Advanced Pipeline

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Personal Protective Equipment

• Are all employees wearing F.R. (Fire Resistant) clothing?

  Safe

  At Risk

  N/A

• Are all employees wearing hard hats?

  Safe

  At Risk

  N/A

• Are all employees wearing steel toe boots?

  Safe

  At Risk

  N/A

• If working in an environment where H2S gas may be present, are all employees wearing a gas clip and have it properly placed?

  Safe

  At Risk

  N/A

• Are all employees wearing protective eye wear?

  Safe

  At Risk

  N/A

• Are gloves, ear plugs, face shields, face masks, respirators, etc., being used when appropriate?

  Safe

  At Risk

  N/A

Procedures

• Has a Job Safety Analysis (JSA) been completed and signed by all personnel?

  Safe

  At Risk

  N/A

• Are the tasks/jobs that are being observed written in the JSA with hazards and mitigation and elimination strategies noted?

  Safe

  At Risk

  N/A

• Are any permits (excavation, confined space, line finding, etc.) required? If so, have they been approved?

  Safe

  At Risk

  N/A

• Are proper procedures for tasks being followed?

  Safe

  At Risk

  N/A

Work Environment

• Is the work environment clean and orderly?

  Safe

  At Risk

  N/A

• Are walking and working surfaces free of tripping hazards?

  Safe

  At Risk

  N/A

• Are there any overhead hazards that can potentially fall?

  Safe

  At Risk

  N/A

Position of People

• Crush Points

  Safe

  At Risk

  N/A

• Falls, Slips, and Trips

  Safe

  At Risk

  N/A

• Contacting Extreme Temperatures

  Safe

  At Risk

  N/A

• Contacting Electrical Current

  Safe

  At Risk

  N/A

Focus Behaviors

• Are employees in the line of fire?

  Safe

  At Risk

  N/A

• Is the proper technique used with suspended loads?

  Safe

  At Risk

  N/A

• Are employees using proper harnesses and lanyards as well as 100% tie offs when utilizing aerial platforms?

  Safe

  At Risk

  N/A

• Are forklift, aerial platform, backhoe, and other heavy machinery operators working safely in all work areas (using back-up alarms, spotters, taglines, appropriate straps and chokers, etc.)

  Safe

  At Risk

  N/A

• Is any excavation being performed and has line finding been performed with proper documentation?

  Safe

  At Risk

  N/A

• Are employees using proper lifting techniques?

  Safe

  At Risk

  N/A

• Are hands and fingers in the proper position?

  Safe

  At Risk

  N/A

Tools and Equipment

• Employees using the right tools for the job?

  Safe

  At Risk

  N/A

• Employees using tools correctly?

  Safe

  At Risk

  N/A

• Are tools in safe condition?

  Safe

  At Risk

  N/A

• Are barricades, fencing, and other forms of warning used when appropriate?

  Safe

  At Risk

  N/A

• Are hand and power tool guards and handles in place and are cords in safe operating conditions?

  Safe

  At Risk

  N/A

• Are forklift, aerial platform, and backhoe operators certified?

  Safe

  At Risk

  N/A

• Are there any electrical hazards or concerns?

  Safe

  At Risk

  N/A

• If necessary, is there a fire extinguisher available and has it been inspected?

  Yes

  No

  N/A