AltaGas Pipeline Inspection

• Client

• Project name:

• Conducted on

  Date

• Prepared by

• Location
  Address

Documentation / Work Planning

• Hazard Assessment <br>Properly completed and reviewed by workers

  Yes

  No

  N/A

• Buried facility locates <br>Completed and valid

  Yes

  No

  N/A

• A clear work plan review

  Yes

  No

  N/A

• Procedures reviewed?

  Yes

  No

  N/A

• All permits received and on site

  Yes

  No

  N/A

• Notification completed: Land owner, pipeline

  Yes

  No

  N/A
Construction Package

• Work package complete?<br>Land work, approvals, crossing agreements, site walk throughs.

  Yes

  No

  N/A

• Drawing details and notes reviewed?<br>Drawing notes acurate compared to land work ?

  Yes

  No

  N/A

• Site Walk through completed

  Yes

  No

  N/A

• Comments

PPE and Emergency Response

• Safety footwear

  Yes

  No

  N/A

• F.R. Coveralls

  Yes

  No

  N/A

• Hard hat

  Yes

  No

  N/A

• Hand protection

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Condition of PPE

  Yes

  No

  N/A

• Fire extinguisher <br>Available / certified<br>NFPA-10 section 6.3

  Yes

  No

  N/A

• MSDS & WHMIS Labels?

  Yes

  No

  N/A

• Spill Response Kit<br>Response kit complete?

  Yes

  No

  N/A

• First-Aid Kit and blankets as required?

  Yes

  No

  N/A

• Personal monitors: bump tested

  Yes

  No

  N/A

• Emergency Response Plan

  Yes

  No

  N/A

• Add media

  Media

• Comments

• Construction signage

Construction signs

• Proper sign placement<br>Traffic accommodation in work zones

  Yes

  No

  N/A

• Traffic cones and or barricades utilized?

  Yes

  No

  N/A

• Traffic control person certified?

  Yes

  No

  N/A

• Traffic control is effective for site

  Yes

  No

  N/A

• Power Lines Marked with Goal Post and Signs

  Yes

  No

  N/A

• Add media

  Media

• Comments

• Compliance with BC OHS Regulations (part 20: Excavations)

Excavation

• Facilities exposed prior to excavation

  Yes

  No

  N/A

• Spotter and fire extinguisher around live lines

  Yes

  No

  N/A

• Pipeline right of way<br>Controlled zone 30 M<br>Exposed prior - 5 M

  Yes

  No

  N/A

• Personal monitors required?<br>Bump tested? Calibrated?

  Yes

  No

  N/A

• Shoring / sloping <br>As per BC OHS Regulations Part 20

  Yes

  No

  N/A

• Safe entry and exits for workers?

  Yes

  No

  N/A

• Spoil pile at correct distance from the edge of excavation

  Yes

  No

  N/A

• Traffic and pedestrians protected from excavation hazards

  Yes

  No

  N/A

• Proper depth achieved?

  Yes

  No

  N/A

• Soil separation completed?<br>

  Yes

  No

  N/A

• No equipment or materials stored at edge of excavation

  Yes

  No

  N/A

• Excavations left open are inspected prior to entry?

  Yes

  No

  N/A

• Add media

  Media

• Comments

• Directional drilling

Directional drilling

• Buried facilities exposed prior?

  Yes

  No

  N/A

• Crossing buried facilities at sight hole?

  Yes

  No

  N/A

• Adequate size reamer?<br>The pilot hole is to be reamed 1.5 times larger than the largest outside diameter (OD) of the pipe installed.

  Yes

  No

  N/A

• Required depth achieved?

  Yes

  No

  N/A

• Pipe free of damage after bore complete?

  Yes

  No

  N/A

• Add media

  Media

• Comments

• Cranes, hoists and lifting devices.

Lift

• Operator certification valid?

  Yes

  No

  N/A

• Set up on firm level ground

  Yes

  No

  N/A

• Log book for crane reviewed and new lift entered.

  Yes

  No

  N/A

• Lifting cables, slings, chains rated, tagged and inspected?<br>ASME B30.9<br>Chapter 11 sub 11.2.4

  Yes

  No

  N/A

• No loads suspended over workers, tag lines in use

  Yes

  No

  N/A

• Waterbody crossing

Creek crossing

• Plan of work reviewed,understood and signed?

  Yes

  No

  N/A

• Spill kit on site? Size and materials appropriate for the job?

  Yes

  No

  N/A

• Pictures taken as per plan of work?

  Yes

  No

  N/A

• Water samples taken as per the plan of work

  Yes

  No

  N/A

• Proper set back from the banks?

  Yes

  No

  N/A

• Creek monitored for frac out?

  Yes

  No

  N/A

• Add media

  Media

• Comments

Hydro Excavation

• Water pressure: max 2000psi(13790 Kpa)<br>Water temp: max 180 F ( 82 C)

  Yes

  No

  N/A

• PPE Utilized<br>

  Yes

  No

  N/A

• Continuous wand motion

  Yes

  No

  N/A

• Adequate protection of holes

  Yes

  No

  N/A

• Power company orientation

  Yes

  No

  N/A

• Add media

  Media

• Comments

• Confined space

Confine space

• Permit

  Yes

  No

  N/A

• Personnel Trained

  Yes

  No

  N/A

• Emergency Rescue Plan

  Yes

  No

  N/A

• Rescue/Retrieval Equipment (Harness, Life Line, etc...)

  Yes

  No

  N/A

• Hot work

Hot work

• Permit

  Yes

  No

  N/A

• Permit Conditions Followed

  Yes

  No

  N/A

• Fire Watch

  Yes

  No

  N/A

• Other:

  Yes

  No

  N/A

• Add media

  Media

• Comments

Welding

• Certified journeyman welders utilized?<br>Welder familiar with welding procedures?

  Yes

  No

  N/A

• Welding rod oven utilized? <br>Z662 7.5.2.4 1 hour max time exposed to atmospheric conditions

  Yes

  No

  N/A

• Condition of pipe is inspected?

  Yes

  No

  N/A

• Preheat is completed?

  Yes

  No

  N/A

• Correct electrodes used?

  Yes

  No

  N/A

• PPE and guards utilized?

  Yes

  No

  N/A

• Appropriate fire extinguishers available?

  Yes

  No

  N/A

• Weld inspection completed?

  Yes

  No

  N/A

• Add media

  Media

• Comments

Pressure testing

• Test medium allowed to stabilize for appropriate amount of time?

  Yes

  No

  N/A

• Pressure rating of all fittings, flanges and hoses appropriate for the test pressure?

  Yes

  No

  N/A

• Available joints leak tested?

  Yes

  No

  N/A

• Site secure for high pressure test? Proper signage?

  Yes

  No

  N/A

• Site restricted to authorized personnel only during pressure testing?

  Yes

  No

  N/A

• Add media

  Media

• Comments

• Backfill

Backfill

• Trench free from objects?

  Yes

  No

  N/A

• Proper pipe shading?

  Yes

  No

  N/A

• Back fill follows municipal requirements?

  Yes

  No

  N/A

• Compaction of soil adequate?

  Yes

  No

  N/A

• Add media

  Media

• Comments

Site securement

• Equipment, materials secured and properly barricaded?

  Yes

  No

  N/A

• Excavations snow fenced and/or barricaded?

  Yes

  No

  N/A

• Pipe ends covered or capped?

  Yes

  No

  N/A
Action item

• Action item

• Hazard Risk rating

• Hazard risk rating
  A: Hazards have the potential for causing immediate serious injury and or damage
  B: Hazards are less severe, but still have the potential for causing injury or damage
  C: Hazards that have the potential to cause minor injury or damage
  Category
  1: Environmental
  2: Safety
  3: Procedure
  4: Equipment

• Complete by:

  Date

• Assigned to:

• Personal on site

• Accepted by:

  Sign

Audit wrap up discussion

• Select date

  Date