EHS AUDIT FORM - DEVONIAN DISTRICT - PRODUCTION ASSETS

• Facility Location:

• Activity:

  Operations

  Construction

  Rig Work

  Other

• CHK Rep/Office:

• Contractor:

• Auditor:

• Date/Time:

  Date

HAZCOM [EHS-101]

• MSDS's available and accessible at all times

  Yes

  No

  N/A

• All liquid containers properly labeled with NFPA or HMIS labels

  Yes

  No

  N/A

PPE [EHS-102]

• FRC utilized

  Yes

  No

  N/A

• Hard hat(s) utilized

  Yes

  No

  N/A

• Appropriate eye protection being utilized

  Yes

  No

  N/A

• Safety toe boots being worn

  Yes

  No

  N/A

• Personal Gas Monitor utilized

  Yes

  No

  N/A

• Other required PPE items being utilized

  Yes

  No

  N/A

Hearing Protection [EHS-104]

• Proper signage present at high noise areas

  Yes

  No

  N/A

• Proper hearing protection worn by workers

  Yes

  No

  N/A

Lockout/Tagout (LOTO) [EHS-105]

• LOTO required

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• LOTO permit properly managed

  Yes

  No

  N/A

• Locks/Tags properly managed

  Yes

  No

  N/A

Hot Work Management [EHS-106]

• Hot Work required

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Hot Work Qualified Individual on-site

  Yes

  No

  N/A

• Hot Work permit properly managed

  Yes

  No

  N/A

• Gas monitors properly used and managed

  Yes

  No

  N/A

• Fire extinguishers available/maintained

  Yes

  No

  N/A

Confined Space [EHS-107]

• Are confined spaces properly posted

  Yes

  No

  N/A

• Confined Space Policy being followed

  Yes

  No

  N/A

Trenching and Excavating [EHS-108]

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Checklist properly managed

  Yes

  No

  N/A

• Gas monitors properly used and managed

  Yes

  No

  N/A

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

  Yes

  No

  N/A

H2S [EHS-110]

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

  No

  Yes

  N/A

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

  Yes

  No

  N/A

• Workers are wearing monitors that are properly maintained

  Yes

  No

  N/A

Chemical, Flammable & Combustable Liquids/Materials [EHS-111]

• All chemical containers are chemical compatible and in good condition

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Chemical storage secondary containment in good condition

  Yes

  No

  N/A

• Secondary containment free of rain water

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Flammable liquid transfer containers are bonded/ grounded

  Yes

  No

  N/A

• All containers properly labeled to meet requirements of HAZCOM

  Yes

  No

  N/A

Heat and Cold Stress [EHS-112]

• All workers taking proper precautions for heat/cold

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Fire Protection [EHS-113]

• Fire extinguisher available

  Yes

  No

  N/A

• Monthly inspection tag on each fire extinguisher

  Yes

  No

  N/A

• Annual Fire Extinguisher Maintenance Record available

  Yes

  No

  N/A

Electrical Safety [EHS-114]

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Fixed equipment grounded properly

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• No flexible cord or wire going through water or doorways

  Yes

  No

  N/A

Powered Industrial Trucks (Forklifts) [EHS-115]

• Forklift operators certified and certificate available

  Yes

  No

  N/A

• Seat belts provided (as per manufacturer)

  Yes

  No

  N/A

• Backup alarm working

  Yes

  No

  N/A

• Auxiliary lighting for use during night time operations

  Yes

  No

  N/A

• Horn working

  Yes

  No

  N/A

• Rated lifting capacity posted on the forklift

  Yes

  No

  N/A

• Pre-Use Inspection Checklist available

  Yes

  No

  N/A

Hoisting & Lifting Equipment [EHS-116]

• Workers operating hoisting and lifting equipment properly trained

  Yes

  No

  N/A

• Monthly Hoisting Machinery Inspection a Record (Overhead) available

  Yes

  No

  N/A

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

  Yes

  No

  N/A

ATV/UTV [EHS-117]

• Proper PPE available or being utilized

  Yes

  No

  N/A

• Equipment in good repair

  Yes

  No

  N/A

• ATV/UTV being transported to site appropriately

  Yes

  No

  N/A

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.)

  Yes

  No

  N/A

Walking-Working Surfaces Policy [EHS-119]

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Ladder Safety [EHS-120]

• No wooden ladders allowed on-site

  Yes

  No

  N/A

• Metal ladders must have a warning label for electrical caution

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Fixed/Portable ladder in good repair

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Bloodborne Pathogens Exposure Control [EHS-121]

• First Aid Kit/ Bloodborne Pathogen Kit available on site

  Yes

  No

  N/A

• Bloodborne Pathogen Exposure training complete

  Yes

  No

  N/A

Pre-Job Safety Assessment [EHS-122]

• Pre JSA safety tour of site conducted

  Yes

  No

  N/A

• Daily safety meeting being conducted

  Yes

  No

  N/A

• Special safety meeting conducted when H2S/SO2 present

  Yes

  No

  N/A

• Safety meetings properly documented

  Yes

  No

  N/A

• Accidents, if any, are discussed during safety meetings

  Yes

  No

  N/A

• PJSA filled out completely and properly

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Ground Disturbance Safety [EHS-124]

• One Call is being utilized before any ground disturbance

  Yes

  No

  N/A

Waste Management [EHS-202]

• All waste being managed properly

  Yes

  No

  N/A

• Wastes are segregated in the proper containers

  Yes

  No

  N/A

NORM Management [EHS-204]

• NORM surveys being conducted on regular basis

  Yes

  No

  N/A

• Facility properly posted with NORM if required

  Yes

  No

  N/A

General [EHS]

• Injuries and incidents reported and documented immediately

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• First Aid Kit available and adequate supplies

  Yes

  No

  N/A

• Hand tools in good working condition

  Yes

  No

  N/A

• Lease road maintenance in good condition

  Yes

  No

  N/A

Housekeeping [EHS]

• Equipment on location kept clean and in good condition

  Yes

  No

  N/A

• No litter on the ground

  Yes

  No

  N/A

• Tripping hazards have been identified and addressed

  Yes

  No

  N/A

• Site maintained free of hydrocarbon stain(s)

  Yes

  No

  N/A

• Lease Sign posted, maintained with facility information

  Yes

  No

  N/A

• Comments: