Facility PM Safety Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Site Details

• Site / Project Name

• Use this audit to assess the cleanliness and housekeeping of a site. Negative responses indicate that attention is required to bring items to a satisfactory standard. Notes and photos should be attached where appropriate, particularly to At Risk items.
  

Ground and Floors

• Do you wish to check site ground and floors at this inspection?

  Yes

  No

  N/A

• Has grass/weeds been cut/removed around Facility site including inside and out of berm, around equipment and a 50' radius around Flare Stack?

  Yes

  No

  N/A

• Are walking surfaces kept clear and free of debris?

  Yes

  No

  N/A

• Have trip hazards including uneven steps, potholes and uneven surfaces been eliminated?

  Yes

  No

  N/A

• Is debris and rubbish correctly removed and disposed in appropriate receptacles?

  Yes

  No

  N/A

• Are trenches covered?

  Yes

  No

  N/A

• Are ramps secure and adequately stabilized?

  Yes

  No

  N/A

Access and Movement

• Do you wish to check site access and movement at this inspection?

  Yes

  No

  N/A

• Are stairways and passageways free of obstructions, materials, supplies and clutter?

  Yes

  No

  N/A

• Are all working areas safe for access and movement by workers?

  Yes

  No

  N/A

• Access routes are generally orderly with hazards minimized?

  Yes

  No

  N/A

• Are driveways and footpaths clear of materials?

  Yes

  No

  N/A

• Are scaffolds clear of debris and material?

  Yes

  No

  N/A

Working Areas

• Do you wish to check work area housekeeping at this inspection?

  Yes

  No

  N/A

• Are working surfaces clean, tidy and free of liquid spills and waste?

  Yes

  No

  N/A

• Are work surfaces cleaned as trades work?

  Yes

  No

  N/A

• Are work areas free from excess materials and other hazards such as incomplete works that may pose a safety risk?

  Yes

  No

  N/A

• Are work areas free of excessive dust and grit?

  Yes

  No

  N/A

Delivery and Storage

• Do you wish to check site material storage and deliveries at this inspection?

  Yes

  No

  N/A

• Is there a designated area for deliveries?

  Yes

  No

  N/A

• Are all deliveries placed into appropriate storage?

  Yes

  No

  N/A

• Is equipment stored in designated areas when not in use?

  Yes

  No

  N/A

• Are storage areas kept free of unnecessary materials?

  Yes

  No

  N/A

• Are storage areas tidy and orderly?

  Yes

  No

  N/A

• Are items stacked appropriately (as to not create risk when adding or retrieving)?

  Yes

  No

  N/A

Rubbish & Waste

• Do you wish to check site rubbish and waste housekeeping at this inspection?

  Yes

  No

  N/A

• Are waste items being disposed of correctly in accordance with the nature of the waste?

  Yes

  No

  N/A

• Are hazardous waste items stored and disposed of correctly?

  Yes

  No

  N/A

General & Common Areas

• Do you wish to check site common areas and general housekeeping at this inspection?

  Yes

  No

  N/A

• Are site common areas free of rubbish and waste?

  Yes

  No

  N/A

• Site is generally orderly and tidy?

  Yes

  No

  N/A

General Comments

• Have labels, signage, windsock, support brackets & car seals on PSVs, circ. pumps, and air compressor if present on site and equipment been inspected/repaired/added if needed?

  Yes

  No

  N/A

• Any further comments or recommendations arising from this inspection?

• Please add any corrective actions to the appropriate questions above before completing this report

• 1. Has LOTO been performed on the HTTR by Chesapeake Representative?

  Yes

  No

  N/A

• a. Are Heater sight glasses the KENCO style and are they clean and installed properly?

  Yes

  No

  N/A

• b. Is the HTTR bottom sight glass drain line installed?

  Yes

  No

  N/A

• c. Is the Heater fuel pot float inspected and cleaned and does it have unions installed for easy access?

  Yes

  No

  N/A

• d. Are hot oil inlet and vent valves installed in the proper places on the Heater lines with check valves?

  Yes

  No

  N/A

• e. Has a PM been completed on BMS with control valves/regulators?

  Yes

  No

  N/A

• f. Are there any signs of corrosion/leaks on HTTR and any lines connected to it?

  Yes

  No

  N/A

• 2. Has LOTO been performed on HPS by Chesapeake Representative?

  Yes

  No

  N/A

• a. Has HPS fuel pot float been inspected/cleaned and have unions been installed for easy access?

  Yes

  No

  N/A

• b. Has the HPS and piping been visibly inspected for corrosion/leaks and has the issue been repaired/replaced if necessary?

  Yes

  No

  N/A

• c. Have LLCs/regulators been repaired/replaced if showing signs of leak or corrosion?

  Yes

  No

  N/A

• d. Have HPS sight glasses been cleaned/repaired/replaced if not visible or showing signs of leaks or corrosion?

  Yes

  No

  N/A

• 3. Has Chesapeake Flare Technician been notified for Facility Tank inspection?

  Yes

  No

  N/A

• a. Has a visual inspection been completed on all Tanks and piping for corrosion/leaks and has the issue been repaired/replaced if necessary?

  Yes

  No

  N/A

• b. Have the Enardo 660 thief hatches been inspected/cleaned/repaired/replaced if gaskets, springs, or Enardo 660 thief hatch itself is leaking/damaged/corroded?

  Yes

  No

  N/A

• c. Have the Enardo 2008 EPRVs been inspected/cleaned/repaired/replaced if gaskets, weights, or EPRV itself is leaking/damaged/corroded?

  Yes

  No

  N/A

• d. Have the Enardo 950 vent valves been inspected/cleaned/repaired/replaced if pallets, gaskets, weight settings, or Enardo 950 itself is leaking/damaged/corroded?

  Yes

  No

  N/A

• e. If Tanks have Lact Unit, has the filter strainer been inspected/cleaned if necessary and are there any signs of corrosion/leaks that need be repaired if necessary?

  Yes

  No

  N/A

• 4. Has LOTO been performed on Flare Stack by Chesapeake Representative?

  Yes

  No

  N/A

• i. Have Flare drums and piping been visibly inspected for any signs of corrosion/leaks and have they been repaired/replaced if necessary?

  Yes

  No

  N/A

• a. Are Flare drum LLCs/regulators showing signs of leaks/corrosion and have they been repaired/replaced if necessary?

  Yes

  No

  N/A

• b. Are KENCO sight glasses installed on Flare drums and have they been cleaned/repaired/replaced if necessary?

  Yes

  No

  N/A

• c. Have Flare drum pumps/jatco pot been visibly inspected for any signs of corrosion/leaks and have they been repaired/replaced if necessary?

  Yes

  No

  N/A

• d. Has 1" supply line filter been inspected and cleaned/repaired/replaced if necessary?

  Yes

  No

  N/A

• e. Have Kimray 130 valves been set in a horizontal position and have they been inspected/cleaned/repaired/replaced if necessary?

  Yes

  No

  N/A

• ii. Has Flare Stack and piping been visibly inspected for any signs of corrosion/leaks and have they been repaired/replaced if necessary?

  Yes

  No

  N/A

• a. Has flame arrestors, pilot, orifice, regulators, and y strainers been inspected and cleaned/repaired/replaced if necessary?

  Yes

  No

  N/A

• b. Has orifice and y strainer been lowered for better accessibility in maintenance and repair?

  Yes

  No

  N/A

• c. Has 1/2" pilot line upstream orifice been replaced with 1" line?

  Yes

  No

  N/A

• d. Has Jatco pot been inspected/cleaned/repaired/replaced if needed and is there a wooden box around pot?

  Yes

  No

  N/A

• Name and Signature of Inspector Completing Facility PM

  Sign

• Name and Signature of Chesapeake Representative

  Sign

• Add all Relevant Photos

  Media

• Have all required Corrective Actions been added as Actions to this Inspection?

  Yes

  No

  N/A