Title Page
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Unit/Area
- COKER
- FCC
- B/H
- SRU I
- SRU II
- TGTU
- WTP
- AWWT
- NLIU CRUDE
- NLIU VAC
- NLIU SGP
- SLIU ISO
- SLIU U/F
- SLIU C3
- SLIU KHT
- AROM ISOM
- AROM DHT
- AROM TETRA
- AROM OFFSITES
- R/O WATER REUSE
- COF SULFUR BLOCK
- OM&S
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Date/Time
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Prepared by
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Company
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Prepared by
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Company
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Prepared by
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Company
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Prepared by
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Company
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Location
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FALL PROTECTION
- YES
- N/A
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All fall protection in the system being worn and used properly?
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100% fall protection for all workers when 6' or higher including aerial lifts?
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Rebar- protected and reinforced steel rebar caps?
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Perimeter guardrails in place (38-42 & mid way for mid-rail)?
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Equipment Inspection Color Code current? (PURPLE)
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Anchor point for fall arrest system adequate?
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MOBILE EQUIPMENT & VEHICLES
- YES
- N/A
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Daily inspection logs/tag on crane or aerial lifts and updated for the current date?
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Are trained spotters being utilized?
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Annual inspection sticker on lifts?
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Audible alarms working? (back-up)
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Qualified operators? (verify training)
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Wheels chocked when required ?
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Load limits observed?
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Driver/operator visual obstructions?
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Load secured?
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Critical lift paperwork completed? Pre-lift meeting held?
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SCAFFOLDS
- YES
- N/A
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Competent person identified on tag?
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Tag updated if used for current shift?
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Scaffold grade planks used?
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Wood is not used near hot processes?
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Planks have minimum 12" overlap or are fastened down?
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No more than 1" between planks?
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Top rail, mid-rail and toe board in place or noted on tag?
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Screw jacks have baseplates and mudsills or casters for mobile scaffolds?
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Baseplates nailed to mudsills?
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Platforms over 10' have falling object protection?
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Builders or users are tied-off to components with pelican hooks in vertical position unless they are steel?
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Builders or users are only tied off to complete rails? (corner to corner)
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Access ladders extend 3' above deck?
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SRL used if platform height to next lower level is 20 ' or more (ladder cage is allowed between 20'-30')?
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EXCAVATIONS
- YES
- N/A
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Adjacent structures protected and supported?
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All materials and equipment are > 2' from edge of excavation?
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Rescue plan known?
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CRANES/HOISTING/RIGGING
- YES
- N/A
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Swing radius barricaded or equivalent?
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HOT WORK/WELDING/CUTTING
- YES
- N/A
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Only tools allowed on the Safe Work Permit are being utilized in the field?
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PERSONAL PROTECTIVE EQUIPMENT (PPE)
- YES
- N/A
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Hard hat is being worn at all times and is being worn properly? ( facing forward, suspension in place)
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Does PPE in the field match the Safe Work or Confined Space Permit?
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FIRE PROTECTION & PREVENTION
- YES
- N/A
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Re-fueling in open areas only and equipment is not running while being re-fueled?
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ELECTRICAL
- YES
- N/A
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Electrical Verification locks are in place on the Breakers and LOTO station?
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Are the correct type of Power cords being used? (no outlet type boxes)
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WALKING/WORKING SURFACES & LADDERS
- YES
- N/A
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A-Frame ladders are fully open when being used?
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Extension ladders, job-made ladders and fixed ladders extend 3 ft. above top access?
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Fixed ladders are protected by swing gates, guillotine bars or chain and are fixed in the closed position?
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Are stairs, ramps and ladders clear of debris and materials on rungs, side rails and access points?
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Are floor openings protected by either hard barricades or floor covering that is secured and marked "HOLE"?
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PERMITTING SYSTEMS
- YES
- N/A
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Attendant can verify how to how and who to contact in the event of an emergency?
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Attendant OR Workers identify nearest safety shower/eyewash?
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Was the First Entry JSA completed prior to the first entry?
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Was the First Entry JSA completed prior to the first entry?
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HOUSEKEEPING
- YES
- N/A
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Waste is being disposed of regularly and daily clean-up of site is being completed?
- Yes
- No
- N/A
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Are unit boundary chains secured and have signage attached to prevent unauthorized access?
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EMERGENCY PROCEDURES
- YES
- N/A
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Do workers know how and where to shelter-in-place?
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Do workers know who to contact for an SDS?
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BARRICADES & SIGNS
- YES
- N/A
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All elevated work platform including: vessel decks, scaffold platforms and mechanical lifts have snow fence, fire blanket or similar materials secured to railings to protect from dropped objects?
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HAND & POWER TOOLS
- YES
- N/A
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Do grinders have a handle, guards and either a dead man switch or interlock?
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Are tools unplugged and stored away when not in use?
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OTHER
- YES
- N/A
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DEFICIENCY NOT NOTED ELSEWHERE
- DEFICIENCY
- N/A
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Description:
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DEFICIENCY NOT NOTED ELSEWHERE
- DEFICIENCY
- N/A
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Description:
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DEFICIENCY NOT NOTED ELSEWHERE
- DEFICIENCY
- N/A
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Description: