Work order

  • Tailgate safety topic is specific to the job performed

  • JHSA signed by all crew members

  • Pre job inspection done on equipment/vehicles

Safety controls

  • Crew is aware of all hazards and how to avoid them

  • LOTO done correctly


  • All permits filled out correctly (Confined Space etc)

  • Is Job in Confined space

  • Has confined space air quality been tested?

  • All PPE present and properly used

  • Are ladders, scaffold, fall protection in use

  • Are the ladders, scaffolds, man lifts and fall protection being properly used

Hydroblasting General Safe Work Practices

  • 4.2.2 house keeping-Is the work area free of all removable hazards?

  • 4.2.4 Is pump properly barricaded to restrict unauthorized people from entering the work area.

  • 4.2.4 is area being cleaned properly barricaded to prevent unauthorized people from entering

  • 4.2.4 is pre-printed barricade tags properly attached (Danger hydroblasting)

  • 4.2.5 Are wheel chocks in place on pump and truck

  • 4.2.6. Whip checks in place

  • 4.2.7 Is pump operator present and close enough to disengage pressure

  • 4.2.8 Is there clear line of site between pump operator and hose end equipment operator. If unable to do so is radio or third person in use

  • 4.2.9 Are hoses routed and protected in a manner that prevents vehicular damage and personnel exposure to hoses

  • 4.2.10 Are all personnel 6' or more away from hose connections while under pressure

  • 4.2.12 Are debris barriers in place

  • 4.2.13 Is pump grounded

  • 4.2.14 Is anti-withdrawal device in use and mounted securely

  • 4.2.15 Is a hard stop required. If so is it being utilized

  • 4.2.17 Is hose shroud in place

  • 4.2.18 Has back thrust been calibrated to 1/3 of operator and properly applied

  • 4.2.19 Is operator controlling the foot pedal

  • 4.2.19 Is foot pedal secure and free from obstruction

Hydroblasting Equipment Requirements

  • 4.3.4 is stinger at least 1.5x the diameter of pipe being cleaned

  • 4.2.5 Is lance marked 24"or more from the end of the compression fitting

  • 4.3.6 Does shotgun have hose shroud

  • 4.3.6 Is the shotgun shroud 6' in length

  • 4.3.6 Has shotgun shroud been properly inspected for current qtr

  • 4.3.7 Is the length of the shotgun 66" from butt stock to end of the nozzle

  • 4.3.8 Are fittings rated for pressure being applied?

  • 4.3.9 Does shotgun have a double trigger

  • 4.3.10 Is entry point where 3D tool is in operation securely covered to prevent spray from exiting vessel

  • 4.3.10 Is 3D tool appropriately suspended (rope not allowed)

  • Blast hose inspected with metal tag in place

  • Blast hose in good repair

  • 10k

  • 20k

  • 40k


  • Is job on an elevated floor

  • Is vac hose properly tied off

  • Is there a hose break in use

  • If necessary, is vac truck properly bonded


  • Is fire extinguisher in place and inspected

  • Is vehicle/equipment clean

Comments and corrections


Corrective Action

  • Auditor

  • Crew Leader/Supervisor

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.