Title Page

  • Commander

  • BUM

  • Site Supervisor

  • Unit Status

  • Company/Well

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Follow up

  • Is there a copy of the previous audit available at the location?

  • Are there any outstanding action items from the previous audit?

  • Does the site supervisor have access to the most current version of Cretic Energy Services' HSEMS?

  • Is there a JSA available, with today's date and signatures of all employees, visitors and contractors?

  • Have each of the hazard control items been completed?

  • Does the JSA have a person of "ultimate authority " listed?

  • Are there blank copies of Cretic's incident report form available?

  • Are there blank copies of Cretic's observation report form available?

  • Is all administrative paperwork kept in an area that is acceptable to all employees?

General work environment

  • Is the general condition of the worksite considered to be "clean and orderly "?

  • Are the work areas well illuminated?

  • Are all washing facilities and restrooms clean and sanitary?

  • Is there an adequate amount of garbage receptacles on site?

  • Is there any signs of leaking or spilled material around waste receptacles?

  • Can the site supervisor produce a copy of the most recent handover notes?

  • Is there an SSE on location?

  • Does the SSE know their mentors name?

Personal Protective Equipment

  • Are all employees dressed in the proper Cretic Energy Services' FRC uniform?

  • Are all employees wearing the proper eye protection for the task that they are performing?

  • Are all employees wearing the proper hand protection for the job they are doing?

  • Is the location equipped with safety goggles?

  • Is the location equipped with face shields?i

  • Is the location equipped with proper fall protection equipment?

  • Do all employees have access to proper forms of hearing protection ?

  • Are all employees wearing the proper form of foot protection for the task that they are performing?

  • Are all employees wearing the proper form of head protection for the task that they are performing?

  • Are all employees wearing a personal H2S monitor?

Walking and working surfaces

  • Are all walkways clear of obstacles and obstructions?

  • Are all walkways clean and clear of oil, grease, water, or any other conditions that may cause slipping?

  • Are all walking surfaces properly maintained with grips or treads to prevent slipping?

  • Are all handrails free of oil, grease, water, or any other conditions that may cause a loss of grip?

  • Are all stairs and steps in good condition and capable of supporting their intended loads?

  • Are all emergency routes clear and accessible?

  • Are all handrails free from defects and properly secured?

  • Are there any items tied to the handrails that could cause an employee to not use the handrails?

  • Are there any items leaning against handrails that could possibly be knocked over by a person using the handrails?

  • Are all ladders in good working order and capable of supporting their maximum intended load?

Fire protection

  • Are all extinguishers accessible, with no obstructions or blockages?

  • Are all extinguishers in good condition?

  • Do any extinguishers show signs of discharge?

  • Are all extinguishers secured to prevent damage or accidental discharge?

  • Is the location of each extinguishers clearly marked with signs, markings or other labels?

  • Are there signs on site identifying the location of the muster areas?

  • Are there extinguishers located in close proximity to flammable/combustible liquids and electrical equipment?

  • Does each extinguisher have a marking indicating that it has been visually inspected in the last month?

  • Does the site have a sufficient number of fire extinguishers?

  • Does each employee on site know the location of the extinguishers?

  • Does each extinguisher have, in place, a pin and holding tab?

  • Does each extinguisher have the date of the last annual inspection clearly marked on it?

  • What was the date of the last fire drill?

Electrical safety and LOTO

  • Do all employees know the location of the main disconnect for the equipment they are working with?

  • Do all employees have access to the main power supply for all equipment on site?

  • Are all power supplies, switches, controls and ESDs labeled?

  • Is there any visible damage to any wires, conduit, cords, cover plates or switches?

  • Is there proper grounding on each piece of equipment and a service/system ground?

  • Is there any equipment, services, or moving parts that cannot be completely locked out.

  • Is there a lock out kit on site?

  • Is there a written procedure, with diagrams, detailing how to lock out each piece of equipment?

  • Is there blank copies of Cretic Energy Services' lock out permit?

  • Are all extension cords in good condition?

  • Do all power tools have a grounding prong or a double insulated symbol?

  • Are all exterior receptacles and wet area receptacles connected to a GFCI protected circuit or pig tail?

  • Are there any multiple plug adaptors on site?

  • Does each employee on site have proof of completing awareness level training in LOTO and Electrical Safety?

  • Is there a current copy of Cretic Energy Services' LOTO policy available on site?

Machine Guarding

  • Are the points of operation for each machine on location adequately guarded?

  • Are all shut off switches within reach of the primary operator?

  • Are all ESDs labeled to indicate which machine they control?

  • Are all machines kept in good condition?

  • Are all machine guards installed in a manner as to not create additional hazards?

  • Does each machine have a single point in which energy can be controlled?

  • Are guards clearly identified on each machine?

  • When engaged, do all guards prevent access to the machine's point of operation ?

  • Is there an automatic feed mechanism that can potentially create a hazard during maintenance of any machine on site?

  • Is each machine fitted with a positive locking device to prevent movement during service, maintenance, or repair?

Hand and Power Tools

  • Are all tool in good working order and free from visible damage?

  • Are all hand tools free of mushroomed handles and chipped heads?

  • Is each tool stored in its proper location?

  • Is there any signs of abuse or uncharacteristic damage to hand tools?

Hazcom

  • Is there a list of all hazardous materials on location?

  • Is the list accessible to all employees?

  • Is there a designated "Right to Know " station on location?

  • Do all chemical containers have legible labels?

  • Is there any damage to chemical containers that could cause a leak or spill?

  • Do all employees have access to chemical protective clothing?

  • Is there a spill control kit on site?

  • Is the location of the spill control kit clearly marked?

  • Is the spill kit sufficiently large enough to contain the volume of material that is under control of Cretic Energy Services' employees?

  • Is there an emergency response guide or equivalent means to assist employees in case of a spill?

  • Is there evidence that the spill control kit has been used?

First Aid

  • Are emergency numbers prominently displayed in a common area and accessible to all employees?

  • Is the first aid drawer or kit orderly and accessible and containing only first aid supplies?

  • Are all supplies clearly labeled and in the manufacturer's original container?

  • Is there an inventory sheet of all first aid supplies in the first aid kit or drawer?

  • Is there a functioning eye wash station or eye wash kit on site?

Vehicles

  • Are all wheel chocks and safety cones in place, as required?

  • Is there any radar, laser, or other form of speed detection devices in any vehicle?

  • Do all vehicles have a current registration in them?

  • Do all vehicles have a current insurance card or deceleration page in them?

  • Is there any signs of damage to any Cretic Energy Services vehicles on site?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.