WCA Observation - LF/TS

• Client / Site

• Conducted on

  Date

• Prepared by

• Observation Location

• Location
  Address

• Personnel

• Start Time

  Date

• End Time

  Date

• Truck Number

• Truck Type

• Weather/Lighting

  Rain/Overcast

  Sunny/Clear

Protective Equipment

• Wears Reflective Clothing (Uniform, Vest)

  Acceptable

  Not Acceptable

• Wears Gloves<br>

  Acceptable

  Not Acceptable

• Wears Hearing Protection (If applicable)<br>

  Acceptable

  Not Acceptable

• Does Not Wear Loose Clothing or Jewelry

  Acceptable

  Not Acceptable

• Wears a Hard Hat<br>

  Acceptable

  Not Acceptable

• Wears Recommended Slip-Resistant Footwear

  Acceptable

  Not Acceptable

• Wears Eye Protection (Goggles, Safety Glasses)

  Acceptable

  Not Acceptable

Landfill/Transfer Station Equipment

• Operates At Proper Speed (Conditions)<br>

  Acceptable

  Not Acceptable

• Proper Distance From Other Vehicles

  Acceptable

  Not Acceptable

• Safety Equipment (Fire Extinguisher)

  Acceptable

  Not Acceptable

• Back-Up Alarms

  Acceptable

  Not Acceptable

• Equipment Condition

  Acceptable

  Not Acceptable

Fire Prevention

• Stores Flammables in Flammable Storage Cabinet<br>

  Acceptable

  Not Acceptable

• Removes Combustible Material Prior to Welding

  Acceptable

  Not Acceptable

• Completes and Follows Hot Work Permit

  Acceptable

  Not Acceptable

Slips and Falls

• Keeps Alert for Medical Waste, Sharps, and Needles

  Acceptable

  Not Acceptable

• Uses Cab, Body, Handrails

  Acceptable

  Not Acceptable

• Watches Where Stepping

  Acceptable

  Not Acceptable

• Reports/Cleans Liquid Spills Immediately

  Acceptable

  Not Acceptable

Lockout / Tagout (LOTO)

• Does Not Remove Guards or Safety Devices without LOTO

  Acceptable

  Not Acceptable

• Uses LOTO when servicing/maintaining equipment

  Acceptable

  Not Acceptable

• Test Lockout Before Working

  Acceptable

  Not Acceptable

Near Miss Identified

• If yes, complete Near Miss Incident Reporting Form

  Yes

  No

  N/A

• Observer comments, positive and corrective

• Employee Signature

  Sign

• Date

  Date

• Site Manager Signature

  Sign

• Date

  Date