the tools in good working order?

  Yes

  No

  N/A

• Are there any additional hazards identified?

  Yes

  No

Personal Protective Equipment:

• Is any PPE required for the task?

  Yes

  No

  N/A

• Is the required and correct PPE being used by employees?

  Yes

  No

  N/A

• If the required PPE is not be used what further PPE is needed?

• Is the PPE being used in Good, Fair, or Poor condition and been inspected before use?

  Good

  Fair

  Poor

Other Required Safety Measures: (LO/TO, Fall Protection, Confined Space, Hot work, Waste Disposal)

• Is Lockout/ Tagout (single or group) required for the task?

  Yes

  No

  N/A

• If multiple sources of energy have to be locked out was a GRC 787 form filled out?

  Yes

  No

  N/A

• Was Lockout/Tagout (single or group) performed correctly?

  Yes

  No

  N/A

• Is Lockout/ Tagout (single or group) required for the task?

  Yes

  No

  N/A

• If multiple sources of energy have to be locked out was a GRC 787 form filled out?

  Yes

  No

  N/A

• Was Lockout/Tagout (single or group) performed correctly?

  Yes

  No

  N/A

• Is a Lifting Device required to be used while performing the task? (crane, chain fall, slings, forklift, etc.)

  Yes

  No

  N/A

• Were all Lifting Devices used inspected before use?

  Yes

  No

  N/A

• Are Lifting Devices being used according to manufacture specifications?

  Yes

  No

  N/A

• Is Fall Protection required to perform the task?

  Yes

  No

  N/A

• If so, has a GRC-979 Fall Prevention form filled out and signed off by a competent person prior to work starting?

  Yes

  No

  N/A

• Is all identified Fall Protection PPE, anchorage points, and systems adequate for the task?

  Yes

  No

  N/A

• Are any Aerial and/or Mobile Lifts being used?

  Yes

  No

  N/A

• Have the Aerial and/or Mobile Lifts been inspected prior to use? (GRC-61)

  Yes

  No

  N/A

• Is the Aerial and/or Mobile Lift in good working condition?

  Yes

  No

  N/A

• Is any of the work taking place in a Confined Space?

  Yes

  No

  N/A

• Is the Confined Space permit required?

  Yes

  No

  N/A

• If work is talking place in a permit required Confined Space was a GRC 199 form filled out and approved prior to work starting?<br>

  Yes

  No

  N/A

• Does any work taking place require Hot Work outside of a designated Hot Work area? (grinding welding, torch cutting, soldering etc.)

  Yes

  No

  N/A

• Was a GRC 7 Hot Work permit requested prior to work starting?

  Yes

  No

  N/A

• Was a GRC 7b or 7c filled out prior to starting work for the day?

  Yes

  No

  N/A

• Inspector(s) Signature:

  Sign

• Is the task generating any Waste which required Waste disposal through the Waste Management?

  Yes

  No

  N/A

• Was a 260a filled out?

  Yes

  No

  N/A

• Is the inspection a "Facility/ Area" inspection?

  Yes

  No

Facility/ Area Inspection:

• Specific Facility or Area being inspected:
  Address

Hazards:

• Is the Facility/ Area free of electrical hazards? (Damaged; extension cords, flexible cords, missing; outlet covers, ground prongs, etc.)

  Yes

  No

  N/A

• Is the Facility/ Area free of slip, trip, or fall hazards?

  Yes

  No

  N/A

• Is all required PPE available to employees and in good condition in the Facility/ Area?

  Yes

  No

  N/A

• Are lifting devices in good working condition and being inspected before use within the Facility/ Area? (cranes, chain falls, forklifts{GRC 50})

  Yes

  No

  N/A

• Are chains, slings (wire or synthetic), shackles, spreaders, etc. in good working condition and being inspected before use within the Facility/ Area?

  Yes

  No

  N/A

• Are any aerial or mobile lifts being used inspected prior to use? (check log book on lift for GRC 61)

  Yes

  No

  N/A

• Is the Facility/ Area paths of egress or emergency exits clear? (minimum 28 inches)

  Yes

  No

  N/A

• Are fire doors closed as required in the Facility/ Area?

  Yes

  No

  N/A

• Is the Facility/ Area free of debris and clutter? (housekeeping)

  Yes

  No

  N/A

• Are all chemicals, not currently in use, properly stored in the Facility/ Area?

  Yes

  No

  N/A

• Are all chemicals clearly labeled and being used properly within the Facility/ Area?

  Yes

  No

  N/A

• Are all power and hand tools in good condition/ working order within the Facility/ Area? (guards in place, cords not damaged, no home made repairs, etc.)

  Yes

  No

  N/A

• Are all machine guards in place and properly adjusted within the shop areas of the Facility/ Area?

  Yes

  No

  N/A

• Are any eyewash/ shower stations, within the Facility/ Area, inspected weekly and monthly?

  Yes

  No

  N/A

• Are compressed gas cylinders stored properly and restrained in the Facility/ Area?

  Yes

  No

  N/A

• Are ventilation and exhaust systems functioning properly in the Facility/ Area?

  Yes

  No

  N/A

• Are any gas sensor devices/ systems calibrated and functioning properly in the Facility/ Area?

  Yes

  No

  N/A

Additional Information:

• Are there any additional hazards to report?<br>

  Yes

  No

• Were any unsafe actions or work practices, performed by employees, observed during the Inspection/ audit?

  Yes

  No

• Name of TFOME employee or Civil Servant Observed:

• Explain corrective action taken to mitigate the situation:

• Inspector(s)/ Auditor(s) signature:

  Sign

• Is the inspection of a "Maintenance Task" taking place?

  Yes

  No

NASA GRC Maintenance Task

• Description of Task being performed (Include Job Plan Number):

• Work Order Number:

Pre Task Planning/ JHA:

• Is a JHA required for the task?

  Yes

  No

  N/A

• Is the JHA applicable or adequate?

  Yes

  No

  N/A

• Has the JHA been reviewed by the Lead and signed by all the employees preforming the task?

  Yes

  No

  N/A

Personal Protective Equipment:

• Is any PPE required for the task?

  Yes

  No

  N/A

• Is the required and correct PPE being used by employees?

  Yes

  No

  N/A

• If the required PPE is not be used what further PPE is needed?

• Is the PPE being used in Good, Fair, or Poor condition and been inspected before use?

  Good

  Fair

  Poor

Lockout/ Tagout:

• Is Lockout/ Tagout (single or group) required for the task?

  Yes

  No

  N/A

• If multiple sources of energy have to be locked out was a GRC 787 form filled out?

  Yes

  No

  N/A

• Was Lockout/Tagout (single or group) performed correctly?

  Yes

  No

  N/A

Work Order

• Is a copy of the Work Order at the job site?

  Yes

  No

  N/A

• Does the Work Order have the correct Asset listed and is the PM tag on the equipment still readable?

  Yes

  No

  N/A

• -If not, make sure to notify the TFOME Maintenance Department.

• Does the Work Order have the correct Location listed?

  Yes

  No

  N/A

• -If not, make sure to notify the TFOME Maintenance Department.

• Does the Work Order have the correct Work Type (PM, PTI, or PGM)? <br>PM(Preventive Maintenance) = Routine maintenance done annually or more frequent.<br>PGM(Programmed Maintenance) = Routine maintenance done less frequent than annually. <br>PTI(Predictive Testing & Inspection) = Maintenance involving predictive technologies or solely inspection tasks.)

  Yes

  No

  N/A

• -If not, make sure to notify the TFOME Maintenance Department.

• Are the Job Plan instructions being followed?

  Yes

  No

  N/A

• If not, make sure any deviations are documented in the Work Log of the Work Order.

• Do the Job Plan instructions need to be updated?

  Yes

  No

  N/A

• If yes, make sure the appropriate updates are communicated to the TFOME Maintenance Department.

• Do Technicians understand why the work is being performed?

  Yes

  No

  N/A

• Do technicians have the right tools to perform the task?

  Yes

  No

  N/A

• Did this task require spare parts, grease, or other materials?

  Yes

  No

  N/A

• Are they documented on the Work Order?

  Yes

  No

  N/A

• If not, make sure the appropriate updates are communicated to the TFOME Maintenance Department.

• General Observations:

• Inspector(s) Signature:

  Sign

• Safety Observation Report (SOR):

  Yes

  No

• Observation (Hazard/ Safety Concern/ Employee Observation):

• Action(s) Taken:

• Immediate Corrective Action:

• Action to Prevent Recurrence:

• Are further Corrective Actions or H Required?

  Yes

  No

  N/A

• Actions Needed:

• Indirect or Direct Cause(s):

• Additional Comments:

• Inspector(s) Signature:

  Sign