Clover Bar Work Site Inspection (WSI)

• Indicate plant and area inspected.

• WO# if applicable.

• Conducted on

  Date

• Prepared by

• Area Inspected
  Address

• * NOTE:
  For Answer Responses: Safe = Good, no action required, At Risk = Bad, follow up required & NA= Not Applicable to this audit

Supervision & Job Planning

• Off

  On

• Is the Location of the First Aid Station Known?

  Safe

  At Risk

  N/A

• Has the field level hazard assessment been completed?

  Safe

  At Risk

  N/A

• Is the Lock Out Tag Out (LOTO) and other Worker Protections (WPS) in place and understood?

  Safe

  At Risk

  N/A

• Is the emergency phone # known (911)?

  Safe

  At Risk

  N/A

• Is the muster (evacuation) procedure known and understood?

  Safe

  At Risk

  N/A

• Are the workers confident they have the skill required for the work?

  Safe

  At Risk

  N/A

LOTO Competence & Compliance (Inadvertent Work on Energized System Audit)

• Off

  On

• Issued date and time entered clearly and correctly?

  Safe

  At Risk

  N/A

• Seal # clearly recorded and is current?

  Safe

  At Risk

  N/A

• Equipment location entered clearly and correctly?

  Safe

  At Risk

  N/A

• Scope of Work clearly described?

  Safe

  At Risk

  N/A

• WO# recorded clearly and correctly?

  Safe

  At Risk

  N/A

• LOTO authorized with signatures for Authorization, Issue and Acceptance?

  Safe

  At Risk

  N/A

• Lock Set reference # clearly indicated and correct?

  Safe

  At Risk

  N/A

• Initial Reference Table completed?

  Safe

  At Risk

  N/A

• LOTO Boundary Points Identified clearly and correctly?

  Safe

  At Risk

  N/A

• LOTO Boundary Points verified?

  Safe

  At Risk

  N/A

• LOTO Transfer Log completed properly and clearly?

  Safe

  At Risk

  N/A

• Limits of protection understood by workers?

  Safe

  At Risk

  N/A

• Workers locked on to correct LOTO?

  Safe

  At Risk

  N/A

• Workers signed on to the LOTO?

  Safe

  At Risk

  N/A

• Workers' lock properly labelled?

  Safe

  At Risk

  N/A

Fall Protection Audit (Fall from Elevation Audit during Shutdown)

• Off

  On

• Workers properly trained?

  Safe

  At Risk

  N/A

• Fall Protection Plan in place?

  Safe

  At Risk

  N/A

• Fall distance calculated?

  Safe

  At Risk

  N/A

• Anchor points identified properly?

  Safe

  At Risk

  N/A

• Fall Protection equipment properly inspected?

  Safe

  At Risk

  N/A

• Use of lanyard or retractable considered?

  Safe

  At Risk

  N/A

• Suspension leg straps available?

  Safe

  At Risk

  N/A

• Proper use of boundary tape to mark drop zones as required?

  Safe

  At Risk

  N/A

• Rescue plan documented properly?

  Safe

  At Risk

  N/A

• Location and condition of rescue equipment known?

  Safe

  At Risk

  N/A

• Emergency and rescue responsibilities understood?

  Safe

  At Risk

  N/A

• Communication devices tested and emergenct contact # known?

  Safe

  At Risk

  N/A

• Fall protection rescue plan reviewed with workers?

  Safe

  At Risk

  N/A

Confined Space Audit

• Off

  On

• Expiry date and time entered correctly?

  Safe

  At Risk

  N/A

• Equipment ID # and name entered correctly?

  Safe

  At Risk

  N/A

• LOTO # indicated clearly and correctly?

  Safe

  At Risk

  N/A

• Reason for entry and work described?

  Safe

  At Risk

  N/A

• Work Area inside the Confined Space described?

  Safe

  At Risk

  N/A

• Potential hazards identified and indicated clearly?

  Safe

  At Risk

  N/A

• Precautions required are indicated clearly on the Confined Space Permit?

  Safe

  At Risk

  N/A

• Air tests taken with clear indication of time and by whom?

  Safe

  At Risk

  N/A

• Date and time the Confined Space Permit was issued are clearly and correctly entered on form?

  Safe

  At Risk

  N/A

• The Confined Space Supervisor is clearly and correctly entered on the form?

  Safe

  At Risk

  N/A

Environment & Chemical Hazards

• Off

  On

• Is secondary containment adequate?

  Safe

  At Risk

  N/A

• Is abatement required for fugitive releases?

  Safe

  At Risk

  N/A

• Are the environmental aspects of the work identified?

  Safe

  At Risk

  N/A

• Are the TDG requirements met?

  Safe

  At Risk

  N/A

• Is the work WHMIS compliant?

  Safe

  At Risk

  N/A

• Is the MSDS understood?

  Safe

  At Risk

  N/A

Hazard Management

• Off

  On

• Are the workers minds on task?

  Safe

  At Risk

  N/A

• Are the workers rushing?

  Safe

  At Risk

  N/A

• Are the workers frustrated?

  Safe

  At Risk

  N/A

• Are the workers fatigued?

  Safe

  At Risk

  N/A

• Are the workers complacent about safety?

  Safe

  At Risk

  N/A

• Are the workers cognizant of the "line of fire"?

  Safe

  At Risk

  N/A

• Has balance, traction and grip been assessed in the FLHI?

  Safe

  At Risk

  N/A

• Are the necessary screens and guards in place (welding, moving parts, barrier tape, etc...)?

  Safe

  At Risk

  N/A

• Are adequate signs and signals being employed?

  Safe

  At Risk

  N/A

Lifting Operations

• Off

  On

• Is the crane logbook being used?

  Safe

  At Risk

  N/A

• Is an engineered or critical lift plan on hand if required?

  Safe

  At Risk

  N/A

• Is the rigging adequate and maintained?

  Safe

  At Risk

  N/A

• Is a signaler identified if required?

  Safe

  At Risk

  N/A

• Is a tag line in use if required?

  Safe

  At Risk

  N/A

Knife Use

• Off

  On

• Is the knife appropriate for the task?

  Safe

  At Risk

  N/A

• Are Hi-Flex gloves required and used?

  Safe

  At Risk

  N/A

• Are the workers positioned correctly to cut away from the body?

  Safe

  At Risk

  N/A

Personal Protective Equipment (PPE)

• Off

  On

• Is adequate eye protection employed for the type of work?

  Safe

  At Risk

  N/A

• Is adequate footwear employed for the work?

  Safe

  At Risk

  N/A

• Is adequate body protection employed for the work (electrical, chemical, etc...)

  Safe

  At Risk

  N/A

• Is the worker's head protection adequate for the work?

  Safe

  At Risk

  N/A

• Is adequate hand protection employed for the work?

  Safe

  At Risk

  N/A

• Is adequate hearing protection employed for the work?

  Safe

  At Risk

  N/A

• Is adequate respiratory protection employed for the type of work?

  Safe

  At Risk

  N/A

Scaffolding and Work Platforms

• Off

  On

• Is the condition of the structure good?

  Safe

  At Risk

  N/A

• Does the scaffold or platform meet the OHS Code?

  Safe

  At Risk

  N/A

• Has the scaffold been inspected and tagged prior to use?

  Safe

  At Risk

  N/A

• Does the inspection tag have an expiry date?

  Safe

  At Risk

  N/A

Vehicles and Motorized Equipment

• Off

  On

• Does the equipment have the required fire extinguisher?

  Safe

  At Risk

  N/A

• Has the equipment been properly certified and maintained?

  Safe

  At Risk

  N/A

• Is the proper log book on hand and being used?

  Safe

  At Risk

  N/A

• Is the operator properly trained or certified?

  Safe

  At Risk

  N/A

Compressed Gases

• Off

  On

• Are cylinders stored and secured properly?

  Safe

  At Risk

  N/A

• Has the storage cylinder expired?

  Safe

  At Risk

  N/A

Worksite Condition

• Off

  On

• Are hand tools in good condition?

  Safe

  At Risk

  N/A

• Are the proper tools being used for the job?

  Safe

  At Risk

  N/A

• Are extension cords in good condition?

  Safe

  At Risk

  N/A

• Is the housekeeping good and is the work area being well maintained?

  Safe

  At Risk

  N/A

• Is the task lighting adequate?

  Safe

  At Risk

  N/A

• Are ladders in good condition and being used properly?

  Safe

  At Risk

  N/A

• Is adequate waste disposal on hand?

  Safe

  At Risk

  N/A

Ergonomics

• Off

  On

• Is proper technique being used for tasks requiring lifting, bending and twisting?

  Safe

  At Risk

  N/A

• Are adequate precautions in place to prevent injuries from repetitive motion?

  Safe

  At Risk

  N/A

• Is the proper technique being used for tasks requiring kneeling, standing, sitting?

  Safe

  At Risk

  N/A

• Is the workers position comfortable for the work?

  Safe

  At Risk

  N/A