Hennigan Energy Service Group

• Location
  Address

• Supervisor/Crew Leader

• Job description

• Conducted on

  Date

• Prepared by

• Personnel

Work order

• Tailgate safety topic is specific to the job performed?

  Yes

  No

  N/A

• JHSA signed by all crew members?

  Yes

  No

  N/A

• Pre job inspection done on equipment/vehicles?

  Yes

  No

  N/A

Safety controls

• Crew is aware of all hazards and how to avoid them?

  Yes

  No

  N/A

• LOTO done correctly?

  Yes

  No

  N/A

• MSDS SHEETS CORRECT

  Yes

  No

  N/A

• Is Respiratory Protection Required ?

  Yes

  No

  N/A

• All permits filled out correctly (Confined Space etc) ?

  Yes

  No

  N/A

• Is Job in Confined space ?

  Yes

  No

• Has confined space air quality been tested?

  Yes

  No

  N/A

• All PPE present and properly used ?

  Yes

  No

  N/A

• Are ladders, scaffold, fall protection in use ?

  Yes

  No

  N/A

• Are the ladders, scaffolds, man lifts and fall protection being properly used ?

  Yes

  No

  N/A

Hydroblasting General Safe Work Practices

• 4.2.2 house keeping-Is the work area free of all removable hazards?

  Yes

  No

  N/A

• 4.2.4 Is pump properly barricaded to restrict unauthorized people from entering the work area.

  Yes

  No

  N/A

• 4.2.4 is area being cleaned properly barricaded to prevent unauthorized people from entering?

  Yes

  No

  N/A

• 4.2.4 is pre-printed barricade tags properly attached (Danger hydroblasting)

  Yes

  No

  N/A

• 4.2.5 Are wheel chocks in place on pump and truck ?

  Yes

  No

  N/A

• 4.2.6. Whip checks in place ?

  Yes

  No

  N/A

• 4.2.7 Is pump operator present and close enough to disengage pressure ?

  Yes

  No

  N/A

• 4.2.8 Is there clear line of site between pump operator and hose end equipment operator. If unable to do so is radio or third person in use ?

  Yes

  No

  N/A

• 4.2.9 Are hoses routed and protected in a manner that prevents vehicular damage and personnel exposure to hoses ?

  Yes

  No

  N/A

• 4.2.10 Are all personnel 6' or more away from hose connections while under pressure?

  Yes

  No

  N/A

• 4.2.12 Are debris barriers in place ?

  Yes

  No

  N/A

• 4.2.13 Is pump grounded ?

  Yes

  No

  N/A

• 4.2.14 Is anti-withdrawal device in use and mounted securely ?

  Yes

  No

  N/A

• 4.2.15 Is a hard stop required. If so is it being utilized ?

  Yes

  No

  N/A

• 4.2.17 Is hose shroud in place ?

  Yes

  No

  N/A

• 4.2.18 Are Face Shields being properly used ?

  Yes

  No

  N/A

• 4.2.19 Is operator controlling the foot pedal or pneumatic controls ?

  Yes

  No

  N/A

• 4.2.19 Is foot pedal secure and free from obstruction ?

  Yes

  No

  N/A

Hydroblasting Equipment Requirements

• 4.3.4 is stinger at least 1.5x the diameter of pipe being cleaned

  Yes

  No

  N/A

• 4.2.5 Is lance marked 24"or more from the end of the compression fitting ?

  Yes

  No

  N/A

• 4.3.6 Does shotgun have hose shroud ?

  Yes

  No

  N/A

• 4.3.6 Is the shotgun shroud 6' in length ?

  Yes

  No

  N/A

• 4.3.6 Has shotgun shroud been properly inspected ?

  Yes

  No

  N/A

• 4.3.7 Is the length of the shotgun 52" from butt stock to end of the nozzle

  Yes

  No

  N/A

• 4.3.8 Are fittings rated for pressure being applied?

  Yes

  No

  N/A

• 4.3.9 Has Dump valve on the shotgun been inspected ?

  Yes

  No

  N/A

• 4.3.10 Is entry point where 3D tool is in operation securely covered to prevent spray from exiting vessel

  Yes

  No

  N/A

• 4.3.10 Is 3D tool appropriately suspended (rope not allowed)

  Yes

  No

  N/A

• Have Boiler wash tools been tied back and tied down secure ?

  Yes

  No

  N/A

• Blast hose in good repair

  Yes

  No

  N/A

• Have Blast Hoses been properly tied and secured and whip checks in place?

  Yes

  No

  N/A

• 10k

• 15K

• 20k

• 40K

• 8k High Volume

• 10K High Volume

Vacuuming

• Is job on an elevated floor?

  Yes

  No

  N/A

• Is vac hose properly tied off?

  Yes

  No

  N/A

• Is there a hose break (Safety-T )in use?

  Yes

  No

  N/A

• If necessary, is vac truck and hose properly bonded and grounded ?

  Yes

  No

  N/A

• Has hoses been properly inspected to prevent leaks and spills?

  Yes

  No

  N/A

Vehicle/equipment

• Is fire extinguisher in place and inspected?

  Yes

  No

  N/A

• Are vehicle/equipment clean and free from trash?

  Yes

  No

  N/A

Observations

• undefined

Corrective Action

• undefined

• Auditor

  Sign

• Crew Leader/Supervisor

  Sign