KDC SAFETY INSPECTION Chevron OCT 2017

• Job No

• Audit Title

• Client / Site

• Prepared by

• Personnel

• Add location
  Address

SIGNAGE

• DOL Poster

  Yes

  No

  N/A

• Chevron Required Permits - WAHP, HW, LOTO, MEWP, SSE and JHA's

  Sign

• LPSA CARD

  Yes

  No

  N/A

• Equipment Islolation - LOTO

  Yes

  No

  N/A

• General Permit

  Yes

  No

  N/A

• KDC rules posted

  Yes

  No

  N/A

• API VERIFICATION

  Yes

  No

  N/A

• Short Service Employee

  Sign

• MPN and map posted

  Yes

  No

  N/A

• Incident Reporting instructions posted

  Yes

  No

  N/A

• Heat illness prevention posters

  Yes

  No

  N/A

• Emergency Evac & Sign In Sheets

  Yes

  No

  N/A

• Permits?<br> Crane<br>Excavation<br>Scaffold<br>Hot Work

  Yes

  No

  N/A

• Tailgate Meeting Current

  Yes

  No

  N/A

• Duty To Warn, Duty To Protect & Duty To Control

  Yes

  No

  N/A

• Pedestrian protection fencing

  Safe

  At Risk

  N/A

• Public protection access egress

  Safe

  At Risk

  N/A

• Scissor lift safety and compliance

  Safe

  At Risk

  N/A

• Fall protection if exposed to a free fall six feet or more

  Safe

  At Risk

  N/A

• PFAS Inspected

  Yes

  No

  N/A

• Scaffold Safety

  Safe

  At Risk

  N/A

• Scaffold Permit

  Yes

  No

  N/A

• Guardrails

  Yes

  No

  N/A

• Tipping Restraint at 14in

  Yes

  No

  N/A

• Base Plates, Mudsills, Planking and Green Tag

  Yes

  No

  N/A

• Excavation Trenching Safety

  Safe

  At Risk

  N/A

• Permit

  Yes

  No

  N/A

• Soil Type identified by competent person

  Yes

  No

  N/A

• Cave In Protection

  Yes

  No

  N/A

• Tool safety including electrical cords and guards

  Safe

  At Risk

  N/A

• Electrical cords extension cords GFCI

  Safe

  At Risk

  N/A

• Ladder Safety including manufacturing labels

  Safe

  At Risk

  N/A

• Brackets

  Yes

  No

  N/A

• Rungs

  Yes

  No

  N/A

• Ladder usage and set up

  Yes

  No

  N/A

• Housekeeping

  Yes

  No

  N/A

• FOCUS FOUR - electrical caught in between struck by fall protection

  Yes

  No

  N/A

• Any trip and fall hazards

  Safe

  At Risk

  N/A

• SWPPP ISSUES?

  Safe

  At Risk

  N/A

• Dust Control

  Safe

  At Risk

  N/A

• PPE

  Yes

  No

  N/A

• Hard Hats

  Yes

  No

  N/A

• Vests

  Yes

  No

  N/A

• ANZI Z87.1

  Yes

  No

  N/A

• Hand Protection Correct for task

  Yes

  No

  N/A

• Hearing Protectiin

  Yes

  No

  N/A

• Respiratory Protection

  Yes

  No

  N/A

• Silica Exposure

  Safe

  At Risk

  N/A

• Silica Exposure Plan Completed

  Yes

  No

  N/A

• Equipment safety

  Yes

  No

  N/A

• Water in compliance with HIPP

  Yes

  No

  N/A

• Machinery equipment tool certifications

  Yes

  No

  N/A

• Safety Non-Compliance

  Safe

  At Risk

  N/A