Daily Safety Inspection Pugh Pipeline Services

• Document No.

• Work order number

• Location/F #
  Address

• Project manager

• Inspector/Buckeye Person In Charge

• Contractor

• Conducted on

  Date

• Prepared by

PROGRAM ADMINISTRATION

• Postings of possible hazards visible

  Yes

  No

  N/A

• Emergency numbers / contacts posted

  Yes

  No

  N/A

• Contractor Safety Manual - onsite and available

  Yes

  No

  N/A

• First aid kits onsite and adequately supplied

  Yes

  No

  N/A

• List all contractors

  Yes

  No

  N/A

• Emergency action plan posted / up to date

  Yes

  No

  N/A

• Verify completed HWA<br><br>Is HWA properly filled out with all applicable Information? All required signatures? Initial four gas readings taken and documented?

  Yes

  No

  N/A

• Verify completed JSA<br><br>Properly filled out and completed by contractors foreman? All tasks, Hazards and mitigations controls documented? All required signatures documented?

  Yes

  No

  N/A

• Verify completed ATW<br><br>Properly filled out with all needed Information? Required signatures are documented?

  Yes

  No

  N/A

• Verify completed LOTO/ Integrity List<br><br>Procedures followed and available? Verified correct individual lock out.

  Yes

  No

  N/A

• Verify completed CSP

  Yes

  No

  N/A

• Weekly safety meeting held and documented

  Yes

  No

  N/A

• Calabration / bump log filled out and current

  Yes

  No

  N/A

PPE

• Hard hats worn

  Yes

  No

  N/A

• Top layer of clothing Fire resistant NFPA 2112 29 CFR 1910.132(b-h)

  Yes

  No

  N/A

• Gloves being worn and adequate for the work activity

  Yes

  No

  N/A

• Face shields being used where required

  Yes

  No

  N/A

• Welding hoods being worn in conjunction with safety glasses

  Yes

  No

  N/A

• Eye protection being worn and adequate for the work activity

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Safety harness and lanyards utilized with adequate anchorage points

  Yes

  No

  N/A

• Respirators and masks utilized, when needed Filter correct for work activity

  Yes

  No

  N/A

• High visible clothing in use, when needed

  Yes

  No

  N/A

HOUSEKEEPING

• Work areas orderly and organized with material and tools properly stored

  Yes

  No

  N/A

• Adequate lighting

  Yes

  No

  N/A

• Job site free of slips, trips and fall hazards

  Yes

  No

  N/A

• Stairways / walkways clear

  Yes

  No

  N/A

• Trash picked up

  Yes

  No

  N/A

• Break areas orderly

  Yes

  No

  N/A

ELECTRICAL / UTILITY

• Is the voltage known

  Yes

  No

  N/A

• Minimum approach based upon voltage + 3 feet is being maintained to live lines and equipment

  Yes

  No

  N/A

• For energized work all blankets, gloves, sleeves, and live line tools have been tested appropriately, maintained, and stored correctly

  Yes

  No

  N/A

• Electrical equipment intrinsically safe

  Yes

  No

  N/A

• Insulation intact on cords and wiring

  Yes

  No

  N/A

• Temporary lighting guarded

  Yes

  No

  N/A

• Electrical panels labeled and covered

  Yes

  No

  N/A

• GFCI protection utilized

  Yes

  No

  N/A

• Lockout / tagout procedures utilized

  Yes

  No

  N/A

HAND AND POWER TOOLS

• Tools maintained in a safe and reliable condition

  Yes

  No

  N/A

• Proper tools being used for the job spark free if needed

  Yes

  No

  N/A

• All mechanical safeguards in use

  Yes

  No

  N/A

MOBILE EQUIPMENT

• Equipment grounded and bonded

  Yes

  No

  N/A

• Brakes, lights, signals, and alarms operative

  Yes

  No

  N/A

• Daily inspections filled out

  Yes

  No

  N/A

• Seat belts worn - LULLS, FORK TRUCKS, ETC.

  Yes

  No

  N/A

• Aerial lift - Harnesses and lanyards being used

  Yes

  No

  N/A

• Cranes - proper setup including distance to power lines

  Yes

  No

  N/A

• Cranes - ground conditions verified and safe for operation (underground wells, vaults, etc.)

  Yes

  No

  N/A

• Cranes- swing radius protected - level

  Yes

  No

  N/A

• Rigging equipment inspected - tag showing

  Yes

  No

  N/A

BARRICADES

• Barricades affixed with proper signage

  Yes

  No

  N/A

• Floor openings planked or barricaded

  Yes

  No

  N/A

• Wall, roof openings covered or barricaded

  Yes

  No

  N/A

• Leading edges guarded

  Yes

  No

  N/A

• Impalement hazards barricaded, protected, or eliminated

  Yes

  No

  N/A

• Open man way barricaded where needed

  Yes

  No

  N/A

EXCAVATION

• One call system in place

  Yes

  No

  N/A

• All permits and approvals completed before ground disturbance

  Yes

  No

  N/A

• Underground utilities have been located and marked

  Yes

  No

  N/A

• Daily documented inspections have been performed by a competent person

  Yes

  No

  N/A

• Adequate benching, sloping, and/or trenching in place by soil type

  Yes

  No

  N/A

• Access and egress means provided

  Yes

  No

  N/A

• Spoil pile set back at least 2 feet

  Yes

  No

  N/A

• Spotter used during excavating

  Yes

  No

  N/A

• Is the excavation more than 5ft, if so, is it adequately protected and has air monitoring been performed and documented

  Yes

  No

  N/A

• Bucket has no teeth exposed

• Is excavation within two feet of pipe? If so is it approved with site completed site safety plan

  Yes

  No

  N/A

LADDERS

• Ladders in good condition

  Yes

  No

  N/A

• Side rails extend 36 inches above landing

  Yes

  No

  N/A

• Proper for job and secure

  Yes

  No

  N/A

• Step ladders fully open when in use

  Yes

  No

  N/A

• Placement of ladder safe

  Yes

  No

  N/A

SCAFFOLDING

• All scaffolds plumb and level

  Yes

  No

  N/A

• Are adequate sills and base plates being used

  Yes

  No

  N/A

• Are scaffold planks installed correctly

  Yes

  No

  N/A

• Are guardrails including top and mid rail in place

  Yes

  No

  N/A

• To protect from falling objects, are toe boards or area barricaded below

  Yes

  No

  N/A

• Is fall protection being used in areas where required

  Yes

  No

  N/A

• Is there a scaffold tag and has it been inspected

  Yes

  No

  N/A

• Is there a safe access ladder, steps or equivalent means for safe access to the scaffold

  Yes

  No

  N/A

• Is the scaffold rated for the proper weight capacity

  Yes

  No

  N/A

FIRE PREVENTION/PROTECTION

• Are hot work permits in order

  Yes

  No

  N/A

• Air monitoring before and during hot work

  Yes

  No

  N/A

• All flammable and/or combustible materials have been removed or protected within the area

  Yes

  No

  N/A

• Fire extinguishers immediately available and inspection tags current

  Yes

  No

  N/A

• Is a fire watch monitoring the area

  Yes

  No

  N/A

• Compressed gas cylinders secured- upright- protected from damage

  Yes

  No

  N/A

• Compressed gas cylinder stored properly

  Yes

  No

  N/A

• Flashback arrestors installed properly

  Yes

  No

  N/A

• Fire blankets and/or spark containment being utilized

  Yes

  No

  N/A

• Welding flash screens being used as required

  Yes

  No

  N/A

CONFINED SPACES

• Proper permits filled out

  Yes

  No

  N/A

• Pre-entry meeting conducted

  Yes

  No

  N/A

• Permits posted at entry

  Yes

  No

  N/A

• LOTO in place if needed and procedures followed

  Yes

  No

  N/A

• containment's in place if needed

  Yes

  No

  N/A

• Atmosphere tested and results documented 02,Co,LEL,H2S,VOC/Benzene

  Yes

  No

  N/A

• Entry Supervisor has classified confined space and authorized entry

  Yes

  No

  N/A

• Everyone has been properly trained

  Yes

  No

  N/A

• Line separation / opening vessel to atmosphere

  Yes

  No

  N/A

• Rescue on site with all appropriate equipment and permits

  Yes

  No

  N/A

• Rescue plan filled out and available

  Yes

  No

  N/A

• Draw space if needed

  Drawing

TRAFFIC CONTROL

• Traffic control in place where required

  Yes

  No

  N/A

• Work zones visible from all directions on roadways

  Yes

  No

  N/A

Line Separation / Opening a vessel to atmosphere

• LOTO procedures followed

  Yes

  No

  N/A

• Facility integrity list current and on site

  Yes

  No

  N/A

• Energy shut out verified

  Yes

  No

  N/A

• Atmosphere monitoring ongoing

  Yes

  No

  N/A

INDUSTRIAL HYGIENE

• Possible oil outlets are contained to prevent spills

  Yes

  No

  N/A

• All chemical containers properly labeled and SDS available

  Yes

  No

  N/A

• All regulated areas maintained ie. asbestos, lead, arsenic, Hex Chrome, etc.

  Yes

  No

  N/A

• All sources of fugitive dust are controlled ie. concrete grinding, road dust, etc.

  Yes

  No

  N/A

• All containers of hazardous or non-hazardous waste are labeled and properly stored or disposed

  Yes

  No

  N/A

COMMENTS AND NOTES

• Notes

  Safe

  At Risk

  N/A

INSPECTOR SIGNATURE

• I have been given a copy of this audit and instructed on the findings of this audit and will make all necessary corrections if applicable. All immediate safety issues have been corrected or stop work procedure in place.

  Sign

Auditor Signature

• Any issues found have been addressed to the correct persons and corrected

  Sign