Information
-
Audit Title
-
Document No.
-
Site Location of Task/Activity
-
Task/Activity Observed
-
Conducted on
-
Prepared by
-
Personnel
Pre-Start Observations
-
Has a Pre-Task Plan (JHA) been completed before the task?
-
Has all work procedures and hazard control measures been reviewed and understood by all employees prior to the task/activity?
-
Has stretch and flex exercises been performed by all employees prior to starting task?
-
Has all restricted work areas and exclusion zones been erected, including signage?
Personal Protective Equiment
-
Are hardhats, safety glasses and hi-visibility vest being worn by all employees (mandatory)?
-
Are hands protected when working with tools, sharp objects, chemicals, hot or cold items?
-
Is appropriate footwear being worn?
-
Is hearing protection being used in high noise areas?
-
Is respiratory protection needed and being used when vapors, dusts, etc., are present?
-
Is fall protection available and being used properly when needed?
Employees Body Position
-
Are employees using proper lifting and twisting techniques?
-
Are employees protected from the "Line of Fire"? Caught-in, Struck-by, Energy Release
-
Are employees keeping their hands out of the danger zone?
-
Are employees staying focused...Eyes on Path (slips, trips and falls)?
-
Are employees properly ascending/descending ladders (free of trip hazards)?
Tools & Equipment
-
Has an inspection been conducted on all tools, equipment, extension cords, etc., prior to the task/activity?
-
Are employees using the correct tools for the task/activity?
-
Are the tools being used in good condition (guards, cords, handles, etc.)?
-
Is a GFCI being used with electrical tools?
-
Are flammable materials removed from the area when using electrical tools?
Housekeeping
-
Are walking and working surfaces free of debris and tripping hazards?
-
Is the work area neat, clean and free of obstructions?
-
Are flammables and combustibles stored properly?
-
Are work areas free of impalement hazards?
Working at Heights
-
Is fall prevention (guardrails) or personal fall arrest systems (harness/SRL) in place and being used properly?
-
Are ladders being used in a safe manner and appropriate for the task?
-
When aerial lifts are being used, are employees using PFAS and tying off?
Excavations
-
Has a trench log been completed prior to the task?
-
Are all excavations greater than 5 feet properly sloped, shored benched?
-
Are ladders placed every 25 feet of lateral movement and do they extend 3 feet above lower landing?
-
Are spoil piles a minimum of 2 feet away from excavation wall?
-
Are employees working in a trench that has water accumulating (ground water or surface water)?
Heavy Equipment / Vehicles
-
Has an pre-trip inspection been conducted on all heavy equipment prior to commencing the job?
-
Does the equipment operator drive the equipment at a safe speed?
-
Does the equipment operator park the equipment in a safe location and lower all attachments before exiting equipment?
-
Does the equipment operator look back prior to backing equipment up?
-
Does the equipment operator use 3 points of contact when entering/exiting equipment?
-
Does the equipment operator use the horn before entering a blind intersection or before moving in any direction?
-
Does the driver park the vehicle in a safe location?
-
Does the driver use the 5 keys of Smith System driving (aim high, get the big picture, keep your eyes moving, leave yourself an out and make sure they see you)?
Comments
-
Safe Acts observed within the task. What were the safe act/acts observed?
-
Unsafe Acts observed within the task. What were the unsafe act/acts observed?
-
Discussion Points/Agreed Corrective Measures
Signatures
-
Observers Signature
-
Team Member Signature
-
Team Member Signature
-
Team Member Signature
-
Team Member Signature
-
Team Member Signature
