AGI Pipe Fitters Safety and Compliance Audit

• Prepared By

• Conducted on

  Date
• Location
  Address

• Personnel

  Select

1. General Site Safety

• 1.1. Appropriate Work Zone Set-Up? (Cones, Lights when needed)

  Safe

  At Risk

  N/A

• 1.2. Appropriate PPE Donned? (Hardhat, Safety Vest, Safety Glasses, Gloves, FR shirt)

  Safe

  At Risk

  N/A

• 1.3. Are First Aid, Burn Kit and Fire Extinguisher accessible?

  Safe

  At Risk

  N/A

• 1.4. Are all COVID 19 procedures Followed? (HASP A-116 onsite, also mask, rubber gloves and hand sanitizer available)

  Safe

  At Risk

  N/A

• 1.5. Are NGrid ID Badge and QR card visible? (NGrid ID worn on neck lanyard, QR card on person)

  Safe

  At Risk

  N/A

• 1.6. Are Worksite Slips, Trips and Fall hazards addressed?

  Safe

  At Risk

  N/A

• 1.7. Is the vehicle Back-Up alarm operational?

  Safe

  At Risk

  N/A

• 1.8. Is CGI calibrated for current month?

  Safe

  At Risk

  N/A

• 1.9. Are Tools Clean and Serviceable? (no broken tools or missing parts)

  Safe

  At Risk

  N/A

• 1.10. Is Volt Stick in Working Order?

  Safe

  At Risk

  N/A

2. Compliance

• 2.1. Access to Standards and O & M Procedures?

  Safe

  At Risk

  N/A

2.2. Is Gas Regulator Vent terminus:

• a. Installed to correct minimum clearances with screen installed? (at least 18" above ground)

  Safe

  At Risk

  N/A

• b. 18" horizontally from any openings? (windows, doors or vents)

  Safe

  At Risk

  N/A

• c. 12" horizontally from any electric meters?

  Safe

  At Risk

  N/A

• d. 10' from any mechanical air intakes?

  Safe

  At Risk

  N/A

• 2.3. Has Gas Meter Header been kept plumb and square with minimum clearance of 6" to the bottom of the meter?

  Safe

  At Risk

  N/A

• 2.4. Is the Vent Pipe Supported? (36" or more in Length only)

  Safe

  At Risk

  N/A

• 2.5. Is Multiple Meter header been properly secured to the building?

  Safe

  At Risk

  N/A

• 2.6. Are all Gauges in working order? (U Gauge or Manometer filled to proper specifications)

  Safe

  At Risk

  N/A

• 2.7. Was DNR, CGI, Dial Test and Soap used or performed?

  Safe

  At Risk

  N/A

• 2.8. Are all POE (points of entry) Sealed?

  Safe

  At Risk

  N/A

• 2.9. Is all piping corrosion free and painted properly?

  Safe

  At Risk

  N/A

• 2.10. Was a paint shield used while painting in close proximity to other objects or dwelling?

  Safe

  At Risk

  N/A

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• House Keeping, has site been cleared of any work related debris

  Yes

  No

  N/A

Sign Off

• On site representative