ESRVL

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Pre-Job Check

• Tailgate Topic

  Safe

  At Risk

  N/A

• Permit if required (Hot work/Safe work)

  Safe

  At Risk

  N/A

• JSA (filled out and signed by all on location

  Safe

  At Risk

  N/A

Emergency Response

• Emergency Response Plan ( documented with primary and secondary muster areas)

  Safe

  At Risk

  N/A

• Alarms & Shutdowns

  Safe

  At Risk

  N/A

• Fire Extinguishers (in good condition, seals, labels, hoses)

  Safe

  At Risk

  N/A

• Eye Wash Station

  Safe

  At Risk

  N/A

• First Aid Kits (stocked with appropriate items, expiration dates)

  Safe

  At Risk

  N/A

Electrical Safety

• Energy Isolation (LOTO)

  Safe

  At Risk

  N/A

• Electrical Equipment (Class I Div. I

  Safe

  At Risk

  N/A

• Grounds

  Safe

  At Risk

  N/A

Fall Protection

• Hand Rails (in use, cracks, breaks, bends)

  Safe

  At Risk

  N/A

• Harness & Lanyard

  Safe

  At Risk

  N/A

• SRL (Inspected and Tested

  Safe

  At Risk

  N/A

• Escape Rope (Geronimo)

  Safe

  At Risk

  N/A

Lines & Slings

• Hoisting Lines (inspected and checked for kinks breaks)

  Safe

  At Risk

  N/A

• Guy Lines/Anchors (flagged, tightened, crossed, condition)

  Safe

  At Risk

  N/A

• Slings wire/webbed (broken strands, cert tags, hooks)

  Safe

  At Risk

  N/A

• Shackles/Pins

  Safe

  At Risk

  N/A

• Chains

  Safe

  At Risk

  N/A

BLow Out Prevention Equipment (BOPE)

• Hoses (holes, tears, hobbles, whip checks)

  Safe

  At Risk

  N/A

• Test & Inspection

  Safe

  At Risk

  N/A

• Bolts

  Safe

  At Risk

  N/A

Tools

• Hand Tools

  Safe

  At Risk

  N/A

• Power Tools

  Safe

  At Risk

  N/A

• Auxiliary Tools

  Safe

  At Risk

  N/A

Hoses

• Hoses (condition, Fittings, Rating)

  Safe

  At Risk

  N/A

• Safety Chains Whip Checks Hobbles

  Safe

  At Risk

  N/A

Rig

• Mast (welds breaks ladder)

  Safe

  At Risk

  N/A

• Drum

  Safe

  At Risk

  N/A

• Rams

  Safe

  At Risk

  N/A

• Cab

  Safe

  At Risk

  N/A

Chemical Hazards

• Storage

  Safe

  At Risk

  N/A

• Add signature

  Sign

• SDS Sheets

  Safe

  At Risk

  N/A