Title Page
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Document #
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Client / Site
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Date of Inspection
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Prepared by
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Who Performed the Work
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Work Order Number
EHS
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Have hazards been identified and mitigated?
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PPE per SOW/JHA being worn and in good working condition?
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Is the work area free of slips trips and falls?
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Are barricades in place with proper signage?
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Are proper tools available for the task, being used correctly and in good working condition? (ladders, Electrical Cords, Etc.)
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LOTO requirements been identified?
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LOTO procedures implemented correctly?
Work Order Information
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Was the customer contacted before the work was started?
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Was the work scheduled and completed in the appropriate time frame?
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Are written instructions clear and understandable?
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Were all the items on the request completed correctly?
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Is the Equipment free of leaks (oil, water, gas), in an operating condition and clean?
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Was a follow up work order entered into the CMMS and referenced in the parent workorder?
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Was the appropriate time charged to the work order?
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Was the proper cost entered into the workorder
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Was the proper piece of equipment entered into the workorder
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Were all the tasks properly completed?
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Did the contractor discuss and leave a service report associated with the work performed?
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Was a PO in place before the work started?
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Contractor / Tech Name:
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Contractor / Tech Signature:
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Manager Name:
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Manager's Signature:
