Field Service Site Safety Inspection

• Conducted on

  Date
• Location
  Address

• CLIENT

• SUPERVISOR/FOREMAN

• HEALTH & SAFETY MANAGER

• JOB NUMBER

• JOB DESCRIPTION

HAZCOM (1910.1200)

• MSDS available on site?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Hazardous work permit completed and signed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Have critical tasks been identified on permit?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Project specific JHA available?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is JHA being followed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Daily Safety meeting held & attended by crew?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

Emergency & Post Emergency Response (1910.120)

• Is this response an emergency or post emergency response?

  Yes

  No

  N/A

• Safety plan signed by crew?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• SSHASP completed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Chapters 1 - 12 attached to chapter 13?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Task specific hazardous work plan completed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

PERSONAL PROTECTIVE EQUIPMENT (1910.132)

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• PPE appropriate for task?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• PPE being properly worn by crew ?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Respiratory Protection being utilized ?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

AIR MONITORING

• Does this task require air monitoring?

  Yes

  No

  N/A

• Appropriate air monitoring being conducted?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Air monitoring instruments properly calibrated?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Readings properly documented?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Action Levels being adhered to ?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is continuos CO monitoring required

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

EMERGENCY PREPAREDNESS

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Location of nearest hospital documented and known by crew?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

ELECTRICAL SAFETY

• Does this task require electrical safety?

  Yes

  No

  N/A

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are equipment leads and extension cords in good repair?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

FIRE SAFETY

• Does this task require fire safety?

  Yes

  No

  N/A

• Are a sufficient number of fire extinguishers present?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are all extinguishers inspected with tags attached?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Has bonding and grounding been checked for continuity?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Have all ignition sources been eliminated?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is LEL area monitoring been conducted?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

HOT WORK

• Does this task require hot work?

  Yes

  No

  N/A

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is the Hot Work permit properly completed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Have explosive atmospheres been eliminated (35 feet)?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are welding blankets being utilized where necessary?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

LOCKOUT / TAGOUT (1910.147)

• Does this task require lock out/tag out?

  Yes

  No

  N/A

• Is a LO/TO Permit completed and available?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Have all types of energy been de-energized?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Do all affected employees have locks applied?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are all other LO/TO Procedures being followed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

EXCAVATION/TRENCHING (1926.651-652)

• Does this task require excavation and/or trenching?

  Yes

  No

  N/A

• Have all utilities been identified or marked?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is there a competent person on site?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is standing water in the excavation being controlled?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Has the excavation been evaluated for confined space hazards?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

Pressure Washing

• Does this task require pressure washing?

  Yes

  No

  N/A

• Are hoses protected by whip checks?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is the wand at least 48 inches long?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are hoses connected by threaded unions?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are shin guards/metatarsals utilized?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

HIGH PRESSURE WATER JETTING

• Does this task require high pressure water jetting?

  Yes

  No

  N/A

• Has the HPWJ checklist been completed & signed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Hoses pressure tested & tagged?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Work area barricaded & HPWJ signs posted?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are whip checks utilized?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Metatarsal guard/shin guards used?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Medical cards carried by all personnel?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Does this task utilize shot gun lancing?

  Yes

  No

  N/A

Shot Gun Lancing

• Barrel proper length?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Dump control valves used & functioning properly?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Body armor used at > 5Kpsi

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Does this task utilize manual flex lancing?

  Yes

  No

  N/A

Manual Flex Lancing

• Lance protector used?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Stinger used?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Anti-withdrawal devices used & appropriate size?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Lance marked 3-feet from tip?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Body armor worn at all pressures?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Lance operator operating his own foot pedal?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• No live withdrawals in progress?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

SCAFFOLD & ELEVATED LIFT SAFETY (1910.128)

• Is scaffolding or elevated lift being utilized?

  Yes

  No

  N/A

• All personnel "User" trained?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Competent Person on site?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Scaffolding erected according to guidelines?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Daily inspection documented?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Inspection tag or equivalent attached to scaffold?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are all components in good working condition?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Load limits documented and followed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is an aerial lift being utilized?

  Yes

  No

  N/A

Aerial lifts

• Manual reviewed by operator?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Daily inspection completed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Full body harness and lanyard used in basket?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

VACTOR SAFETY

• Is vactor equipment being utilized?

  Yes

  No

  N/A

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Double hearing protection used?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Hose secured to prevent "bucking"

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

WORKING ON OR NEAR WATER

• Does this task require working on or near water?

  Yes

  No

  N/A

• Has a boating safety checklist been completed?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Has the boat operator been certified by CHES?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are appropriate PFD's being used?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

FALL PROTECTION (GREATER THAN 6 FEET)

• Is fall protection required for this task?

  Yes

  No

  N/A

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Are harnesses and appropriate lanyards being worn?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

MISCELLANEOUS SAFETY ITEMS

• Have appropriate smoking and eating areas been designated?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

• Is the work zone properly barricaded or secured?

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

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

  Acceptable

  Deficient

  Correct Immediately

  Further Action Required

  Non Applicable

GENERAL SITE CONDITIONS OR COMMENTS

• Site Conditions?

  Excellent

  Good

  N.I.

  Poor

  Unsatisfactory

• Attach picture of site if applicable.

  Media

• Comments?

Action Items

• Site description?

• REVIEWED H&S MANAGER:

  Sign

• SUPERVISOR / FOREMAN

  Sign