JOB SAFETY AUDIT

• Safe Work Permit #:

• Supporting Info

  Media

• Supporting Info

  Media

• Job Description

• CF Personnel / Contractor

• Conducted on

  Date

• Max Rivera

Job Safety Audit

• F.T.R.A. Completed:

• W.H.A.T. Completed:

• Contractor JSA completed

Emergency Response

• Do Employees know nearest Shelter in Place?

  Yes

  No

  N/A

• Do employees know nearest Rally Points?

  Yes

  No

  N/A

• Do Employees know where Nearest Safety Shower is?

  Yes

  No

  N/A

• Do Employees know where nearest EEBA's are?

  Yes

  No

  N/A

• Do Employees know where nearest Fire Extinguisher is?

  Yes

  No

  N/A

Type of Work:

• Cold Work?

  Yes

  No

  N/A

• Hot Work

  Yes

  No

  N/A

• Precautions Noted on Permit

• Fire Watch noted on Permit / Log

• Confined Space

  Yes

  No

  N/A

• Confined Space Permit issued

• Atmospheric Testing performed

• Does it require Continuous Testing?

  Yes

  No

  N/A

• Rescue Plan available

• EHS Signature

• Excavation

  Yes

  No

  N/A

• Excavation perimit issued

• Excavation Permit #:

• Line Break

  Yes

  No

  N/A

• Appropriate PPE for Chemical Exposure?

  Safe

  At Risk

  N/A

Observations:

• Positive Observations:

• Positive Rewards:

• At Risk Observations:

• Corrective Action:

Notifications:

• CF Contact:

• Name

• Contractor Supervisor:

• Name:

• Completed by: Max Rivera

  Sign