Information

  • Location:

  • Activity

  • CHK Rep/Office:

  • Contractor:

  • Auditor:

  • Date/Time:

HAZCOM [EHS-101]

  • MSDS's available and accessible at all times

  • All liquid containers labeled with NFPA or HMIS labels

PPE [EHS-102]

  • FRC utilized

  • Hard hat(s) utilized

  • Appropriate eye protection being utilized

  • Safety toe boots being worn

  • Personal Gas Monitor used

  • Other required PPE items being utilized

Hearing Protection [EHS-104]

  • Proper signage present at high noise areas

  • Proper hearing protection worn by workers

Lockout/Tagout (LOTO) [EHS-105]

  • LOTO required

  • LOTO permit available on-site<br>{105-B}

  • LOTO permit properly managed

  • Locks/Tags properly managed

Hot Work Management [EHS-106]

  • Hot Work required

  • Hot Work permit available on-site<br>{106-A}

  • Hot Work Qualified Individual on-site

  • Hot Work permit properly managed

  • Gas monitors properly used and managed

  • Fire extinguishers available/maintained

Confined Space [EHS-107]

  • Are confined spaces properly posted

  • Confined Space Policy being followed (No confined space entry)

Trenching and Excavation [EHS-108]

  • Trenching and Excavation Checklist required (depth > or = 48")

  • Checklist available on-site<br>{108-A}

  • Checklist properly managed

  • Gas monitors properly used and managed

  • Engineering Best Practices being utilized (sloping/benching/egress)

  • One call being utilized

H2S [EHS-110]

  • Site has an H2S concern (concentration in well stream > or = 10 ppm)

  • Site is properly posted (signs at > or = 10 ppm/windsock at > or = 100 ppm)

  • Workers are wearing monitors that are properly maintained

Chemical, Flammable and Combustible Liquids/Materials [EHS-111]

  • All chemical containers are in good condition

  • All chemicals are properly stored and in secondary containment if required

  • All chemical containers are closed/sealed when not in use

  • All containers are bonded/grounded in liquid transfer

Heat and Cold Stress [EHS-112]

  • All workers taking proper precautions for heat/cold

  • PJSAs state hazards of heat/cold stress and how to mitigate

  • Controls/supplies in place to prevent heat/cold stress

Fire Protection [EHS-113]

  • Fire extinguisher available in company trailer

  • Monthly inspection tag on each fire extinguisher

  • Annual Fire Extinguisher Maintenance Record available

Electrical Safety [EHS-114]

  • Electrical equipment operating at a voltage of greater than 600V labeled as high voltage

  • Work clearance of at least 36 inches maintained in front of electrical equipment

  • Fixed equipment grounded properly

  • Only 3-wired and GFSI extension cords and electrical power cords being used

  • All extension cords and electrical power cords are in good working condition

  • No flexible cord or wire going through windows or doorways

Powered Industrial Trucks (Forklifts) [EHS-115]

  • Forklift operators certified and certificate available

  • Seat belts provided (as per manufacturer)

  • Backup alarm working

  • Auxiliary lighting for use during nighttime operations

  • Horn working

  • Rated lifting capacity posted on the forklift

  • Pre-Use Inspection Checklist available

Hoisting and Lifting Equipment [EHS-116]

  • Workers operating hoisting and lifting equipment properly trained

  • Monthly Hoisting Machinery Inspection Record (Overhead) available

  • Straps and slings have been inspected and are in proper working condition

ATV/UTV [EHS-117]

  • Proper PPE available of being utilized

  • Equipment in good repair

Lifting and Carrying Safety [EHS-118]

  • Proper lifting and carrying techniques being used (i.e., bending at knees, back straight, object close to body, etc.)

Walking-Working Surfaces Policy [EHS-119]

  • Any working surface above 4 feet from the ground must be protected by a work platform with guardrails and toe boards or personal fall arrest system

  • Guardrails must be at least 42 inches above the platform and have intermediate mid- rail and toe board

  • Fall arrest system must have a full body harness, deceleration device and a lifeline.

  • Anchorage used for fall arrest equipment must be capable of supporting at least 5,000 lbs.

  • All walking/working surfaces are clear of debris and tripping hazards and/or tripping hazards have been identified

Ladder Safety [EHS-120]

  • No wooden ladders allowed on site

  • Metal ladders must have a warning label for electrical caution

  • Ends/feet of ladder must be fitted with insulated non-slip material

  • Extension ladders must extend 3 feet past the landing if used to access another working surface and be secured

  • While on a ladder, workers are using 3-point contact procedure

  • Fixed ladders are to be inspected annually and fill out a Fixed Ladder Annual Inspection Checklist

  • Portable ladders are to be inspected monthly and fill out a Portable Ladder Monthly Inspection Checklist

Bloodborne Pathogen Exposure Control [EHS-121]

  • First Aid Kit/Bloodborne Pathogen Kit available on site

  • Bloodborne Pathogens Exposure training complete

Pre-Job Safety Assessment [EHS-122]

  • Pre PJSA safety tour on site conducted

  • Daily safety meeting being conducted

  • Special safety meetings conducted when H2S/SO2 present

  • Safety meetings properly documented

  • Accidents, if any, are discussed during safety meetings

  • PJSA filled out completely and properly

  • Individual contractors conducting Job Safety Analysis (JSA) to identify task-specific hazards

Ground Disturbance Safety [EHS-124]

  • One call is being utilized before any ground disturbance

Waste Management [EHS-202]

  • All vendors are managing their waste appropriately

  • Wastes are segregated in the proper containers

NORM Management [EHS-204]

  • NORM surveys being conducted on a regular basis

Incidents

  • Injuries and incidents reported and documented immediately

  • All incidents resulting in injuries to employees investigated and documented to prevent recurrence

Housekeeping

  • Walking/Working surfaces clean and clear of debris

  • Equipment on location is neat

  • No trash on the ground

  • Tripping hazards have been identified and addressed

  • Seasonal conditions have been identified and addressed

Extras

  • Comments

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.