IPS field ticket Work permit hazard Assessment - Williamsport

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Coil Tubing Operations Work permit

• Description of task

Required references

• Have relevant procedures, standards, or safe work practices been reviewed

  Yes

  No

  N/A

• Attach or list required procedures

Risk Assessment

• Must existing procedures or work practices be modified to perform this work? (Management of change required)

  No

  Yes

• Even after mitigation are there any hazards that continue to present a potentially significant risk? (Scenario-based risk assessment required)

  No

  Yes

• If yes to either above, Stop and contact the person in charge to perform a management of change or risk assessment .

PPE required

• Summarize PPE required to perform task

  Select Hard Hat safety Boots Hearing protection Safety Glasses Fall Protection Flame Resistant Clothing Gloves Cotton Gloves Impact Gloves chemical Respirator Scba/supplied air Foul weather gear Face shield Chemical Apron

  • Hard Hat
  • safety Boots
  • Hearing protection
  • Safety Glasses
  • Fall Protection
  • Flame Resistant Clothing
  • Gloves Cotton
  • Gloves Impact
  • Gloves chemical
  • Respirator
  • Scba/supplied air
  • Foul weather gear
  • Face shield
  • Chemical Apron

JSA review

• Pending confirmation by the task leader of site conditions, I Agree the Attached JSA identifies the significant task steps, hazards and controls.

• Supervisor or Crew lead signature

  Sign

Worksite Verification

• The work team has assessed the worksite conditions and confirms:
  - The JSA addresses the applicable hazards and necessary controls.
  - the team has adequate resources (people and equipment) to do the job safely.
  - others that could be affected by the work have been informed.
  - energy isolation (if applicable) has been Verified and demonstrated.

• Supervisor, Task leader or permit holder signature

  Sign

Work team Declaration

• I Acknowledge that I reviewed the attached JSA, I understand my roles and responsibilities, I have the required skills/knowledge, and will comply with the instructions for this task.

• Supervisor Signature

  Sign

• Coil Operator

  Sign

• Pump operator

  Sign

• Back up operator

  Sign

• Coil tubing helper

  Sign

Job Safety Analysis - Task Hazard Assesment form

• Use this template to identify hazards relevant to the proposed work. The template does not include all potential hazards. Determine the hazards that are present for the task and identify the controls. Also use the required PPE for the activity and conditions.

• Pressurized Equipment

  Select isolate NA depressurize, drain, purge vent relieve trapped pressure avoid auto-refrigeration when depressurizing anticipate residual pressure/ fluids LOTO

  • isolate
  • NA
  • depressurize, drain, purge vent
  • relieve trapped pressure
  • avoid auto-refrigeration when depressurizing
  • anticipate residual pressure/ fluids
  • LOTO

• Poor lighting or visibility

  Select provide alternate lighting NA wait/ defer until visibility improves no work over water that could require rescue

  • provide alternate lighting
  • NA
  • wait/ defer until visibility improves
  • no work over water that could require rescue

• Personnel

  Select provide induction or training for new workers NA mentor, coach or supervise verify competencies, skills, and experience address applicable limitations (Fatigue, exhaustion, restricted duty manage multiple languages

  • provide induction or training for new workers
  • NA
  • mentor, coach or supervise
  • verify competencies, skills, and experience
  • address applicable limitations (Fatigue, exhaustion, restricted duty
  • manage multiple languages

• Confined Space

  Select discuss confined space entry safe work practice NA monitor access, entry protect surface from inadvertent contact do not locate mobile engines near confined space provide observer develop rescue plan

  • discuss confined space entry safe work practice
  • NA
  • monitor access, entry
  • protect surface from inadvertent contact
  • do not locate mobile engines near confined space
  • provide observer
  • develop rescue plan

• Simultaneous operations

  Select follow SIMOPS matrix NA MOC for deviation from SIMOPS restrictions required establish interface between groups use barriers and signs to segregate activities have permit counter signed by leader of affected groups

  • follow SIMOPS matrix
  • NA
  • MOC for deviation from SIMOPS restrictions required
  • establish interface between groups
  • use barriers and signs to segregate activities
  • have permit counter signed by leader of affected groups

• Weather

  Select implement controls for slippery surfaces NA high winds - goggles, Wind speed meters heat - hydration, breaks cold - PPE, heaters, exposure lightning - tool selection, defer work other

  • implement controls for slippery surfaces
  • NA
  • high winds - goggles, Wind speed meters
  • heat - hydration, breaks
  • cold - PPE, heaters, exposure
  • lightning - tool selection, defer work
  • other

• Ignition sources

  Select remove or manage combustible materials NA provide fire fighting equipment construct a fire safe habitat provide fire watch during / after hot work conduct gas testing bond /earth for static electricity or cathodic protection

  • remove or manage combustible materials
  • NA
  • provide fire fighting equipment
  • construct a fire safe habitat
  • provide fire watch during / after hot work
  • conduct gas testing
  • bond /earth for static electricity or cathodic protection

• Hazardous Substances

  Select drain / purge equipment NA follow msds controls implement health hazard controls test or analyze materials

  • drain / purge equipment
  • NA
  • follow msds controls
  • implement health hazard controls
  • test or analyze materials

• Potential spills

  Select drain equipment NA provide containment have spill clean up equipment or kits restrain and isolate hoses when not in use provide msds for all chems on site

  • drain equipment
  • NA
  • provide containment
  • have spill clean up equipment or kits
  • restrain and isolate hoses when not in use
  • provide msds for all chems on site

• Equipment hot / cold

  Select heat or cool equipment before work starts NA install barriers before work starts provide warning signs wear thermal gloves

  • heat or cool equipment before work starts
  • NA
  • install barriers before work starts
  • provide warning signs
  • wear thermal gloves

• High noise

  Select wear correct hearing PPE NA manage exposure shut down equipment use sound barriers use hand signals to communicate

  • wear correct hearing PPE
  • NA
  • manage exposure
  • shut down equipment
  • use sound barriers
  • use hand signals to communicate

• Falling or dropped objects

  Select provide barriers and signs NA secure tools / tie off

  • provide barriers and signs
  • NA
  • secure tools / tie off

• Lifting Equipment

  Select confirm lifting equipment condition and certification NA obtain approval for lifts over processing equipment have documented and approved lift plans

  • confirm lifting equipment condition and certification
  • NA
  • obtain approval for lifts over processing equipment
  • have documented and approved lift plans

• Working at heights

  Select discuss working at heights safe work practice NA verify fall restraint certification and inspection have a spotter other controls

  • discuss working at heights safe work practice
  • NA
  • verify fall restraint certification and inspection
  • have a spotter
  • other controls

• Portable electronic equipment

  Select inspect equipment for safe condition NA implement gas testing protect electrical leads from impact or damage

  • inspect equipment for safe condition
  • NA
  • implement gas testing
  • protect electrical leads from impact or damage

• Radiation hazards

  Select restrict access -barriers and signs NA notify personnel who may be affected implement norm controls conduct rad testing

  • restrict access -barriers and signs
  • NA
  • notify personnel who may be affected
  • implement norm controls
  • conduct rad testing

• Moving objects /equipment

  Select confirm machine guarding NA provide protective barriers observer to monitor proximity of people to equipment shut down or lock out equipment

  • confirm machine guarding
  • NA
  • provide protective barriers
  • observer to monitor proximity of people to equipment
  • shut down or lock out equipment

• Manual handling

  Select assess manual handling task NA limit load size manage posture confirm load stability get assistance or mechanical aid

  • assess manual handling task
  • NA
  • limit load size
  • manage posture
  • confirm load stability
  • get assistance or mechanical aid

• Equipment / tools

  Select inspect equipment and tools before use NA no use of modified tools use protective guards on tools use correct tools and equipment for task protect / remove sharp edges

  • inspect equipment and tools before use
  • NA
  • no use of modified tools
  • use protective guards on tools
  • use correct tools and equipment for task
  • protect / remove sharp edges

• Vibrating equipment

  Select manage exposure times NA assess affects of vibration on equipment use low vibration equipment apply noise controls

  • manage exposure times
  • NA
  • assess affects of vibration on equipment
  • use low vibration equipment
  • apply noise controls

• Slips, trips and falls

  Select identify and shield uneven or open surfaces NA secure / cover cables, cords, tubing clean up liquids barricade / rope off holes or openings

  • identify and shield uneven or open surfaces
  • NA
  • secure / cover cables, cords, tubing
  • clean up liquids
  • barricade / rope off holes or openings

• High Energy or high voltage

  Select restrict access to authorized personnel NA discharge equipment and make electrically dead observe safe work distance from live cables use flash burn FR PPE clothing use insulated gloves / tools / mats

  • restrict access to authorized personnel
  • NA
  • discharge equipment and make electrically dead
  • observe safe work distance from live cables
  • use flash burn FR PPE clothing
  • use insulated gloves / tools / mats

• Excavation

  Select have an excavation plan NA locate underground utilities de-energize underground services implement confined space entry controls

  • have an excavation plan
  • NA
  • locate underground utilities
  • de-energize underground services
  • implement confined space entry controls

• Waste clean up and disposal

  Select apply enviornmental management practices NA follow site waste management procedures clean up equipment and materials at the site optimize task to minimize waste production

  • apply enviornmental management practices
  • NA
  • follow site waste management procedures
  • clean up equipment and materials at the site
  • optimize task to minimize waste production

• Other energy sources

  Select implement spring compression or expansion controls NA implement electromagnetic controls manage pressure /vacuum manage heat generation

  • implement spring compression or expansion controls
  • NA
  • implement electromagnetic controls
  • manage pressure /vacuum
  • manage heat generation

• Mobile equipment

  Select assess condition of equipment NA implement controls on use access monitor proximity to live equipment manage overhead hazards adhere to road /site rules

  • assess condition of equipment
  • NA
  • implement controls on use access
  • monitor proximity to live equipment
  • manage overhead hazards
  • adhere to road /site rules

• Other hazards

  Select implement abrasive blasting controls NA manage potential blocked or plugged equipment obtain MOC for temporary connections or modifications

  • implement abrasive blasting controls
  • NA
  • manage potential blocked or plugged equipment
  • obtain MOC for temporary connections or modifications

• Emergency response

  Select keep egress routes open NA keep shower and eye wash stations accessible have a rescue plan in place keep emergency alarm, fire equipment, and shut down equipment locations unobstructed

  • keep egress routes open
  • NA
  • keep shower and eye wash stations accessible
  • have a rescue plan in place
  • keep emergency alarm, fire equipment, and shut down equipment locations unobstructed