Information
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Document No.
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Conducted on
Safety
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Department:
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Are there any safety COILS or CI's?
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If so, are they expired?
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Are the employees in the department trained on task and work procedures?
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Did this action create a CI or COIL?
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Are the employees wearing the proper PPE?
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Did this action create a CI or COIL?
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Are all tools safe, no frayed chords, no cracks, free from damage and debris?
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Include pic of risk
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Did this action create a CI or COIL?
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All items stored in a manner to protect from damage and dirt?
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Include pic of risk
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Did this item create a CI or COIL?
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Are 2MD's (2 minute drills) completed and displayed in work spaces?
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Include pic of risk
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Did this item create a CI or COIL?
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Is there a visible effort to maintain safety and quality in the department?
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Include pic of risk
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Did this item create a CI or COIL
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Is 6S, housekeeping, organization, and cleanliness being maintained? (Working on level surfaces, free of trip and slip hazards, hazard signs visible)
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Include pic of risk
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Did this item create a CI or COIL
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Are all equipment guards in place and in the proper specification for standard?
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Include pic of risk
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Did this item create a CI or COIL
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Why?
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Signature:
Quality
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Are all parts identified with job number and inspection status?
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Take pic if needed
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Did this item create a CI or COIL?
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Are there any expired items, out-of-calibration or test equipment out of specification?
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Take pic if needed
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Did this item create a CI or COIL?
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Are there work instructions/checklist available where work is being performed?
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Did this item create a CI or COIL
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Are work plans being followed and signed?
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Did this item create a CI or COIL?
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Are records being retained and archived away from damage and debris?
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Take pic if needed
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Did this item create a CI or COIL
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Is rework, NCR and CARS being documented and discussed at UCE boards?
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Did this item create a COIL?
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Why?
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Signature: