Health & Safety Field Inspection

• Date of Inspection

  Date
• Location of Inspection
  Address

• Name

• Confirm Branch before you begin:

  Select

Health and Safety Field Inspection

• Customer Name

• What Line of Business is this Inspection for?

  Field Services

  Technical Services

  Safety Kleen Environmental

• TS / Retail / Insite Task Being Inspected?

  Select Centrifuge Vacuum Services Inspections Material Handling Drum Handling Bulking/Consolidating Forklift Operations Waste Segregation HHW Lab Pack Pour Off Dewatering Solid Waste Management Healthcare Retail Clean Pack Flex Bins Paintcare Medical Waste Handling Packing Light Bulbs Cylinder Handling Lab Move(Lab Pack) Overpacking High Haz DEA TSA Other

  • Centrifuge
  • Vacuum Services
  • Inspections
  • Material Handling
  • Drum Handling
  • Bulking/Consolidating
  • Forklift Operations
  • Waste Segregation
  • HHW
  • Lab Pack
  • Pour Off
  • Dewatering
  • Solid Waste Management
  • Healthcare
  • Retail
  • Clean Pack
  • Flex Bins
  • Paintcare
  • Medical Waste Handling
  • Packing Light Bulbs
  • Cylinder Handling
  • Lab Move(Lab Pack)
  • Overpacking
  • High Haz
  • DEA
  • TSA
  • Other

• Has the SOP been reviewed and JHA signed?

  Pass

  Fail

  N/A

• Has a Front Line Risk Assessment (FLRA) form been completed as required?

  Pass

  Fail

  N/A

• Are sufficient number of appropriate fire extinguishers present?

  Pass

  Fail

  N/A

• Are all fire extinguishers inspected with tags attached?

  Pass

  Fail

  N/A

• Is grounding / bonding in place with acceptable ground source?

  Pass

  Fail

  N/A

• Has grounding / bonding been checked for continuity?

  Pass

  Fail

  N/A

• Has the Power Inverter been isolated at the battery?

  Pass

  Fail

  N/A

• Has the compatibility bucket test been performed successfully?

  Pass

  Fail

  N/A

• Is the total volume to be poured less than 5 gals? if not, has H&S been contacted?

  Pass

  Fail

  N/A

• Other comments

• Containers and bags are closed and free of obvious hazards before handling/transporting?

  Pass

  Fail

  N/A

• Needlestick resistant gloves available and in use when sharps risk is present?

  Pass

  Fail

  N/A

• Waste consolidation/transfer limited to MAA only? (only rigid container handling in customer hallways and SAA’s)

  Pass

  Fail

  N/A

• Employee avoiding using hands to manipulate bagged waste as much as possible?

  Pass

  Fail

  N/A

• Cut resistant arm guards and cut resistant apron available and in use for bagged waste transfer?

  Pass

  Fail

  N/A

• Drum and container integrity assessed before handling?

  Pass

  Fail

  N/A

• Drums and containers free of gross outer contamination?

  Pass

  Fail

  N/A

• Pinch points avoided by using tools for drums with ring closures?

  Pass

  Fail

  N/A

• Are Clean Harbors Cut/puncture resistant gloves being worn for the task?

  Pass

  Fail

  N/A

• Drum carts or dollies available and in use?

  Pass

  Fail

  N/A

• Drum spinner tools available and used for drum positioning in truck?

  Pass

  Fail

  N/A

• Drums flat and level while being transported on lift gate?

  Pass

  Fail

  N/A

• Liftgate capacity not exceeded?

  Pass

  Fail

  N/A

• Employee standing to the side or top when operating liftgate?

  Pass

  Fail

  N/A

• Bulging drums not handled, isolated and call made to Health & Safety?

  Pass

  Fail

  N/A

Housekeeping

• Is the work area clean?

  Pass

  Fail

  N/A

• Is material and equipment properly stored?

  Pass

  Fail

  N/A

• Are walkways and passage's clear?

  Pass

  Fail

  N/A

• Are slip, trip and fall hazards eliminated?

  Pass

  Fail

  N/A

• Are appropriate warning signs and barriers in place?

  Pass

  Fail

  N/A

• Are mobile equipment wheels chocked?

  Pass

  Fail

  N/A

• Company Vehicles are organized and clean?

  Pass

  Fail

  N/A

• Housekeeping Comments

Emergency Preparedness

• Is the site prepared for an emergency?

  Pass

  Fail

  N/A

• First aid Kit onsite and available?

  Pass

  Fail

  N/A

• Are at least two First Aid Trained personnel onsite?

  Pass

  Fail

  N/A

• Safety Shower or eye wash available? (10ft) within working area

  Pass

  Fail

  N/A

• Emergency Numbers documented on Permits / JHA?

  Pass

  Fail

  N/A

• Location of nearest hospital documented?

  Pass

  Fail

  N/A

• Are Fire Extinguishers present?

  Pass

  Fail

  N/A

• Fire Extinguisher(s) are in compliance and tag is attached?

  Pass

  Fail

  N/A

• A site evacuation procedure has been documented and is understood by the crew?

  Pass

  Fail

  N/A

• Safe house / area has been identified when dangerous weather occurs?

  Pass

  Fail

  N/A

• Emergency Preparedness Comments

Job Related Safety Items

• Have appropriate smoking / Eating areas been designated?

  Pass

  Fail

  N/A

• Is the proper equipment onsite to complete the project safely?

  Pass

  Fail

  N/A

• Is a GFCI (ground fault circuit interrupter) used on all equipment and in good condition?

  Pass

  Fail

  N/A

• Are extension cords in good condition?

  Pass

  Fail

  N/A

• Have decontamination zones / areas been established?

  Pass

  Fail

  N/A

• Is the crew's system of communication sufficient?

  Pass

  Fail

  N/A

• Is the worksite secure?

  Pass

  Fail

  N/A

• Is the lighting safely illuminating the work zone?

  Pass

  Fail

  N/A

• Are approved safety knives being used?

  Pass

  Fail

  N/A

• Job related Safety Items

PPE (Personal Protective Equipment)

• Is the head, face, eye and neck protection appropriate for the hazard?

  Pass

  Fail

  N/A

• is the hearing protection appropriate for the hazard?

  Pass

  Fail

  N/A

• Is the hand protection appropriate for the hazard?

  Pass

  Fail

  N/A

• Take a picture of the hand protection

  Media

• Is the foot protection appropriate for the hazard?

  Pass

  Fail

  N/A

• Are the chemical protective suits appropriate for the hazard?

  Pass

  Fail

  N/A

• is special equipment appropriate for the hazard? (Hi-vis, FRC, PFD, tape and barrier cream)

  Pass

  Fail

  N/A

• Is the PPE being used match what is documented on the permit?

  Pass

  Fail

  N/A

• Is respiratory protection being used?

  Yes

  No

• Are the employees clean shaved?

  Pass

  Fail

  N/A

• Fit test is Complient?

  Pass

  Fail

  N/A

Housekeeping

• Is the work area clean?

  Pass

  Fail

  N/A

• Is material and equipment properly stored?

  Pass

  Fail

  N/A

• Are walkways and passage's clear?

  Pass

  Fail

  N/A

• Are slip, trip and fall hazards eliminated?

  Pass

  Fail

  N/A

• Are appropriate warning signs and barriers in place?

  Pass

  Fail

  N/A

• Are mobile equipment wheels chocked?

  Pass

  Fail

  N/A

• Company Vehicles are organized and clean?

  Pass

  Fail

  N/A

• Housekeeping Comments

• Site Safety Lead established and held pre-job safety meeting with all staff?

  Pass

  Fail

  N/A

• Heat stress being managed with cold water, shade or AC available and work/rest cycles established?

  Pass

  Fail

  N/A

• Vehicle traffic safety managed with use of spotters for supply vehicles and designated lanes for customer vehicles?

  Pass

  Fail

  N/A

• Customers instructed to put car in park and stay in their vehicles?

  Pass

  Fail

  N/A

• All containers checked for labels prior to removal and questionable materials brought to supervisor attention?

  Pass

  Fail

  N/A

• Spill supplies, first aid kits, fire extinguishers and safety shower/eye wash all readily available in sorting area?

  Pass

  Fail

  N/A

• Ergonomics managed with carts for material transport, mechanical assistance or team lifting for heavy/awkward items?

  Pass

  Fail

  N/A

• Dump and sort techniques or remote handling tools used to eliminate hand injuries?

  Pass

  Fail

  N/A

• SKE Task Being Inspected

  Select Parts Washer Service Driving CWS Service Oil Service Oil Offload Oily water tank transfer Drum handling Oily water/aqueous drum transfer Other SSR Task OSSR Task VSSR Task

  • Parts Washer Service
  • Driving
  • CWS Service
  • Oil Service
  • Oil Offload
  • Oily water tank transfer
  • Drum handling
  • Oily water/aqueous drum transfer
  • Other
  • SSR Task
  • OSSR Task
  • VSSR Task

Housekeeping

• Is the work area clean?

  Pass

  Fail

  N/A

• Is material and equipment properly stored?

  Pass

  Fail

  N/A

• Are walkways and passage's clear?

  Pass

  Fail

  N/A

• Are slip, trip and fall hazards eliminated?

  Pass

  Fail

  N/A

• Are appropriate warning signs and barriers in place?

  Pass

  Fail

  N/A

• Are mobile equipment wheels chocked?

  Pass

  Fail

  N/A

• Company Vehicles are organized and clean?

  Pass

  Fail

  N/A

• Housekeeping Comments

Emergency Preparedness

• Is the site prepared for an emergency?

  Pass

  Fail

  N/A

• First aid Kit onsite and available?

  Pass

  Fail

  N/A

• Are at least two First Aid Trained personnel onsite?

  Pass

  Fail

  N/A

• Safety Shower or eye wash available? (10ft) within working area

  Pass

  Fail

  N/A

• Emergency Numbers documented on Permits / JHA?

  Pass

  Fail

  N/A

• Location of nearest hospital documented?

  Pass

  Fail

  N/A

• Are Fire Extinguishers present?

  Pass

  Fail

  N/A

• Fire Extinguisher(s) are in compliance and tag is attached?

  Pass

  Fail

  N/A

• A site evacuation procedure has been documented and is understood by the crew?

  Pass

  Fail

  N/A

• Safe house / area has been identified when dangerous weather occurs?

  Pass

  Fail

  N/A

• Emergency Preparedness Comments

Job Related Safety Items

• Have appropriate smoking / Eating areas been designated?

  Pass

  Fail

  N/A

• Is the proper equipment onsite to complete the project safely?

  Pass

  Fail

  N/A

• Is a GFCI (ground fault circuit interrupter) used on all equipment and in good condition?

  Pass

  Fail

  N/A

• Are extension cords in good condition?

  Pass

  Fail

  N/A

• Have decontamination zones / areas been established?

  Pass

  Fail

  N/A

• Is the crew's system of communication sufficient?

  Pass

  Fail

  N/A

• Is the worksite secure?

  Pass

  Fail

  N/A

• Is the lighting safely illuminating the work zone?

  Pass

  Fail

  N/A

• Are approved safety knives being used?

  Pass

  Fail

  N/A

• Job related Safety Items

PPE (Personal Protective Equipment)

• Is the head, face, eye and neck protection appropriate for the hazard?

  Pass

  Fail

  N/A

• is the hearing protection appropriate for the hazard?

  Pass

  Fail

  N/A

• Is the hand protection appropriate for the hazard?

  Pass

  Fail

  N/A

• Take a picture of the hand protection

  Media

• Is the foot protection appropriate for the hazard?

  Pass

  Fail

  N/A

• Are the chemical protective suits appropriate for the hazard?

  Pass

  Fail

  N/A

• is special equipment appropriate for the hazard? (Hi-vis, FRC, PFD, tape and barrier cream)

  Pass

  Fail

  N/A

• Is the PPE being used match what is documented on the permit?

  Pass

  Fail

  N/A

• Is respiratory protection being used?

  Yes

  No

• Are the employees clean shaved?

  Pass

  Fail

  N/A

• Fit test is Complient?

  Pass

  Fail

  N/A

• Has a Front Line Risk Assessment (FLRA) form been completed as required?

  Pass

  Fail

  N/A

• Are spotters used when navigating close quarters or areas of restricted access?

  Pass

  Fail

  N/A

• Slip and trip hazards addressed or eliminated?

  Pass

  Fail

  N/A

• Environmental extremes (heat, cold noise, etc.) addressed or eliminated?

  Pass

  Fail

  N/A

• Ergonomic issues (access, lifting, push/pull, etc.) addressed or eliminated?

  Pass

  Fail

  N/A

• Are sufficient number of appropriate fire extinguishers present?

  Pass

  Fail

  N/A

• Are any prohibited activities (confined space entry, expired profiles, etc.) being performed

  Pass

  Fail

  N/A

• mechanical assistance (PIV, dolleys, etc.) available/used for heavy loads?

  Pass

  Fail

  N/A

• Containers are in shippable condition (Dirty, bulging, no labels, not closed)?

  Pass

  Fail

  N/A

• Are spotters used when navigating close quarters or areas of restricted access?

  Pass

  Fail

  N/A

• Slip and trip hazards addressed or eliminated?

  Pass

  Fail

  N/A

• Environmental extremes (heat, cold noise, etc.) addressed or eliminated?

  Pass

  Fail

  N/A

• Ergonomic issues (access, lifting, push/pull, etc.) addressed or eliminated?

  Pass

  Fail

  N/A

• Are sufficient number of appropriate fire extinguishers present?

  Pass

  Fail

  N/A

• Has grounding / bonding been performed?

  Pass

  Fail

  N/A

• Have overhead hazards (awnings, trees, cables, doors) been mitigated?

  Pass

  Fail

  N/A

• Has traffic (vehicle, equipment, pedestrian) been mitigated?

  Pass

  Fail

  N/A

• Are there uncontrolled hazardous operations (hostile persons/fire/health) in the area?

  Pass

  Fail

  N/A

• Are any prohibited activities (confined space entry, expired profiles, etc.) being performed

  Pass

  Fail

  N/A

• Is there sufficient volume in truck compartment?

  Pass

  Fail

  N/A

• Have safety cones and hose protection been deployed?

  Pass

  Fail

  N/A

• Has a Front Line Risk Assessment (FLRA) form been completed as required?

  Pass

  Fail

  N/A

• Are spotters used when navigating close quarters or areas of restricted access?

  Pass

  Fail

  N/A

• Slip and trip hazards addressed or eliminated?

  Pass

  Fail

  N/A

• Environmental extremes (heat, cold noise, etc.) addressed or eliminated?

  Pass

  Fail

  N/A

• Ergonomic issues (access, lifting, push/pull, etc.) addressed or eliminated?

  Pass

  Fail

  N/A

• ChlorDtect or ph checked?

  Pass

  Fail

  N/A

• Fall hazards (pits/trenches/manholes, etc) addressed?

  Pass

  Fail

  N/A

• Are any prohibited activities (confined space entry, expired profiles, etc.) being performed?

  Pass

  Fail

  N/A

• Hoses secured to prevent jumping and whipping?

  Pass

  Fail

  N/A

• Proper tools available/used when removing grates and man hole covers?

  Pass

  Fail

  N/A

• What Field Service task is being Inspected?

  Select Vacuum Services HPWJ Pressure Washing Air Mover (Guzzler/Vactor/Cusco) Confined Space Entry Decontamination Roll Off Operations ER/ Post Spill Response Tank Cleaning (Non-Entry) System Flush Chemical Cleaning Drum Handling Excavation / Heavy Equipment Utility Manhole (Non-Entry) Jet Rodder Boom Change out NORM Decon Abrasive Blasting Segregating Waste Battery Packing Working from heights Flammable / Combustible Liquid Transfer Neutralize / Stabilize Working On or Near Water Repackage Solid Waste Other

  • Vacuum Services
  • HPWJ
  • Pressure Washing
  • Air Mover (Guzzler/Vactor/Cusco)
  • Confined Space Entry
  • Decontamination
  • Roll Off Operations
  • ER/ Post Spill Response
  • Tank Cleaning (Non-Entry)
  • System Flush
  • Chemical Cleaning
  • Drum Handling
  • Excavation / Heavy Equipment
  • Utility Manhole (Non-Entry)
  • Jet Rodder
  • Boom Change out
  • NORM Decon
  • Abrasive Blasting
  • Segregating Waste
  • Battery Packing
  • Working from heights
  • Flammable / Combustible Liquid Transfer
  • Neutralize / Stabilize
  • Working On or Near Water
  • Repackage Solid Waste
  • Other

CSE Permit

• Entry Supervisor, Attendant and Entrant named on the Permit?

  Pass

  Fail - Minor Offense

  N/A

• All sections of the permit completed or marked NA?

  Pass

  Fail - Minor Offense

  N/A

• Safety Meeting Documented?

  Pass

  Fail - Minor Offense

  N/A

• Entrant in/out times are documented?

  Pass

  Fail - Major Offense

  N/A

• FS Work Permit completed along with CSE Permit? (FS Work permit authorizes the work outside of the space)

  Pass

  Fail - Major Offense

  N/A

• Document the deficiencies from the permit (take picture of Permit)

  Media

Ventilation

• Ventilation set up is appropriate (exhausted away from employees or other personnel)?

  Pass

  Fail - Severe

  N/A

• Air flow is being exhausted not forced?

  Pass

  Fail - Severe

  N/A

• Does the ventilation equipment provide adequate Air Exchanges for the space? (8-10 Per air changes/hr and 3 air changes prior to entry)

  Pass

  Fail - Major Offense

  N/A

• Is equipment bonded and grounded?

  Pass

  Fail - Severe

  N/A

Air Monitoring

• Is the proper Air Monitoring equipment onsite?

  Pass

  Fail - Severe

  N/A

• Are action levels understood and documented?

  Pass

  Fail - Severe

  N/A

• Bumped checked (daily) / Calibrated (weekly)?

  Pass

  Fail - Severe

  N/A

• Monitoring frequency is appropriate for the hazard? (Readings are documented for: 15 Min Periodic "Gastec/Dragger Tubes", 30 min for continuous "4/5 Gas Meter")

  Pass

  Fail - Severe

  N/A

• Pre entry readings have been conducted and documented on the permit?

  Pass

  Fail - Major Offense

  N/A

Rescue

• Are required Harnesses being worn by all entrants and designated rescue personnel?

  Pass

  Fail - Severe

  N/A

• Are horizontal/Vertical lifelines attached?

  Yes

  No

  N/A

• Are additional hazards present that make wearing the lifeline more dangerous?

  Pass

  Fail - Severe

  N/A

• Did H&S approve the removal of Lifeline?

  Pass

  Fail - Severe

  N/A

• Is CHES Rescue being utilized?

  Yes

  No

• Is the Rescue teams training up to date?

  Pass

  Fail - Severe

  N/A

• Can all entrants be seen?

  Pass

  Fail - Severe

  N/A

• Rescue plan on Permit is complete? (Section 10)

  Pass

  Fail - Severe

  N/A

• First Aid / CPR is in compliance?

  Pass

  Fail - Severe

  N/A

• Is a Mechanical extraction device being used for spaces greater than 5 ft?

  Pass

  Fail - Severe

  N/A

• Confined Space Entry Comments

• If manual HPWJ is being performed (shot gunning, hand lancing, etc), has Critical HPWJ Approval Form been completed?

  Pass

  Fail - Severe

  N/A

• HPWJ Checklist completed?

  Pass

  Fail - Severe

  N/A

• Hoses are hydro tested and marked per CHES standard?

  Pass

  Fail - Severe

  N/A

• Are all hoses and fittings rated for 1.5X Maximum pressure?

  Pass

  Fail - Severe

  N/A

• Have hoses been inspected prior to use and appear in good condition?

  Pass

  Fail - Severe

  N/A

• Are we Shot Gunning?

  Yes

  No

• Is a protective hose shroud (10ft Minimum) in place on the shot gun?

  Pass

  Fail - Severe

  N/A

• Blast Boots and Metatarsal/shin guards are being worn?

  Pass

  Fail - Severe

  N/A

• Appropriate wand length (48 inches not including handle) per CHES standard?

  Pass

  Fail - Severe

  N/A

• Is manual flex lancing taking place?

  Yes

  No

• is Anti Withdrawal Device in placed?

  Pass

  Fail - Severe

  N/A

• Does flex lance have a warning mark 3 Ft from the tip?

  Pass

  Fail - Severe

  N/A

• Is the flex lance fitted with a rigid stinger 1.5X the inside diameter of the pipe?

  Pass

  Fail - Severe

  N/A

• Body Armor is worn while flex lancing?

  Pass

  Fail - Severe

  N/A

• HPWJ comments

• Is the pressure washing wand 48" long?

  Pass

  Fail - Severe

  N/A

• Are all hose connections threaded? (no quick connects)

  Pass

  Fail - Severe

  N/A

• Are whip checks used between the pump hose and between individual hose lengths?

  Pass

  Fail - Severe

  N/A

• Are metaltarsal and shin guards being worn?

  Pass

  Fail - Severe

  N/A

• Pressure Washing Comments

• Has bonding and grounding been performed and checked for continuity?

  Pass

  Fail - Severe

  N/A

• Hands and Feet are kept 2 ft away from hose end?

  Pass

  Fail - Severe

  N/A

• Safety T is in place, being utilized and manned for jobs with more than 20ft of hose?

  Pass

  Fail - Severe

  N/A

• Is the flex hose secured to eliminate whipping action?

  Pass

  Fail - Severe

  N/A

• Double Hearing protection worn by crew?

  Pass

  Fail - Severe

  N/A

• Does the crew have line of sight on the employee working the end of the hose?

  Pass

  Fail - Severe

  N/A

• Task Description

• Substance of Concern

FS Work Permit / Supporting Documents

• All sections of the FS Work permit completed or marked NA?

  Pass

  Fail - Minor Offense

  N/A

• Has Health and Safety reviewed Sections 1-3 prior to day of the job?

  Pass

  Fail - Minor Offense

  N/A

• What required support documents are onsite?

  Select JHA HASP Chapter 13 (Emergency Response) SDS Job Task Sheet

  • JHA
  • HASP
  • Chapter 13 (Emergency Response)
  • SDS
  • Job Task Sheet

• Has JHA been approved by Health and Safety?

  Pass

  Fail - Minor Offense

  N/A

• Has JHA been reviewed and signed off by field crew prior to job starting?

  Pass

  Fail - Minor Offense

  N/A

• Has the HASP been approved by Health and Safety?

  Pass

  Fail - Minor Offense

  N/A

• Has the HASP been reviewed and signed off by field crew prior to job starting?

  Pass

  Fail - Minor Offense

  N/A

• Chapter 13 is onsite and completed by supervisor?

  Pass

  Fail - Minor Offense

  N/A

• Chapter 13 has been reviewed / signed off by crew?

  Pass

  Fail - Minor Offense

  N/A

• SDS available and reviewed when specific chemicals are present?

  Pass

  Fail - Minor Offense

  N/A

Site Hazard Assessment

• Tailgate safety meeting completed and documented?

  Pass

  Fail - Minor Offense

  N/A

• Have the hazards of the job site been communicated / identified / controlled?

  Pass

  Fail - Minor Offense

  N/A

Housekeeping

• Is material and equipment properly stored?

  Pass

  Fail - Minor Offense

  N/A

• Are walkways and passage's clear to and from the truck to the work area?

  Pass

  Fail - Major Offense

  N/A

• Are slip, trip and fall hazards eliminated?

  Pass

  Fail - Major Offense

  N/A

• Are appropriate warning signs and barriers in place?

  Pass

  Fail - Minor Offense

  N/A

• Are mobile equipment wheels chocked?

  Pass

  Fail - Minor Offense

  N/A

• Company Vehicles are organized and clean?

  Pass

  Fail - Minor Offense

  N/A

• Are safety cones in place?

  Pass

  Fail - Minor Offense

  N/A

• Has all critical safety equipment been inspected prior to use (Harnesses, Lifelines, DBI's etc..)?

  Pass

  Fail - Minor Offense

  N/A

• Housekeeping Comments

Emergency Preparedness

• First aid Kit onsite and available?

  Pass

  Fail - Major Offense

  N/A

• Are at least two First Aid Trained personnel onsite?

  Pass

  Fail - Major Offense

  N/A

• Safety Shower / eye wash / fresh water source available and functioning with in the general work area?

  Pass

  Fail - Severe

  N/A

• Emergency Numbers / Nearest hospital location documented on Permits / JHA?

  Pass

  Fail - Severe

  N/A

• Are Fire Extinguishers present?

  Pass

  Fail - Severe

  N/A

• Fire Extinguisher(s) are in compliance and tag is attached?

  Pass

  Fail - Minor Offense

  N/A

• A site evacuation procedure has been documented and is understood by the crew?

  Pass

  Fail - Minor Offense

  N/A

• Safe area has been identified when dangerous weather occurs?

  Pass

  Fail - Minor Offense

  N/A

• Emergency Preparedness Comments

Job Related Safety Items

• Have appropriate smoking / Eating areas been designated?

  Pass

  Fail - Minor Offense

  N/A

• Is the proper equipment onsite to complete the project safely?

  Pass

  Fail - Minor Offense

  N/A

• Is a GFCI (ground fault circuit interrupter) used on all equipment and in good condition?

  Pass

  Fail - Minor Offense

  N/A

• Are extension cords in good condition?

  Pass

  Fail - Minor Offense

  N/A

• Have decontamination zones / areas been established?

  Pass

  Fail - Major Offense

  N/A

• Is the crew's system of communication sufficient?

  Pass

  Fail - Minor Offense

  N/A

• Is the worksite secure?

  Pass

  Fail - Minor Offense

  N/A

• Is the lighting safely illuminating the work zone?

  Pass

  Fail - Major Offense

  N/A

• Are unapproved safety knives not present on the jobsite?

  Pass

  Fail - Severe

  N/A

• Job related Safety Items

PPE (Personal Protective Equipment)

• Is the head, face, eye and neck protection appropriate for the hazard?

  Pass

  Fail - Severe

  N/A

• is the hearing protection appropriate for the hazard?

  Pass

  Fail - Severe

  N/A

• Is the hand protection appropriate for the hazard?

  Pass

  Fail - Severe

  N/A

• Is the foot protection appropriate for the hazard?

  Pass

  Fail - Severe

  N/A

• Are the chemical protective suits appropriate for the hazard?

  Pass

  Fail - Severe

  N/A

• is special equipment appropriate for the hazard? (Hi-vis, FRC, PFD, tape and barrier cream)

  Pass

  Fail - Severe

  N/A

• Is the PPE being used match what is documented on the permit or JHA?

  Pass

  Fail - Severe

  N/A

• Is respiratory protection being used?

  Yes

  No

• Are the employees clean shaved?

  Pass

  Fail - Severe

  N/A

• Fit test is Compliant (Proof of fit test completion available onsite or at branch location)?

  Pass

  Fail - Major Offense

  N/A

• Is bonding and grounding in place and been verified?

  Pass

  Fail - Major Offense

  N/A

• Have all ignition sources been eliminated?

  Pass

  Fail - Severe

  N/A

• Is LEL area monitoring been conducted?

  Pass

  Fail - Severe

  N/A

• Is there a Excavation Competent Person onsite?

  Pass

  Fail - Minor Offense

  N/A

• Has the daily trenching & excavation checklist been completed?

  Pass

  Fail - Minor Offense

  N/A

• Have all utilities been identified and marked by Dig Safe?

  Pass

  Fail - Minor Offense

  N/A

• Has a "NO MAN's LAND" been established 3/4 of the excavations depth away from the edge?

  Pass

  Fail - Severe

  N/A

• Has the excavation been evaluated for potential confined space hazards?

  Pass

  Fail - Severe

  N/A

• Does this task involve trenching?

  Yes

  No

• For excavations greater than 4ft are sloping or shoring options in place?

  Pass

  Fail - Severe

  N/A

• Is a ladder available in the excavation every 25ft?

  Pass

  Fail - Severe

  N/A

• Are excavation spoils located at least 2 ft from the edge of the excavation?

  Pass

  Fail - Severe

  N/A

• Is standing water in the excavation being controlled?

  Pass

  Fail - Severe

  N/A

• Is work on scaffolding being performed?

  Yes

  No

  NA

• Scaffold erected according to guidelines?

  Pass

  Fail - Severe

  N/A

• All personnel "scaffold user" or "aerial lift" trained?

  Pass

  Fail - Severe

  N/A

• All scaffold components are in good condition?

  Pass

  Fail - Severe

  N/A

• Daily inspection is documented?

  Pass

  Fail - Severe

  N/A

• Is there a Scaffold Competent Person on site?

  Pass

  Fail - Severe

  N/A

• Is a Aerial Lift being utilized onsite?

  Yes

  No

• Required fall protection equipment is being utilized?

  Pass

  Fail - Severe

  N/A

• Are you working from Heights?

  Yes

  No

  NA

• Is fall prevention being used instead of fall protection (Barriers 6ft from edge)?

  Pass

  Fail - Minor Offense

  N/A

• Tie off / Anchor points are appropriate and rated for 5000lbs or higher?

  Pass

  Fail - Severe

  N/A

• Appropriate Lifelines (lanyards, SRL's) have been selected based on Fall clearance?

  Pass

  Fail - Severe

  N/A

• Fall protection equipment has been inspected prior to use?

  Pass

  Fail - Major Offense

  N/A

• Are you utilizing a Motorized water craft?

  Yes

  No

• Is the boat operator certified by Clean Harbors?

  Pass

  Fail - Minor Offense

  N/A

• Has a boating checklist / float plan been completed?

  Pass

  Fail - Minor Offense

  N/A

• Are USCG approved

  Pass

  Fail - Minor Offense

  N/A