BERRY BROS GENERAL CONTRACTORS, INC

• Document No.

• Client

• Conducted on

  Date

• Prepared by

• Location
  Address

• Foreman On Site

• Shell Oil Representative

• Select date

  Date

HOUSEKEEPING / ENVIRONMENTAL

• Are all pathways / walkways clear of rubbish or obstructions and slip free.

  Yes

  No

  N/A

• Are all stairs and steps in good/safe condition with suitable non-slip surface?

  Yes

  No

  N/A

• Are handrails secure and in good condition?

  Yes

  No

  N/A

• Is staircase in place over berm containment wall? And is it being utilized?

  Yes

  No

  N/A

• Is Emergency Response Plan in place?

  Yes

  No

  N/A

• Are there spills on location?

  Yes

  No

  N/A

• Are spill kits available?

  Yes

  No

  N/A

ELECTRICAL

• Are all electrical cords in good repair with no broken or damaged plugs or sockets?

  Yes

  No

  N/A

• Do all electrical tools and cords appear to have quarterly inspections? (1st - white, 2nd - blue, 3rd - green, 4th - red)

  Yes

  No

  N/A

• Are breakers labeled and kept closed?

  Yes

  No

  N/A

• Are generators in good working condition without any visible defects?

  Yes

  No

  N/A

• Are generators properly grounded?

  Yes

  No

  N/A

• Are Ground Fault Circuit Interbeing correctly utilized?

  Yes

  No

  N/A

• Are all electrical tools in good condition (cords, switches, guards. etc...)

  Yes

  No

  N/A

EQUIPMENT

• Are there any visible spills or discharges from equipment?

  Yes

  No

  N/A

• Are all hand tools in good condition? Without any modifications?

  Yes

  No

  N/A

• Are backup alarms functional on all mobile equipment?

  Yes

  No

  N/A

• Have daily equipment inspections been completed?

  Yes

  No

  N/A

• Are operators properly certified and wearing seatbelts?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Are all employees wearing required PPE?

  Yes

  No

  N/A

• Are employees wearing hearing protection when necessary?

  Yes

  No

  N/A

• Are employees wearing face shields while grinding or chipping?

  Yes

  No

  N/A

WORKING AT HEIGHTS

• Are full body harnesses being utilized correctly?

  Yes

  No

  N/A

• Are proper lanyards being used? With correct anchor points?

  Yes

  No

  N/A

• Are ladders in good condition and used properly?

  Yes

  No

  N/A

• Have fall protection inspections been completed?

  Yes

  No

  N/A

• Have affected employees received fall protection training?

  Yes

  No

  N/A

GENERAL SAFETY

• Is someone on location First Aid/CPR trained?

  Yes

  No

  N/A

• Is First Aid Kit available? And fully stocked?

  Yes

  No

  N/A

• Are compressed cylinders secure and capped?

  Yes

  No

  N/A

• Are fire extinguishers properly mounted and inspected?

  Yes

  No

  N/A

• Are lockout/tagout materials readily available on site if needed?

  Yes

  No

  N/A

• Are lift slings and straps in good condition and stored properly?

  Yes

  No

  N/A

• Are guards in place on machinery, shafts, and pinch points?

  Yes

  No

  N/A

• Are fuel cells properly secured and labeled?

  Yes

  No

  N/A

• Are proper fuel cans being used? And labeled?

  Yes

  No

  N/A

• Are tag lines used when necessary?

  Yes

  No

  N/A

• Are all open holes or trenches properly guarded?

  Yes

  No

  N/A

• Is designated smoking area identified with butt can available?

  Yes

  No

  N/A

• Has muster area been identified?

  Yes

  No

  N/A

DOCUMENTATION

• Is sign-in sheet being complete and in place?

  Yes

  No

  N/A

• Has JSEA been completed?

  Yes

  No

  N/A

• Is proper Work Permit completed and on site?

  Yes

  No

  N/A

• Was tailgate meeting held before starting job?

  Yes

  No

  N/A

• Are evacuation procedures available for employees/visitors to review?

  Yes

  No

  N/A

• Do employees have current safety training cards (Safeland, client orientation, H2S awareness)

  Yes

  No

  N/A

• Are SDS materials available for all substances on site?

  Yes

  No

  N/A

• Are emergency drills practiced and documented? Date of last drill?

  Yes

  No

  N/A

• Are new employees given site specific orientation?

  Yes

  No

  N/A

• Are visitors informed of work hazards?

  Yes

  No

  N/A

• Is crew statistic sheet completed and on site?

  Yes

  No

  N/A

• Are One Call and line find map available for ground disturbance?

  Yes

  No

  N/A

• Is atmospheric testing being recorded when necessary?

  Yes

  No

  N/A

HOT WORK

• Has necessary permits been completed and on site?<br>

  Yes

  No

  N/A

• Is proper fire fighting equipment available and in good condition?

  Yes

  No

  N/A

• Is fire watch personnel in place and properly trained?

  Yes

  No

  N/A

SUMMARY

CORRECTIVE ACTIONS

SIGN OFF

• I confirm I have had the contents of this audit report explained to me.

• Site Foreman

  Sign

• Person conducting this Audit.

  Sign

CLOSURE

• All actions on this report have been completed on:

  Date