Information

  • Conducted on

  • Location
  • CLIENT

  • SUPERVISOR/FOREMAN

  • HEALTH & SAFETY MANAGER

  • JOB NUMBER

  • JOB DESCRIPTION

HAZCOM (1910.1200)

  • MSDS available on site?

  • Hazardous work permit completed and signed?

  • Have critical tasks been identified on permit?

  • Project specific JHA available?

  • Is JHA being followed?

  • Daily Safety meeting held & attended by crew?

Emergency & Post Emergency Response (1910.120)

  • Is this response an emergency or post emergency response?

  • Safety plan signed by crew?

  • SSHASP completed?

  • Chapters 1 - 12 attached to chapter 13?

  • Task specific hazardous work plan completed?

PERSONAL PROTECTIVE EQUIPMENT (1910.132)

  • PPE identified on permit or JHA matches what is being used?

  • PPE appropriate for task?

  • PPE being properly worn by crew ?

  • Respiratory Protection being utilized ?

AIR MONITORING

  • Does this task require air monitoring?

  • Appropriate air monitoring being conducted?

  • Air monitoring instruments properly calibrated?

  • Readings properly documented?

  • Action Levels being adhered to ?

  • Is continuos CO monitoring required

EMERGENCY PREPAREDNESS

  • Appropriate size first-aid kits on site, available and stocked?

  • Minimum of two First-aid/CPR trained personnel on site? (where appropriate)

  • Safety shower, or hose and eye wash in immediate vicinity when working with acids or caustics?

  • Emergency numbers obtained, posted and means to contact emergency services posted?

  • Location of nearest hospital documented and known by crew?

ELECTRICAL SAFETY

  • Does this task require electrical safety?

  • Is an operable Ground Fault Circuit Interrupter (GFCI) used on all equipment? (Where appropriate)

  • Is equipment appropriate for the location (e.g. U/L listed Class 1 Division 1 for flammable locations?

  • Are equipment leads and extension cords in good repair?

FIRE SAFETY

  • Does this task require fire safety?

  • Are a sufficient number of fire extinguishers present?

  • Are all extinguishers inspected with tags attached?

  • For flammable/combustible transfers, has bonding and grounding been performed?

  • Has bonding and grounding been checked for continuity?

  • Have all ignition sources been eliminated?

  • Is LEL area monitoring been conducted?

HOT WORK

  • Does this task require hot work?

  • Are available fire hoses, sprinklers or extinguishers in good repair?

  • Is the Hot Work permit properly completed?

  • Hot work equipment (torches, welders, grinders) in good repair?

  • Have containers, tanks or vessels been inerted to less than 8% oxygen?

  • Have explosive atmospheres been eliminated (35 feet)?

  • Have all wall and floor openings been covered (35 feet)?

  • Are welding blankets being utilized where necessary?

  • Has paint or coatings been removed from the area where the hot work will be conducted?

  • Have all combustible & flammable materials/liquids been removed from the area (35 feet)?

  • Has a fire watch been maintained for 30 minutes after completion of the hot work?

LOCKOUT / TAGOUT (1910.147)

  • Does this task require lock out/tag out?

  • Is a LO/TO Permit completed and available?

  • Have all types of energy been de-energized?

  • Do all affected employees have locks applied?

  • Are all other LO/TO Procedures being followed?

EXCAVATION/TRENCHING (1926.651-652)

  • Does this task require excavation and/or trenching?

  • Have all utilities been identified or marked?

  • Is there a competent person on site?

  • Is there a ladder available in the excavation for every 25 feet of travel distance?

  • For excavations over 4 feet, are sloping or shoring options being followed?

  • Are excavation spoils located at least 2 feet from the edge of the excavation?

  • Is standing water in the excavation being controlled?

  • If no personnel entry is required has a "no-mans-land" been established 3/4 of the excavation depth away from the edge?

  • Has the excavation been evaluated for confined space hazards?

Pressure Washing

  • Does this task require pressure washing?

  • Are hoses protected by whip checks?

  • Is the wand at least 48 inches long?

  • Are hoses connected by threaded unions?

  • Are shin guards/metatarsals utilized?

HIGH PRESSURE WATER JETTING

  • Does this task require high pressure water jetting?

  • Has the HPWJ checklist been completed & signed?

  • Hoses pressure tested & tagged?

  • Work area barricaded & HPWJ signs posted?

  • Are whip checks utilized?

  • Metatarsal guard/shin guards used?

  • Medical cards carried by all personnel?

  • Does this task utilize shot gun lancing?

Shot Gun Lancing

  • Barrel proper length?

  • Dump control valves used & functioning properly?

  • Body armor used at > 5Kpsi

  • Does this task utilize manual flex lancing?

Manual Flex Lancing

  • Lance protector used?

  • Stinger used?

  • Anti-withdrawal devices used & appropriate size?

  • Lance marked 3-feet from tip?

  • Body armor worn at all pressures?

  • Lance operator operating his own foot pedal?

  • No live withdrawals in progress?

SCAFFOLD & ELEVATED LIFT SAFETY (1910.128)

  • Is scaffolding or elevated lift being utilized?

  • All personnel "User" trained?

  • Competent Person on site?

  • Scaffolding erected according to guidelines?

  • Daily inspection documented?

  • Inspection tag or equivalent attached to scaffold?

  • Are all components in good working condition?

  • Load limits documented and followed?

  • Work platform complete with top rail, middle rail and toe boards?

  • Is an aerial lift being utilized?

Aerial lifts

  • Manual reviewed by operator?

  • Daily inspection completed?

  • Full body harness and lanyard used in basket?

VACTOR SAFETY

  • Is vactor equipment being utilized?

  • Vacuum relief manned and in line of sight of hose end?

  • Electric vacuum relief or in-line tee being utilized?

  • Hands & feet kept a minimum 2' from the end of the hose?

  • Double hearing protection used?

  • Hose secured to prevent "bucking"

WORKING ON OR NEAR WATER

  • Does this task require working on or near water?

  • Has a boating safety checklist been completed?

  • Has the boat operator been certified by CHES?

  • Are appropriate PFD's being used?

FALL PROTECTION (GREATER THAN 6 FEET)

  • Is fall protection required for this task?

  • Are anchor points of sufficient strength (i.e.. 5000 capacity)

  • Are harnesses and appropriate lanyards being worn?

  • If no harness/lifelines are utilized, has a warning line been placed at least 6 feet from the edge?

MISCELLANEOUS SAFETY ITEMS

  • Have appropriate smoking and eating areas been designated?

  • Is the work zone properly barricaded or secured?

  • Are appropriate work zones (hot deacon support) established and sufficient?

  • Is the system of communication utilized by the crew sufficient?

  • Is the lighting utilized on the site sufficient to safely illuminate the work zone?

GENERAL SITE CONDITIONS OR COMMENTS

  • Site Conditions?

  • Attach picture of site if applicable.

  • Comments?

Action Items

  • Site description?

  • REVIEWED H&S MANAGER:

  • SUPERVISOR / FOREMAN

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