Information

  • Project #

  • Order #

  • Job Type

  • Division #:

  • Conducted on

  • Prepared by: Joshua T. Shaw

  • Location
  • Personnel

  • Signature of Teammates completing Audit

Safety & PPE

  • Daily Field Report

  • Buffer Zone Established

  • Electrical Cables Managed

  • Vehicle Warning Lights Operating

  • Worksite Free of Tripping and Slipping Hazards

  • Vehicle Warning Lights Operating

  • Properly Maintained and Housekeeping (worksite free of clutter)

  • Proper Cone Placement

  • Placement of Vehicle and Ignition Sources away and Upwind from Work Area

  • Proper Return/Transition Area

  • Work Area Marked/Identified

  • Tools Properly Staged and Stored

  • Pedestrian Traffic Addressed

  • Flagger(s) present if necessary

  • Excavation Protected by Cones and/or Barricades

  • Meter(s) Properly Stored

  • Personal Protective Equipment

  • Hard Hat

  • Gloves

  • Eye Protection

  • Proper Footwear (foot protection)

  • Respiration Protection

  • Measures for Bonding Stray Current

  • Proper Clothing Used

  • Atmospheric Monitoring

  • Fall Protection

  • Traffic Vest

  • Hearing Protection

  • Face Protection

  • All PPE in Clean and Serviceable Condition

  • O2 Monitor Calibrated and used when necessary

  • Excavation Safety

  • Equipment and Tools

  • Availability and Conditions of Tools

  • Hand Tools in Good Condition

  • Air Hoses and Fittings in Good Condition

  • Flashlight Intrinsically Safe (Class 1 DIV 1)

  • Gauges and Instruments Calibrated

  • Power Tools not used in a Gaseous Atmosphere

  • Welding Cables Free of Splices within 10' of holder

  • Critical Valve Key on Vehicle (2" Gate Key)

  • Grounding-Tools/Pipes/Containers

  • Ladders in Good Condition

  • Equipment Calibrated

  • Guards on all Portable Tools

  • Vehicles

  • Engine Off when Parked

  • Low Gear or Reverse when Parked (manual)

  • Wheels Chocked

  • Ignition Keys Removed when Unattended

  • Parking Brake Set

  • Vehicle Free of Clutter and in Cab Distractions

  • MDT Properly Secured

  • Vehicle Backed into Parking Space where Practicle

  • Mirrors Adjusted Properly

  • Strobes and/or Warning Lights in Use at Night

  • Insurance and Crash Packet Available

  • Ergonomics

  • Employees Away from Pinch Points

  • Proper Lifting Techniques Used

  • Employees Positioned Away from Moving Equipment and Parts

  • Proper Body Mechanics (Pull/Push)

  • Slings

  • HAZMAT/Chemicals

  • Recognition of Hazards

  • Motor Carrier Safety

  • Electrical Equipment

  • Fire Protection/First Aid

  • Fire Extinguisher Inspected Monthly

  • First Aid Kit Complete and Sanitary

  • First Aid Kit Consumables Replaced

  • Fire Extinguisher Tag Current

  • Fire Extinguisher Positioned Properly

  • Appearance

Plant & Construction

  • Welding Operations

  • Welding Operations

  • Welding Operations

  • Welding Operations

  • Welding Operations

  • Plastic Fusion

  • Joining by Mechanical Fittings

  • Install/Replace/Repair Meter & Regulator Sets

  • OQ Valid

  • Valid One Call

  • Materials Inspected

  • Followed Manufacturer's Installation Instructions

  • Properly Handled and Stored Pipe and Materials

  • Installed Service Line at the Proper Depth and Undisturbed or well compacted soil

  • Adequate Clearance from other Underground Facilities

  • EFV Installed and Applicable

  • Avoided Excessive Bending and Pipe Deflection

  • Internally Cleaned Carrier Pipe

  • Casing Ends were reamed to minimize damage to the carrier pipe; Shims were installed in casing ends around carrier pipe

  • The leading end of the carrier pipe was closed (sealed) during insertion

  • Protected Above ground Service Piping from Physical Damage

  • Protected isolated steel service lines against corrosion

  • Installed Service Line piping in a continuous straight line when possible

  • Installed tracer wire/electronic markers as applicable

  • Used bonding cables when separating steel pipelines

  • Grounded Plastic Service Lines and Tools (as applicable) whenever cutting or squeezing-off plastic lines containing gas

  • Tap Fitting Positioned Properly

  • Installed a Shut-off Type Tee at the Tap Connection that met the minimum tap hole requirements for taps smaller than 2"

  • Installed compression-type connections to effectively sustain longitudinal Pull-Out and Thrust Forces

  • Made Tap connections on 6" and smaller cast iron or ductile iron mains using an approved mechanical fitting

  • Used Casing insulators when steel pipe was installed in steel casing

  • Plastic Pipe was not inserted in above ground casing (except company approved risers)

  • Examined the carrier pipe for damage after the insertion; if damage was observed, the pipe was removed and discarded

  • Piping was properly supported at casing entrance/exit points

  • Curb valve installed when required

  • Installed valve at or near the property line or easement so that the on-off position of the valve could be easily recognized

  • Properly backfilled the trench

  • Installed warning tape in the upper 6"-12" of the trench

  • Turned Gas off at the Meter Valve (or Curb Valve as applicable)

  • Sealed gas off at the meter valve (as applicable)

  • Apply & Monitoring Corrosion Control

  • Tapping Pipelines

  • Purging Pipelines

  • Locate and Mark Underground Facilities

  • Pressure Testing Pipelines

  • Maintain line valves

  • Install/Replace/Repair Main Lines

  • Plow-in Method

  • Repair/Protect Cast Iron Pipe

  • Abandon/Deactivate Gas Piping

  • Teammate can demonstrate how to access the Gas Standards

  • Years of Service

Plus & Delta Feedback

  • Plus

  • Observation

  • Impact

  • Plan

  • Plus

  • Observation

  • Impact

  • Plan

  • Delta

  • Observation

  • Impact

  • Plan

  • Delta

  • Observation

  • Impact

  • Plan

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.