SAFETY OBSERVATION

Date:*

Observer:*

Worksite:*

Crew Members Observed:*

1.0 Chemical Control

1.1 Did the employee(s) demonstrate knowledge of chemical control standards?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

1.2 Did the employee(s) have access to SDS and Specimen labels of all chemicals on worksite?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

2.0 Emergency Action Plan (EAP)

2.1 Did the employee(s) have action plan for emergency situations? (911 address, location of nearest hospital, first aid kit & fire extinguisher locations)*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

3.0 Job Hazard Analysis (JHA)

3.1 Did employee(s) demonstrate & document understanding of the work scope, work sequence & assigned job task responsibility?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

3.2 Did the employee(s) demonstrate knowledge of hazards associated with the work to be performed including critical tasks?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

3.3 Did the employee(s) understand and utilize the elimination strategy, mitigate risks and take special precautions?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

3.4 Did the employee(s) demonstrate a questioning attitude to clear up any vague or interpretive guidance?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

3.5 Did the employee(s) demonstrate knowledge of when to call a STOP process?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

3.6 If additional specific JHA's or amendments were needed, did employee(s) use accordingly?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

3.7 Was the JHA effectively communicated and understood?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

3.8 Was the JHA specific to the work site and conditions?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.0 Personnel

4.1 Are all Power Safety requirements met and current?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.2 Are crew members maintaining clear and effective communication throughout the job (clear understanding of verbal & hand signals)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.3 Did employee(s) attempt to accommodate concerns and respect for property owner(s) while still performing work to expected standards (personal or physical thres require immediate stop of work, departure from work site and reported)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.4 Did the employee(s) demonstrate proper body positioning and mitigate ergonomic risks?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.5 Did the employee(s) have a plan to mitigate environmental conditions (heat, cold, rainy, etc.), including hydration and rest schedules?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.6 Was the employee designated to observe the work qualified and familiar with the work to be performed?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.7 Was the employee performing the task qualified to perform the task or being coached by a qualified person?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.8 Was there sufficient manpower to do the job properly (Traffic control, debris cleanup)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

4.9 Were interactions between employee(s) and property owner(s) positive (including ruts, debris clean-up, fences or gates)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

5.0 Planning

5.1 Did each employee have a clear Pre-Job assignment and direction for the work to be performed safely and effectively (including a Post-Job review & documentation)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

5.2 Did employees position equipment for safe departure of jobsite?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

5.3 Did employees use best access path to jobsite?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

5.4 Did employees use the most appropriate equipment for the work to be performed?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

5.5 If felling trees, where the requirements of the tree felling best practices met?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

6.0 Tools & Equipment

6.1 Are employees familiar with/complying with manufacturer safety rules regarding equipment use? (keeping safe distance from running equipment, proper tie-down or safe security of materials for supplies, etc.)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

6.2 Did employee(s) properly use approved, unmodified tools that are in good working condition (including saw, blade & sharp tool covers)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

6.3 Did employees utilize required PPE and IPE (footwear, Eye and hearing protection, Hardhat, etc.)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

6.4 Did the employee(s) utilize appropriate fall protection for the work being performed and have a rescue plan in place (including knowledge of physical stress & kinetic energy)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

6.5 Do the employees know if their safety/medical equipment (First aid kits, fire extinguisher, and expiration dates of materials or supplies) meet requirements?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

6.6 Were the employee(s) properly equipped to complete the work to be performed?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

7.0 Human Performance

7.1 Did the employees demonstrate knowledge of HU Tools? (Ex: self checks, peer checks, stop/timeouts)*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

7.2 Did the employees demonstrate knowledge of HU Traps? (Ex: drowsiness, distractions,over-confidence, time pressure, vague and imprecise guidance, inexperience, complacency, etc.)*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

8.0 Worksite Safety

8.1 Did employed(s) notify appropriate controlling authorities for work site (TCC, DOC, VEG OC, CIP, Substation safety monitoring, Nuclear facility security, public controlled access site security, etc.)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

8.2 Did employee(s) review JHA and specific worksite hazards with all personnel prior to entering worksite?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

8.3 Did the employee(s) identify and mitigate/take special precautions against line of fire, pinch point risk (including insect & animals)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

8.4 Has the worksite been set up to ensure the safety of all crew members and and public. (Barricades, traffic vest, cones, flagman, housekeeping, drop zone & weather threats)?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

8.5 Is crew maintaining minimum safe distance from all T&D conductors and down-guys?*

SAFEAT RISKN/A

Observation for the above "AT RISK" selection.*

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