HBL HCAPP

• Audit Title

• HBL Job #:

• Conducted on:

  Date

• Facility:

• Project:

• Prepared by

• Hoyt, Brumm & Link, Inc. is committed to providing a safe and healthy work environment for all employees and subcontractors. Employees and subcontractors are expected to comply with all applicable safety rules and regulations.

To be completed by supervisor prior to commencing work.

• Have you and/or the assigned employees inspected the work area?

  Yes

  No

• Are any work permits required for today's work?

  Yes

  No

• Have all required work permits been received?

  Yes

  No

• IF YOU HAVE NOT RECEIVED A PERMIT, AND ONE IS REQUIRED, THEN THE JOB MUST NOT PROCEED UNTIL A PERMIT IS ISSUED

• Do today's tasks require special training, licenses, or certifications?

  Yes

  No

• Have properly trained & qualified personnel been assigned?

  Yes

  No

• Do any of today's tasks require air monitoring?

  Yes

  No

• "Confined Space" means a space that: (1) Is large enough and so configured that an employee can bodily enter and perform assigned work; and (2) Has limited or restricted means for entry or exit (for example, tanks, vessels, silos, storage bins, hoppers, vaults, and pits are spaces that may have limited means of entry.); and (3) Is not designed for continuous human occupancy.

• Do any of today's tasks involve a confined space?

  Yes

  No

• Does the confined space meet the definition of a PRCS?

  Yes

  No

• Have all the requirements of the HBL and/or owner PRCS program been satisfied ?

  Yes

  No

• In addition to the (3) requirements that make a space a confined space, a "Permit Required Confined Space" (PRCS) also has one or more of the following characteristics: (1) Contains or has a potential to contain a hazardous atmosphere; (2) Contains a material that has the potential for engulfing an entrant; (3) Has an internal configuration such that an entrant could be trapped or asphyxiation by inwardly converging walls or by a floor which slopes downward and tapers to a smaller cross-section; or (4) Contains any other recognized serious safety or health hazard.

• Are assigned personnel familiar with the work to be performed, the associated hazards, and the control measures and safe work practices necessary to reduce or eliminate hazards?

  Yes

  No

• Has this HCAPP been effectively communicated with the owner's designated representative and all required notifications been made to same?

  Yes

  No

  N/A

• Are assigned personnel familiar with evacuation routes & emergency procedures associated with this HCAPP?

  Yes

  No

• Is necessary emergency equipment such as first aid kits, fire extinguishers, eyewash stations, etc. readily available and in satisfactory condition?

  Yes

  No

• Have the required materials, tools & equipment been provided and inspected?

  Yes

  No

• If the work area is congested or the work impacts other trades, has the work plan been coordinated with other trades?

  Yes

  No

  N/A

• Is a SDS review necessary for any of today's tasks?

  Yes

  No

• Should HBL safety be present for any of today's tasks?

  Yes

  No

• CONTACT HBL SAFETY DIRECTOR PRIOR TO PERFORMING TASK

• If at any time the scope of work exceeds the parameters of, varies from, or exposes hazards not addressed in this HCAPP... ◆◆◆STOP◆◆◆ It is the responsibility of a competent or qualified person to assess and identify any new risks as well as the associated hazards and control measures necessary to mitigate or eliminate those hazards. The work outlined in this HCAPP must be suspended until the new risks are identified and the hazards addressed. Any and all changes to this HCAPP must be communicated to all affected employees.

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(CHECK ALL THAT APPLY)

• Control of Hazardous Energy (LOTO)

• Elevated Work - Fall Potential

• Hot Work - Welding / Cutting / Grinding

• Limited Access - Confined Spaces

• Material Handling - Lifting / Rigging

• Moving Equipment, Vehicles, Conveyors

• Chemical and/or Environmental

• Health Hazards

• Other:

• Other:

LOTO - CONTROL OF HAZARDOUS ENERGY

• Gas

• Steam

• Hydraulic

• Pneumatic

• Water

• Electric

• Other:

• Do any of the above energy states exist, and need to be controlled prior to work

  Yes

  No

  N/A

• All Feeds Identified

• Equipment or Process Shut Down

• Equipment / Process Isolated & LOTO

• Control of Stored Energy (Blocking/Blanking/Bleeding/De-Energizing/Purging)

• Isolation Verified

ELEVATED WORK

• Fall from Height

• Ladders

• Aerial Work Platforms

• Roof Work

• Scaffolding

• Holes / Falling Objects

• Other:

MATERIAL HANDLING | LIFTING / RIGGING | MOVING EQUIPMENT

• Struck By

• Caught Between

• Lifting Rigging

• Equipment Loading / Unloading

• Pinch Points

• Sharp Objects

• Crane Action Plan / Critical Lift

• Heavy Equipment

• Manual Lifting

• Elevated Loads

• Other:

HOT WORK - WELDING / CUTTING / GRINDING

• Fire / Explosion

• Compressed Gasses

• Thermal Burns

• Toxic Fumes

• Other:

LIMITED ACCESS | CONFINED SPACES | UNSTABLE CONDITIONS

• Confined Space / PRCS

• Inadequate Access

• Excavations / Trenches

• Isolated Work Area

• Other:

CHEMICAL

• Chemical Spill

• Chemical Burns

• SDS Review

• Radiation

• Other

ENVIRONMENTAL

• High Heat Exposure

• Cold Exposure

• Snow / Ice

• High Winds

• Poor Lighting

• Other:

HEALTH HAZARDS

• Asbestos / Lead

• Cadmium / Chromium VI

• Hazardous Chemicals

• Inhalation Hazards

• Other:

PPE RELATED

• Particles in Eyes

• Flying Sparks & Debris

• Working at Height

• High Noise Levels

• Hand Lacerations

• Material Striking Feet

• Respirators / Supplied Air / SCBA

• Chemical Splash

• Other:

GENERAL / OTHER

• Electrical Shock

• Powered Tools

• Housekeeping

• Slips & Trips

• Plant Operation Impact

• Other:

• Other:

PERMITS REQUIRED

• Hot Work

• Confined Space

• Roof Access

• Lifting / Rigging

• Other:

• Special Licenses Required:

• Skills / Certifications Required:

• Hardhats Required

• Eye Protection Required

• Full Faceshield Necessary

• Gloves Necessary

• Hi-Viz Clothing Required

• Personal Fall Arrest System Necessary

• Hearing Protection Necessary

• Respirator Necessary

• Coveralls (Cleansuit) Necessary

• Thermal Protection Necessary

• Other:

• Special Equipment:

By signing below, employees are confirming that they have reviewed the assigned work tasks and have been made aware of, or will request further information regarding the associated hazards and preventative measures necessary to mitigate or reduce the likelihood of any potential hazards. All employees at all levels and all subcontractors are expected to work in a safe manner themselves and to encourage their fellow co-workers to do the same. Any and all safety and health concerns should be immediately directed to HBL's site supervisor or HBL's Safety Director.

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