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Competency Verification/Job Task Observation
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Date/Time Observation Conducted
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Location (Physical Location of the Observation)
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Name of Individual Observed
*
*
Observed Individual Employee ID
*
Business Segment
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Post-Incident
Post-Incident
No
Post-Incident
Yes
Observation Type
*
Attended
At a Distance
Competency Verification
Virtual
Operations Observed
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Operations Observed
Confined Space Entry
Identify the roles and responsibilities for the confined space participants
Follows Standard
Intervention Needed
Entrant confirmed meter is bump tested, calibrated within the past 30 Days and functioning properly
Follows Standard
Intervention Needed
Demonstrate how to Zero the monitor and bump test before use
Follows Standard
Intervention Needed
Identify the required air monitoring readings to conduct a confined space entry
Follows Standard
Intervention Needed
Identify requirements for different types of rescue
Follows Standard
Intervention Needed
Safety and rescue equipment visually inspected to assure in working condition
Follows Standard
Intervention Needed
Permits/hazard assessments completed and posted
Follows Standard
Intervention Needed
Atmospheric testing completed at a minimum of 2 hr intervals
Follows Standard
Intervention Needed
Confined Entry Log completed per policy
Follows Standard
Intervention Needed
Confined Space Entry Observation - Deviation from Standard and Action Taken
*
Trailer LockOut/Tag Out (LOTO)
Keys locked in hasp
Follows Standard
Intervention Needed
Trailer locked per policy and secured against unauthorized movement
Follows Standard
Intervention Needed
Unit positioned per site requirements with brakes applied and wheel chocks in place
Follows Standard
Intervention Needed
Trailer LockOut/Tag Out (LOTO) - Deviation from Standard and Action Taken
*
Shunt Truck Operation
Employee wearing seatbelt
Follows Standard
Intervention Needed
DVIR being completed for every day of operation
Follows Standard
Intervention Needed
Driver using GOAL procedure in slow speed maneuvering
Follows Standard
Intervention Needed
Driver using Cones when backing
Follows Standard
Intervention Needed
Yard speed limit being followed-adjusting speed for yard congestion
Follows Standard
Intervention Needed
Uses three points of contact entering and exiting vehicle
Follows Standard
Intervention Needed
Shunt Truck Operation - Deviation from Standard and Action Taken
*
Forklift/Mobile Equipment
Employee wearing seatbelt
Follows Standard
Intervention Needed
Forklift Inspection being completed/documented for every day of operation
Follows Standard
Intervention Needed
Forks lowered to a few inches from floor when moving without a load
Follows Standard
Intervention Needed
Parked forklift has forks flat on floor, controls set to neutral, parking brake set
Follows Standard
Intervention Needed
Operator Uses three points of contact entering and getting out of vehicle
Follows Standard
Intervention Needed
DVIR is completed up to the level required
Follows Standard
Intervention Needed
Forklift/Mobile Equipment Operation - Deviation from Standard and Action Taken
*
Fall Protection
Employee wearing approved harness
Follows Standard
Intervention Needed
Harness is properly adjusted (tested by having fit two fingers between harness and leg)
Follows Standard
Intervention Needed
Harness has no indication of cut webbing, bent connectors or stress marks
Follows Standard
Intervention Needed
Harness inspected before each use
Follows Standard
Intervention Needed
D-ring location in proper location in the middle of back between shoulder blades
Follows Standard
Intervention Needed
100% tie-off
Follows Standard
Intervention Needed
Fall Protection - Deviation from Standard and Action Taken
*
Flare Stack
Flare Stack Permit completed per Policy. Reading documented on the permit
Follows Standard
Intervention Needed
Unit #
*
Was the local fire department contacted
Follows Standard
Intervention Needed
Are the hoses hooked up in the proper sequence
Follows Standard
Intervention Needed
Is the fire extinguisher in place and charged
Follows Standard
Intervention Needed
Is the Flame adjusted satisfactory
Follows Standard
Intervention Needed
Flare Stack - Deviation from Standard and Action Taken
*
Trailer Hot Work
Unit #
*
Hot work permit completed per policy, readings documented on permit
Follows Standard
Intervention Needed
Trailer is confirmed empty and “Last Contained” document is available
Follows Standard
Intervention Needed
Trailer tested to ensure LEL is 10% or below
Follows Standard
Intervention Needed
Identification tags (Green/Yellow/Red) are in place
Follows Standard
Intervention Needed
“Live unit” warning light activated appropriately if necessary
Follows Standard
Intervention Needed
Work instructions given to employee, either a RO, DVIR, repairs for PM Sheet
Follows Standard
Intervention Needed
Does the employee fully understand what work is allowed for the applied TAG
Follows Standard
Intervention Needed
Observer verified unit was properly tested and identified properly as per the Hot Work Procedure, and signed the Hot work tag
Follows Standard
Intervention Needed
Trailer Hot Work - Deviation from Standard and Action Taken
*
Tools and Equipment
Tools and equipment used appear to be in safe operating condition
Follows Standard
Intervention Needed
Tools are used appropriately for the job
Follows Standard
Intervention Needed
Required guards in place
Follows Standard
Intervention Needed
Operator is trained to use the equipment, and understands it’s safe operation
Follows Standard
Intervention Needed
Tools and Equipment - Deviation from Standard and Action Taken
*
Personal Injury
Maintains neat, clean, and organized work area
Follows Standard
Intervention Needed
Maintains clear walk path – floors clear of tools, cords, hoses, and other trip hazards
Follows Standard
Intervention Needed
Proper lifting techniques (lifts with legs, bends at the knees not the waist)
Follows Standard
Intervention Needed
Keeps objects in the Power Zone; minimizes end range motion
Follows Standard
Intervention Needed
Personal Injury - Deviation from Standard and Action Taken
*
Contractors/Visitors
Contractors/Visitors have signed in and completed the required hazard assessment
Follows Standard
Intervention Needed
Contractors/Visitors are wearing required PPE
Follows Standard
Intervention Needed
Contractors/Visitors - Deviation from Standard and Action Taken
*
Body Maneuvers
Employee uses proper lifting techniques, bends at knees-lifts with legs
Follows Standard
Intervention Needed
Employee uses the proper tool, or seeks help with heavy objects
Follows Standard
Intervention Needed
Body Maneuvers - Deviation from Standard and Action Taken
*
Three Points of Contact
Observed Individual uses 2 hands and one foot,faces towards the grip points while ascending or descending with nothing in their hands.
Follows Standard
Intervention Needed
Three Points of Contact - Deviation from Standard and Action Taken
*
Safety Footwear
Safety Shoes have a hard sole, reinforced toe, are over the ankle and are fully laced and in good condition.
Follows Standard
Intervention Needed
Safety Footwear - Deviation from Standard and Action Taken
*
Safety Eyewear
Observed Individual wears safety glasses in the shop.
Follows Standard
Intervention Needed
Safety Eyewear - Deviation from Standard and Action Taken
*
Wheel Inspection
Does the unit have an axle stand on each elevated axle?
Follows Standard
Intervention Needed
Do the tires have the proper tread and depth for application
6/32 of an inch on steer tires, 5/32 of an inch on wide-based tires and 4/32 of an inch on drives and trailer tires
Follows Standard
Intervention Needed
Do the tires match up within the 1/4" max height variance as well as the tread variance (no more than 4/32” of an inch)?
Follows Standard
Intervention Needed
Does tech clean all wheel & nut mating surfaces?
Follows Standard
Intervention Needed
Does the technician use the oil can to apply the required one drop of SAE30 oil on the last 2-3 threads of the stud and between the nut and flange of the nuts?
Follows Standard
Intervention Needed
Does the technician use the mandatory 350ft/lb. torque stick for initial install and follow the proper tightening sequence?
See Standard Work Instruction for proper sequence
Follows Standard
Intervention Needed
Did the wheel nuts move when using the certified torque wrench for final torque
The difference between the 350ft/lbs. with the torque stick and the 500ft/lbs. on the torque wrench?
Follows Standard
Intervention Needed
Did the technician fill in the DVIR for tire install, identifying the wheel position that was worked on and initialing the document?
Follows Standard
Intervention Needed
Wheel Inspection - Deviation from Standard and Action Taken
*
Wheel Inspection with Wheel Master
Does the unit have an axle stand on each elevated axle?
Follows Standard
Intervention Needed
Do the tires match up within the 1/4" max height variance as well as the tread variance (no more than 4/32” of an inch)?
Follows Standard
Intervention Needed
Does tech clean all wheel & nut mating surfaces?
This should include, drum to rim flange, rim to rim flanges on dual wheels, and the rim flange to nut flange
Follows Standard
Intervention Needed
Does the technician use the oil can to apply the required one drop of SAE30 oil on the last 2-3 threads of the stud and between the nut and flange of the nuts?
Follows Standard
Intervention Needed
Does the technician verify the air pressure on the Wheel Master tool is adjusted properly for the 500ft/lb torque
See Standard Work Instruction for proper sequence
Follows Standard
Intervention Needed
Does the technician follow the Wheel Master use as instructed in the SWI guide
Follows Standard
Intervention Needed
Did the technician fill in the DVIR for tire install, identifying the wheel position that was worked on and initialing the document?
Follows Standard
Intervention Needed
Wheel Inspection with Wheel Master - Deviation from Standard and Action Taken
*
Yard Movement
Observed Individual is wearing all the proper PPE required by the yard policy, or by NTS work procedures.
Follows Standard
Intervention Needed
Shunt truck drivers operate under the posted yard speed limit.
Follows Standard
Intervention Needed
Yard Movement - Deviation from Standard and Action Taken
*
MBWA
Offices - Scan the area for cleanliness and safety - is the room organized and clear of debris?
Follows Standard
Intervention Needed
Parts Room - Scan the area for cleanliness and safety, is the room organized and clear of debris, are all parts put away that need to be?
Follows Standard
Intervention Needed
Shop Tools - Are all shop tools put back where they need to be? Does all shelving units look as they should?
Follows Standard
Intervention Needed
Exterior of building - Is the exterior of the building clear of debris and clutter, are all man doors and bay doors clear of debris?
Follows Standard
Intervention Needed
Shop Bays - As you walk through the bays, is work in the bay going well? If not determine if help is needed and act on it.
Follows Standard
Intervention Needed
Shop Bays - Scan the area for cleanliness, organization and safety. (When the job is done, is clean up including disposal of parts occurring?
Follows Standard
Intervention Needed
Are there any parts, consumables or shop supplies laying around that need to be put away?
Follows Standard
Intervention Needed
Is the shop floor in good condition? No fluid spills, floors swept? Benches are clean and tidy?
Follows Standard
Intervention Needed
Is all tooling and equipment in good working order? If not remove from service immediately and have fixed or replaced
Follows Standard
Intervention Needed
MBWA - Deviation from Standard and Action Taken
*
Wash Procedures
Prewash inspection (last contained and hazards identification)
Follows Standard
Intervention Needed
Safe opening of a tanker and heel verification
Follows Standard
Intervention Needed
Follow each step of the appropriate wash procedure
Follows Standard
Intervention Needed
Parts assembly and final inspection / PREP
Follows Standard
Intervention Needed
Wash Procedures - Deviation from Standard and Action Taken
*
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Satisfaction Rating
Level 1 - Satisfactory Observation
Level 2 - Monitoring Required
Level 3 - Immediate Action Required
Observed Individuals Response to Observation
*
Open To Coaching
Not Receptive to Comments
Observed Individual Unavailable
Comments/Training Instructions Given
*
Observed Employee/IC Commitments
*
A copy of this Job Task Observation will be automatically forwarded to the region safety manager.
Name of Observer
*
Observer Email Address
*
*
*
Branch Manager Email Address
*
*
*
Email address of Individual being observed
*
*
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