Title Page

  • Site Name:

  • Location
  • Date of Visit:

  • Visited by:

  • Network:

Site Documentation

1. Site Documentation

1.1

  • For sites with kiosks is the site log book available and up to date?

  • Is electrical equipment fitted on site including within all buildings suitably rated for use with the zone/area in which it is installed as shown upon the site sr25 hazardous area drawing.?

Site Civils, Access & Security

2. Site Civils, Access & Security

2.1

  • Is there good vehicular access and parking?

2.2

  • Are all gates:

  • In good condition?

  • Securely locked?

  • Unable to be lifted off their hinges?

  • Gate stops / restraint mechanism fitted and working safely?

2.3

  • Are emergency / personnel exits:

  • Provided?

  • Operational in a safe manner?

  • Free from obstruction?

  • Is appropriate signage fitted to the inside and outside of all site panic gate,s?

  • Is the area beyond the panic gate,s including escape route free from obstruction.?

  • Secure from outside the site?

  • Are the gate,s padlocked, is the instruction to unlock before commencing work present?

2.4

2.5

  • Security fence:

  • Type.?

  • In good order?

  • Are any retaining walls in satisfactory condition?

2.6

  • Is there any evidence of unauthorised access?

  • Are there any features close to the fence which would aid unauthorised access?

  • Is there any vandalism to the site?

2.7

  • Is site lighting provided?

  • Does the site lighting appear sufficient for safe access / egress?

  • Is the site lighting switch:

  • Located by the main access gates?

  • Operational?

2.8

  • Are the site identification and warning notices visible to the general public, legible and current?

  • Do the notices contain the following information?

  • Gas Emergency Service telephone number 0800 111999

  • Safety notices?

  • No Smoking?

  • Site Name & Location Number?

2.9

  • Are the current emergency contact telephone numbers displayed?

2.10

  • Is there safe access / egress to all working areas?

2.11

  • Are all roadways and footpaths in satisfactory condition?

2.12

  • Are suitable guarded access platforms provided to all high level equipment?

2.13

  • Is the ducting satisfactory and securely covered?

2.14

  • Is the site drainage satisfactory?

2.15

  • Are other civil works in satisfactory condition?

2.16

  • Is there any evidence of ground movement (subsidence etc.) on site?

2.17

  • Are valve pits securely guarded with handrails or covers?

2.18

  • Is all vulnerable equipment suitably protected against vehicular damage?

2.19

  • Is the general site housekeeping satisfactory? (e.g. Grass cutting, weed control etc.

2.20

  • Where permanent trip hazards exist on access routes, are they clearly identified / guarded?

2.21

  • Are all pipe supports in good condition and in contact with pipework.?

2.22

  • Are there any problems associated with wildlife? (e.g. Burrowing rabbits)

2.23

  • Are all site buildings and kiosks securely locked?

Electrical & Instrumentation

3 General Electrical

3.1

  • Are there any obvious electrical faults / issues.

4 General Telemetry

4.1

  • Are there any obvious telemetry faults / issues.

5 General Instrumentation

5.1

  • Are there any obvious instrumentation faults / issues.

Regulator Buildings

6 Regulator Buildings

6.1

  • Are the regulators under cover? Specify type:

6.2

  • If the regulators are covered:

  • Is the cover in good condition?

  • Does the hydraulic mechanism operate satisfactorily?

  • Are the runners in good condition?

  • Is there safe access / egress to the regulators.?

6.3

  • If installed, are light switches:

  • In good working order?

  • Suitably located?

6.4

  • Are exits:

  • Suitably positioned?

  • Unobstructed?

6.5

  • Does the ventilation appear to be:

  • Free from obstruction?

6.6

  • Is the building:

  • Clean and tidy?

  • Are buildings in a satisfactory condition, free from water ingress, doors intact, etc.

6.7

  • Is the building fitted with an explosion relief roof and/or panels?

6.8

  • Are all relief vents:

  • Piped to outside?

  • At a safe Height<br>

  • Protected against ingress of water / dust / dirt

6.9

  • Are the areas requiring the use of ear defenders adequately identified?

6.10

  • Are on-site noise insulation and attenuation measures still intact and working? (e.g. Noise lagging materials and door seals in good repair etc.)

Regulators, Plant & Pipework

7 Regulators, Plant & Pipework

7.1

  • Are the following labelled in accordance with the PSSR schematic diagram:

  • Valves and regulators?

  • Streams?

  • Heaters?

  • Filters?

7.2

  • Are all valve handles / wheels:

  • Securely locked?

  • Removed?

  • Secure by location?

7.3

  • Can pipework and plant be worked on safely?

7.4

  • Is the condition of the pipe coating/wrapping system satisfactory?

7.5

  • Does the coating have an excessive covering of algae?

7.6

  • Is the impulse pipework supported?

7.7

  • Is there evidence of corrosion on the impulse pipework?

7.8

  • Is there evidence of any gas leakage from the equipment, associated pipework and plant?

7.9

  • Are filter bodies in a satisfactory condition?

7.10

  • Are continuity bonds fitted and in a satisfactory condition?

7.11

  • Is there evidence of excessive pipe or impulse pipework vibration.?

7.12

  • Does there appear to have been any significant movement of the pipework on site, particularly around the pig traps?

7.13

  • Are control cabinets locked and labelled?

7.14

  • Are the pressure settings available to staff?

Waterbath Heaters

8 Waterbath Heaters

8.1

  • Are Waterbath heaters installed?

8.2

  • Are they operational at the time of the visit?

8.3

  • Are flues in good condition? (e.g. No signs of rust (bottom of flue), terminal in good condition)

8.4

  • Are there signs of complete combustion? (e.g. No soot on the flue)

8.5

  • Is the burner box in good condition? (e.g. no rust, holes in box)

8.6

  • Is the lagging / outer casing in good condition?

8.7

  • Is the control cabinet (if fitted) in good condition? (e.g. no rust)

8.8

  • Is the control equipment in good condition?

8.9

  • Is there any evidence of water leakage from the Waterbath heater?

Boilers

9 Boilers/electrical pre heating

9.1

  • Are boilers/electrical pre heater/s installed.?

9.2

  • Are they operational at the time of the visit?

  • Is there an up-to-date mechanical, instrumentation and electrical schematic diagram available on site?

9.3

  • Are the flues in good order? (e.g. sealed correctly, no obvious leakage, flue termination in good condition etc.)

9.4

  • Are there any signs of complete combustion? (e.g. No soot on flue, around boiler)

9.5

  • Do the boilers/heaters look in good condition?

9.6

  • Is all the pipework adequately protected and painted so they are easily identified?

9.7

  • Have all hot surfaces been adequately insulated to reduce heat loss and prevent burns?

9.8

  • Is the pipe lagging on the heating circuits:

  • Adequate?

  • In good condition?

9.9

  • Are the relief vents from the boiler vented to outside?

  • If so:

  • Relief vents have not operated (e.g vents are not passing water ?)

9.10

  • Is the boiler control unit in good condition and correctly labelled for easy identification?

Cathodic Protection

10 Cathodic Protection

10.1

  • Is there any Cathodic Protection for the site?

10.2

  • Are the posts in good condition & fitted with covers.?

Land Issues

11 Land Issues

11.1

  • Are there any plant protection issues on site or caused by activities taking place on adjacent sites?

  • Confirm that there are no obvious environmental issues on site which have been caused by activities taking place on adjacent sites?

Spill Control

12 Spill Control

12.1

  • Are drums containing liquids stored on site?

  • If so:

  • Are they in good condition?

  • Are they appropriately labelled?

  • Are they stored appropriately?

12.2

  • Is there evidence of solid or liquid spills?<br>(Pay particular attention to site drains, watercourses, and at points of loading and offloading?

12.3

  • Does the site have any emergency spill control measures?<br>(e.g. absorbent granules, containment booms, drain isolation covers, etc)

Asbestos

15 Asbestos

15.1

  • Are there any known materials containing asbestos in use on site shown within site,s Asbestos survey report?<br>(e.g. pipe & boiler insulation, roofing materials, flues, boarding, gaskets, etc.)

Herbicides

16 Herbicides

16.1

  • Are herbicides used on site to control weeds?

16.2

  • Are notices/application records available on site to inform those attending site what herbicides have been used and when?

Additional Photographs

Photographs and associated comments:

  • Photograph 1:

  • Comments Regarding Photograph 1:

  • Photograph 2:

  • Comments Regarding Photograph 2:

  • Photograph 3:

  • Comments Regarding Photograph 3:

  • Photograph 4:

  • Comments Regarding Photograph 4:

  • Photograph 5:

  • Comments Regarding Photograph 5:

  • Photograph 6:

  • Comments Regarding Photograph 6:

  • Photograph 7:

  • Comments Regarding Photograph 7:

  • Photograph 8:

  • Comments Regarding Photograph 8:

Additional Comments

  • Comments 1:

  • Comments 2:

  • Comments 3:

  • Comments 4:

  • Comments 5:

  • Comments 6:

  • Comments 7:

  • Comments 8:

  • Comments 9:

  • Comments 10:

Summary

  • Summary Comments:

  • Signature of Reviewer:

  • Signature of Additional Reviewer:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.