AEGION E&M PLANT SITE INSPECTION FORM rev 1

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Facility Location:

• TBC Plant 2

• TBC Plant 3

• TBC ID Plant

• TBC innergard

• TBC DDJ

• TBC load outs

• TBC Yard

• TBC BWW

• Corrpro Sand Springs

• CCSI

• CRTS Tulsa

• Plant

• Supervisor

• Work description

• Subcontractors Onsite

• Subs name

General Area

• JSA complete and reviewed with workers

  Yes

  No

  N/A

• Workers instructed on site hazards and controls

  Yes

  No

  N/A

• Toolbox meeting conducted

  Yes

  No

  N/A

• Observations being conducted

  Yes

  No

  N/A

• Workers properly trained

  Yes

  No

  N/A

• Workers know Emergency Action Plan

  Yes

  No

  N/A

• Are the emergency routes posted?

  Yes

  No

  N/A

• How are responders identified?

  Yes

  No

  N/A

• Workers have Health Bridge Number

  Yes

  No

  N/A

• Are the muster points posted?

  Yes

  No

  N/A

• SDS available or accessible

  Yes

  No

  N/A

• First Aid on site, workers know location

  Yes

  No

  N/A

• Have they been recently inspected?

  Yes

  No

  N/A

• Fire Extinguisher Onsite

  Yes

  No

  N/A

• Add media

  Media

Walkways

• Walkways clear and clean

  Yes

  No

  N/A

• Exits identified and not blocked?

  Yes

  No

  N/A

• Add media

  Media

Floor Openings

• Drain grating in place

  Yes

  No

  N/A

• Temporary holes protected

  Yes

  No

  N/A

• Barriers in place for unguarded holes

  Yes

  No

  N/A

• Add media

  Media

Ladders

• All ladders in good repair

  Yes

  No

  N/A

• Ladders properly stored

  Yes

  No

  N/A

• Ladders inspected

  Yes

  No

  N/A

• Add media

  Media

Abrasive wheels

• Safety guard in place and in good repair

  Yes

  No

  N/A

• Tool rest 1/8" spacing Top guard 1/4" spacing

  Yes

  No

  N/A

• Eye protection signs in place

  Yes

  No

  N/A

• Add media

  Media

Electrical

• All extension cords inspected and tagged

  Yes

  No

  N/A

• Are extension cords being used for permanent wiring? Greater than 90 days?

  Yes

  No

  N/A

• Exposed wires

  Yes

  No

  N/A

• GFCI in use

  Yes

  No

  N/A

• LOTO equipment available

  Yes

  No

  N/A

• Are lockout devices identifiable?

  Yes

  No

  N/A

• Does the facility have a system for multiple lockouts?

  Yes

  No

  N/A

• Knockout plugs missing

  Yes

  No

  N/A

• Are there abandoned uncapped conduit?

  Yes

  No

  N/A

• Are strain reliefs in good repair?

  Yes

  No

  N/A

• Proper wiring to machines

  Yes

  No

  N/A

• Are electrical panels, junction boxes etc free from combustible dust?

  Yes

  No

  N/A

• Add media

  Media

Equipment

• Equipment inspections completed and documented

  Yes

  No

  N/A

• All guards installed

  Yes

  No

  N/A

• Secured

  Yes

  No

  N/A

• Chains, tie downs, ropes inspected

  Yes

  No

  N/A

• Have PM's been completed on all equipment

  Yes

  No

  N/A

• All rotating equipment guarded

  Yes

  No

  N/A

• Are "E" stops in place and working properly

  Yes

  No

  N/A

• Add media

  Media

Personal Protective Equipment

• Are all employees wearing required amount

  Yes

  No

  N/A

• Safety glasses / goggles Hard hat Safety toed shoes Reflective vests Gloves Aprons Personal Fall Arrest

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are they working above 6 feet?

  Yes

  No

  N/A

• Do they have fall protection?

  Yes

  No

  N/A

• Guard rails<br>Personal Fall Arrest System

  Yes

  No

  N/A

• Is it being worn correctly

  Yes

  No

  N/A

• Is it clean and in good order

  Yes

  No

  N/A

• Is it appropriate for the hazards

  Yes

  No

  N/A

• Working near navigation waterways

  Yes

  No

  N/A

• Are they wearing a Personal Floatation Device?

  Yes

  No

  N/A

• Respirators required

  Yes

  No

  N/A

• Full Face respirators Half Mask respirators 95N Respirators Dust Masks

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Have employees been medically cleared?

  Yes

  No

  N/A

• Have employees been fit tested within the last 12 months

  Yes

  No

  N/A

• Noise above 85dB

  Yes

  No

  N/A

• If above 85 db are they wearing hearing protection?

  Yes

  No

  N/A

• Add media

  Media

Hand Safety

• Are employees aware of hazards

  Yes

  No

  N/A

• How are they aware?

  Yes

  No

  N/A

• Have employees been trained in hand safety

  Yes

  No

  N/A

• The appropriate gloves available

  Yes

  No

  N/A

• Leather gloves<br>Bulldog leather gloves<br>Knit or Jersey gloves<br>Skinny dipped gloves<br>Dotted gloves<br>Kevlar Gloves<br>Kevlar Skinny dipped gloves<br>PVC or chemical resistant gloves

  Yes

  No

  N/A

• Pinch points identified on JSA

  Yes

  No

  N/A

• Have pinch points been identified in the plant (signage)?

  Yes

  No

  N/A

• During cutting activities are Kevlar gloves on non cutting hand

  Yes

  No

  N/A

• Add media

  Media

Material Handling

• Proper storage

  Yes

  No

  N/A

• Proper labeling

  Yes

  No

  N/A

• Lifts proper

  Yes

  No

  N/A

• Chemical classification posted

  Yes

  No

  N/A

• Add media

  Media

Sanitation

• Water available

  Yes

  No

  N/A

• Cleanliness meets requirements

  Yes

  No

  N/A

• Eye wash / Showers clean and inspected

  Yes

  No

  N/A

• Add media

  Media

Fall protection

• Equipment inspections completed

  Yes

  No

  N/A

• Fall plan required

  Yes

  No

  N/A

• Rescue plan verified

  Yes

  No

  N/A

• Is equipment appropriate

  Yes

  No

  N/A

• Add media

  Media

Confined Space Entry

• Permit required?

  Yes

  No

  N/A

• Permit in place and completed?

  Yes

  No

  N/A

• Gas monitor available and calibrated

  Yes

  No

  N/A

• Rescue plan in place

  Yes

  No

  N/A

• Add media

  Media

Welding & Cutting

• Proper eye protection

  Yes

  No

  N/A

• Proper gas cylinder storage

  Yes

  No

  N/A

• Hot work permit

  Yes

  No

  N/A

• Add media

  Media

Other

• Anything removed from service

  Yes

  No

  N/A

• Items requiring repair

  Yes

  No

  N/A

• Safety concerns

  Yes

  No

  N/A

• Comments

  Yes

  No

  N/A

• Add media

  Media

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign