Freeman HSE Site Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

General

• List current operations.

• Has the JSA and all related documents been completed and filled out in accordance to the task being performed - to include one-call, excavation safety report, hot work, etc.?

  Yes

  No

  N/A

• Have the hazards associated with each job step been identified on the JSA?

  Yes

  No

  N/A

• Have the hazards identified been mitigated?

  Yes

  No

  N/A

• Were you approached by an employee to review JSA prior to entering work area?

  Yes

  No

  N/A

• Does the site have appropriate warning signs to identify hazards upon approaching location?

  Yes

  No

  N/A

• Is Foreman/Supervisor engaging employees and actively overseeing job tasks - Supervisor not operating equipment?

  Yes

  No

  N/A

• Upon arrival, are all employees wearing proper PPE?

  Yes

  No

  N/A

Equipment

• Can the equipment operator provide training documentation for the piece of equipment being operated?

  Yes

  No

  N/A

• Can proof of inspection be provided for trackhoe, backhoe, etc.?

  Yes

  No

  N/A

• Have all major hazards been identified and mitigated prior to operation? Has Mechanic been notified about non-conformities on equipment?

  Yes

  No

  N/A

• Is equipment being operated in a safe manner?

  Yes

  No

  N/A

• Does equipment have owner's manual? (if not, record make, model & VIN in notes)

  Yes

  No

  N/A

• Are all lifting straps in acceptable condition? (if not, remove immediately and instruct Supervisor to retrieve replacement strap)

  Yes

  No

  N/A

• Is preventative maintenance being conducted and documented?

  Yes

  No

  N/A

• Is equipment free of excessive loose objects or trash?

  Yes

  No

  N/A

• Are all trucks (inside and outside) free of excessive loose objects or trash?

  Yes

  No

  N/A

• Do all trucks have first aid kit? Is it stocked to an acceptable level?

  Yes

  No

  N/A

• Do all trucks have fire extinguisher present and mounted properly?

  Yes

  No

  N/A

• Do fire extinguishers have annual and monthly tag affixed and in date?

  Yes

  No

  N/A

• Are fire extinguishers fully charged, have pin and breakaway tie in place, and show no signs of excessive rust or damage?

  Yes

  No

  N/A

• Are all of the following in acceptable condition - seat belts, AC, windshield, brakes, mirrors, blinkers, lights, horn, leaks, tires?

  Yes

  No

  N/A

• Are seat belts being utilized while operating mobile equipment?

  Yes

  No

  N/A

Energy Control

• Does Supervisor have assigned lock box with at least 10 locks present and labeled?

  Yes

  No

  N/A

• Have all equipment location points been identified and notated on the Energy Control Form?

  Yes

  No

  N/A

• Have all locks been applied and identified properly?

  Yes

  No

  N/A

• Are tags filled out thoroughly?

  Yes

  No

  N/A

• Is lock box in acceptable condition?

  Yes

  No

  N/A

Welding

• Are welders and helpers wearing PPE properly?

  Yes

  No

  N/A

• Is the fire extinguisher easily accessible in case of emergency?

  Yes

  No

  N/A

• Is there a designated fire watch in place that is trained and competent in extinguishing operations?

  Yes

  No

  N/A

• Are compressed gas cylinders in adequate condition and at a safe distance away from where work is being completed?

  Yes

  No

  N/A

• Was extinguisher inspected prior to selection?

  Yes

  No

  N/A

• Do grinders have guards in place?

  Yes

  No

  N/A

• All welding leads in acceptable condition with no exposed wires?

  Yes

  No

  N/A

Excavations

• Have all excavations been identified and blockaded, when applicable?

  Yes

  No

  N/A

• Is excavation sloped/benched properly?

  Yes

  No

  N/A

• Is competent person for excavation on site and did competent person inspect excavation prior to entry?

  Yes

  No

  N/A

• Was the excavation tested for H2S or any other hazards prior to entry?

  Yes

  No

  N/A

• Are piles of dirt at least 2 feet away from the edge of the hole?

  Yes

  No

  N/A

Working at Heights

• Are employees tied off with acceptable devices?

  Yes

  No

  N/A

• Are all tools being used overhead tethered? If not, is the area below taped off to prevent entry of personnel to prevent fall hazard injuries?

  Yes

  No

  N/A

• Are personnel working from heights competent in doing so?

  Yes

  No

  N/A

Painting and Sandblasting

• Have all hazards related to painting or sandblasting been identified?

  Yes

  No

  N/A

• Has equipment been inspected and in good condition?

  Yes

  No

  N/A

• Is all additional PPE in acceptable condition and being utilized?

  Yes

  No

  N/A

Employee Questionnaire

• Can employees explain Energy Control Procedures?

  Yes

  No

  N/A

• Can employee explain procedures to extinguishing a fire?

  Yes

  No

  N/A

• Can employee explain topics discussed in pre-job safety meeting? (should reflect JSA hazards and mitigation steps)

  Yes

  No

  N/A

• Can employees explain hazards involved in excavation work?

  Yes

  No

  N/A

• Can employees explain hazards involved in working at heights?

  Yes

  No

  N/A

• Can employees explain hazards involved in welding and cutting?

  Yes

  No

  N/A

• Can employees explain hazards involved in driving?

  Yes

  No

  N/A

• Can employees explain hazards involved with working near "live lines"?

  Yes

  No

  N/A

• Can employees explain hazards involved with working near overhead power lines?

  Yes

  No

  N/A

• Can employees explain hazards of operating equipment without a spotter?

  Yes

  No

  N/A

• Can employees explain hazards of not wearing proper PPE?

  Yes

  No

  N/A

• Can employees explain hazards of working in hot weather?

  Yes

  No

  N/A

• Can employees explain hazards working in H2S environments?

  Yes

  No

  N/A

• Can employees explain hazards working in confined spaces?

  Yes

  No

  N/A

• Can employees explain fire prevention methods that can be used on location?

  Yes

  No

  N/A

• Can employees explain hazards related to painting or sandblasting?

  Yes

  No

  N/A

• Can employees explain the importance of the Time Out For Safety Program?

  Yes

  No

  N/A

• Can employees explain the "3 Core Expectations"?

  Yes

  No

  N/A

• Can employee explain the purpose of the Hazard Communication program?

  Yes

  No

  N/A

• Can employees explain the incident reporting procedures?

  Yes

  No

  N/A

• Additional Comments/Concerns