Waller 070 Safety Observation Checklist

• Shop/Department

• Document No.

• Supervisor

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Was daily safety check completed?

• Is a Task Hazard Assessment form present?

  Yes

  No

  N/A

• Has the THA been reviewed by the supervisor/leadman?

  Yes

  No

  N/A

• Does the THA provide a brief discription of the job?

  Yes

  No

  N/A

• Are before and after risk evaluations in accordance with the Pre Job Hazard Registry? (Note: they do not need to match if the author can explain why they choose a diffrent risk number)

  Yes

  No

  N/A

• THA are to be filled in each day for each job at hand. Items looked for if working in a group has the group agreed and signed the THA on the back left side? Any visitor to the work site/cell must sign the back right side agreeing to the authors precautions.

  Yes

  No

  N/A

• Comments on THA's:

Housekeeping

• Aisles/Walkways kept clear?

  Safe

  At Risk

  N/A

• Work area kept organized?

  Safe

  At Risk

  N/A

• Housekeeping: spills, cords or other trips, trash/clutter, lighting, or Flammables

Personal Protective Equipment

• All appropriate equipment or gear worn correctly?

  Safe

  At Risk

  N/A

• PPE kept in good condition?

  Safe

  At Risk

  N/A

• Personal protective equipment: hand, body, eyes/face, head, foot, respiratory, fall protection, hearing protection, or FR clothing/gear

Working Position

• Body position

  Safe

  At Risk

  N/A

• Location in working environment

  Safe

  At Risk

  N/A

• Working Position: poor posture, over stretched, above shoulder, below knees, twisting, caught in between, struck by, working at heights greater than 4', floor or wall opening, unprotected work edge, or false ceiling or floor.

Tools and Equipment

• Appropriate tools or equipment being used?

  Safe

  At Risk

  N/A

• Tools or equipment being used correctly?

  Safe

  At Risk

  N/A

• Tools or equipment in good condition?

  Safe

  At Risk

  N/A

• Tools and equipment: ladders, power or hand tools

Safe behaviors observed-actions taken to encourage safe behavior

Unsafe behaviors observed-action taken to correct and prevent recurrence

Line of fire. Is the worker in the line of fire?

• Grinding or drilling operations creating flying objects or particles - goggles/face-shield. Heavy equipment movement in the area - operator aware of pedestrian? Around rigging operations - hand in pinch point not under equipment? Working in front of live electrical panel - NFPA70E PPE

Safety procedures

• Lock-out/Tag-out, Arc Flash, Hot Work Permit, Confined Space

  Safe

  At Risk

  N/A

• Add media

  Media

• Auditor signature

  Sign