Gas Projects

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

WHAT TYPE OF WORK IS BEING PERFORMED? & HOW MANY MEMBERS ARE ON THE CREW?

JOB BRIEF (H&M SAFETY HANDBOOK section 8.2, PG., 48)

• Is the job brief complete in its entirety?

  Yes

  No

  N/A

• Is the Job brief signed by all employees and visitors on site?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT (H&M SAFETY HANDBOOK section 7.1, PG., 36)

• Are all employees wearing proper PPE (including gloves)?

  Yes

  No

  N/A

• Are employees wearing pants and long or short sleeve shirts? <br>(Sleeveless shirts are prohibited)

  Yes

  No

  N/A

• Are workers using the right PPE for the task? <br>i.e.,If an employee is welding, is he/she wearing proper gloves, clothing, face shied.

  Yes

  No

  N/A

HOUSEKEEPING (H&M SAFETY HANDBOOK section 14.1, PG., 83)

• Is the Jobsite Clean & Organized? <br>

  Yes

  No

  N/A

• Is the walkway free of Tripping Hazards? <br>

  Yes

  No

  N/A

• Are the Porter Johns Cleaned and in good condition?

  Yes

  No

  N/A

DIRECTIONAL DRILLING

• Is the directional drill barricaded properly?

  Yes

  No

  N/A

• Was the drill inspected, in good use and clean from previous use?

  Yes

  No

  N/A

• Is the directional drill grounded?

  Yes

  No

  N/A

• Is the safety bar on the drill released?

  Yes

  No

  N/A

• Is the operator maintaining clear communication with the locater?

  Yes

  No

  N/A

• Are employees wearing di-electric boots within 25ft of the drill and bore rod?

  Yes

  No

  N/A

• Is the drill barricaded properly?

  Yes

  No

  N/A

• Are rubber goods current and attached to the drill?

  Yes

  No

  N/A

LOCATES / DIGGING (H&M SAFETY HANDBOOK section 25.1, PG., 190)

• Were underground facilities located before digging?

  Yes

  No

  N/A

• Is the digger number onsite, along with the dig start date and expiration date?

  Yes

  No

  N/A

• Was the gas monitor bumped tested before use?

  Yes

  No

  N/A

• Was atmospheric testing complete and readings documented at 3ft? (PGL A4.7.2 Jobsite Inspection, PG., 88)

  Yes

  No

  N/A

• Is the spoil-pile 2ft away from the excavation?

  Yes

  No

  N/A

WORK AREA PROTECTION (H&M SAFETY HANDBOOK section 19.1, PG., 107)

• Is the Work Zone Secured from Pedestrians with proper barricades, fencing or cone bars?<br>

  Yes

  No

  N/A

• Pedestrian Walkway free of Tripping Hazards? <br>

  Yes

  No

  N/A

• Sidewalk Closed Signs Posted? <br>

  Yes

  No

  N/A

• Alternative Walkway provided when applicable? <br>

  Yes

  No

  N/A

• Transition Area Established and cones spaced correctly?<br>

  Yes

  No

  N/A

• Are the proper advance warning signs posted and spaced properly?

  Yes

  No

  N/A

FLAGGING (H&M SAFETY HANDBOOK section 19.4, PG., 112)

• Do all flaggers have their flagger cards?

  Yes

  No

  N/A

• Is the flagger card on their person, along with a state ID or drivers license?

  Yes

  No

  N/A

• Are all flagger cards valid?

  Yes

  No

  N/A

• Are stop/slow paddles 5'-7' in height, 24"X"24 in diameter and readable with ridged edges?

  Yes

  No

  N/A

• If in an emergency situation, is the flagger using a 24" red flag?

  Yes

  No

  N/A

• Is the flagger wearing the proper PPE and facing traffic while flagging?

  Yes

  No

  N/A

• Are the flaggers communicating with each other?

  Yes

  No

  N/A

ENVIORMENTAL (H&M SAFETY HANDBOOK section 29.1, PG., 213)

• If employees are using the wet cut method to cut concrete, is the silica dust being contained properly? <br>

  Yes

  No

  N/A

• Crew Leader - SDS sticker on Hard Hat? <br>

  Yes

  No

  N/A

• Are spills being contained properly?

  Yes

  No

  N/A

• is silk screen being used for sewer inlet?

  Yes

  No

  N/A

VEHICLE / EQUIPMENT INSPECTION

• Are wheel chocks used on all commercial vehicles , trailers, and towed equipment? (PGL pg. 120)

  Yes

  No

  N/A

• Are proper first aid kit, burn kit and fire extinguisher labels posted on the outside of the vehicle?

  Yes

  No

  N/A

• Vehicle have burn kit?

  Yes

  No

  N/A

• Vehicle have first aid kit?

  Yes

  No

  N/A

• Straps, chains, and other lifting material is in good condition? <br>no frays, tears, rips, etc.

  Yes

  No

  N/A

CONFINED SPACE H&M Safety Handbook - Section 20.1

• Is the confine space permit complete before work commence?

  Yes

  No

  N/A

• Was atmospheric testing conducted before entering the confine space?

  Yes

  No

  N/A

• Vehicle have updated fire extinguisher?

  Yes

  No

  N/A

• Were atmospheric results recorded on H&M confine space entry form?

  Yes

  No

  N/A

• If the manhole was pumped, was it retested before entering?

  Yes

  No

  N/A

• Is the four gas meter calibrated and up to date?

  Yes

  No

  N/A

• Does the ladder extend 3ft above the surface of the confine space and secure?

  Yes

  No

  N/A

• Is rescue/retrieval equipment readily available and near confine space?

  Yes

  No

  N/A

• Is the employee wearing a full body harness while inside the confine space?

  Yes

  No

  N/A

EXCAVATION H&M Safety Handbook - Section 21.1

• Is the excavation checklist complete prior to all excavating activity?

  Yes

  No

  N/A

• If electrical wires are in the confine space, is it confirmed that wires are dead and/or locked out tagged out? <br>

  Yes

  No

  N/A

• Was atmospheric testing complete at 3ft? (Per PGL requirements)<br>

  Yes

  No

  N/A

• Was the soil type determined before digging ? <br>

  Yes

  No

  N/A

• If the trench is 4ft or more in depth, is there a means of exit?

  Yes

  No

  N/A

• Are ladders secure and extended 36" above the landing?

  Yes

  No

  N/A

• Are methods of controlling standing water and water accumulation put in place?

  Yes

  No

  N/A

• Is there a ladder every 25ft of the excavation, or near employees?

  Yes

  No

  N/A

• Are employees removed from trench during a rainstorm?

  Yes

  No

  N/A

• Is the excavation greater than 5ft bench, shored or sloped?

  Yes

  No

  N/A

• Is the excavation 20ft deep or greater? Was the protective system designed by a registered professional engineer?

  Yes

  No

  N/A

• Is tabulated data on site and/or readily available?

  Yes

  No

  N/A

• Is shoring complete to specifications?

  Yes

  No

  N/A

• Is there a updated fire extinguisher within 5ft of where the crew is working?

  Yes

  No

  N/A

• If the trench/excavation is 6ft or greater, are guardrails installed that withstand the weight of 200lbs in any direction? (PGL) - PG. 88)

  Yes

  No

  N/A

• Is ten feet of clearance maintained from overhead electrical lines ?

  Yes

  No

  N/A

• Cutting Woods (timbers, etc.): Is the employee wearing a face shield, chaps and ear plugs while using the chain saw?

  Yes

  No

  N/A

• is the chain saw stored properly?

  Yes

  No

  N/A

• Are permanent identification tags attached to the rigging equipment? (22.4.2.4)

  Yes

  No

  N/A

• Was all rigging equipment inspected and is in good condition - (non suspect or counterfeit chains are to be used?) (22.2.2 / 22.2.3)

  Yes

  No

  N/A

• Was the weight of the load determined and was the proper size for slings and components made-out? (22.3.1.1/22.3.1.2)

  Yes

  No

  N/A

EQUIPMENT

• Is the condition of the equipment in good shape?

  Yes

  No

  N/A

• Was equipment inspected before use?

  Yes

  No

  N/A

• Does the tool cord and/or extension cord have a current monthly inspection sticker? (in accordance with H&M assured grounding program)

  Yes

  No

  N/A

• Are employees using the right equipment for the job?

  Yes

  No

  N/A

Hot Work (PGL A4.4.1 Pg. 77)

• Is a fire watch present for at least 30 minutes to ensure no flare up?

  Yes

  No

  N/A

• Are cylinders chained and stored properly in an upright position with the valves closed? Are cylinders stored away from oil, grease, chemicals and other combustibles?

  Yes

  No

  N/A

• If hot work is taking place, is the hot permit complete in its entirety and is at least 50ft. away from where work is taking place?

  Yes

  No

  N/A