Audit

This document is to be used as information resource and to identify and mitigate all hazards associated with the task to be performed. Any change in scope, additional identified hazards, or stop work event will require a new JHSA to be completed before work commences on this task.

GENERAL JOB INFORMATION

SUPERVISOR

CREW MEMBERS

Job Number

PLANT EMERGENCY NUMBER

LOCATION OF NEAREST PHONE

EVACUATION AREA

EMERGENCY ALARMS REVIEWED

HAS NEAREST EMERGENCY SHOWER/EYE WASH STATION FOUND

Date and Time

Detailed Job Description

PLEASE LIST DETAIL PRE-JOB TAILGATE SAFETY TOPICS. THESE TOPICS NEED TO BE SPECIFIC TO THE JOB BEING PERFORMED. EXAMPLES:
IF THE TOPIC IS SLIPPERY SURFACES THEN NOTE AS "MATERIAL ON FLOOR IS SLICK AND CAN CAUSE A FALL"
IF TOPIC IS PINCH POINTS THEN NOTE "WORKING AROUND THE CONVEYOR BEWARE PINCH POINT BETWEEN WHEEL AND BELT"

Hydroblasting

Are all whip checks in place?

If lancing is anti-withdrawal device in place

Explain why anti-withdrawal device is not present

If lancing, is stinger/nozzle combination 1.5 times the diameter of the pipe/tube

Explain why stinger/nozzles in not 1.5 times the ID of pipe/tube.

Dry Vacuuming

Is the vacuum break in place?

Does vacuum truck have proper tail hose?

HAZARD IDENTIFICATION AND PPE
POTENTIAL SAFETY HAZARDS (SELECT ALL THAT APPLY)

PLEASE LIST OTHER POTENTIAL SAFETY HAZARDS

SAFETY EQUIPMENT (SELECT ALL THAT APPLY)

PLEASE LIST OTHER SAFETY EQUIPMENT

PLEASE LIST OTHER SAFETY EQUIPMENT

IF PERSONAL MONITOR IS NEED PLEASE SELECT ALL THAT APPLY

PPE REQUIREMENTS

BLAST BOOTS

RUBBER BOOTS

FACESHIELD

CHEMICAL GOGGLES

SEALED SAFETY GLASSES

LONG SLEEVES

FRC CLOTHING

RAIN SUIT

CHEMICAL SUIT

TYVEK

LEVEL A SUIT

LEVEL B SUIT

CHEMICAL GLOVES

CUT RESISTANT GLOVES

(HARD HAT SAFETY GLASSES HIGH VIZ VEST LEATHER GLOVES STEEL TOED BOOTS EAR PLUGS ARE MINIMUM PPE REQUIREMENTS)

SUPERVISOR AND CREW RESPONSIBILITIES

PRE-JOB START UP QUESTIONS

HAS A PRE JOB SAFETY MEETING BEEN HELD WITH EMPLOYEES?

HAS THE WORK AFREA BEEN BARRICADED TO LIMIT ACCESS?

HAS THE SUPERVISOR LOCKED AND TAGGED OUT ANY INVOLVED

IF WORK AREA IS A CONFINED HAS THE AIR BEEN TESTED AND ENTRY PERMIT BEEN CORRECTLY COMPLETED AND POSTED?

HAS ALL VEHICLE EQUIPMENT BEEN PROPERLY CHOCKED AND SPILL PADS AVAILABLE FOR LEAKS/SPILLS?

POST JOB QUESTIONS

HAS ALL ENVIROVAC EQUIPMENT BEEN INVENTORIED, CLEANED, AND RETURNED?

HAVE ALL LOTO LOCKS BEEN REMOVED?

HAVE ALL TRUCKS AND PUMPS BEEN PROPERLY DECONTAMINATED?

HAS THE WORK SITE BEEN CLEANED?

SUPERVISOR
CREW MEMBER
CREW MEMBER
CREW MEMBER
CREW MEMBER
CREW MEMBER
CREW MEMBER
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.