Mid-Ohio Pipeline Services, LLC - (CCarter Version)

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date
• Location
  Address

• Personnel

• Prepared by

• Certification Signature

  Sign

• 1.1 - Has the previous inspection been reviewed prior to beginning this inspection?

  Yes

  No

  N/A

• 1.2 - Are there any outstanding corrective actions not complete from previous inspection?

  Yes

  No

  N/A

• 1.2.1 What outstanding item(s) exist(s), and reason(s) for failure to correct?

• 2.1 Is there a hospital, clinic, or infirmary for medical care near your workplace or is at least one employee on each shift currently certified to render first aid?

  Yes

  No

  N/A

• 2.1.1 For first audit of job provide address and contact information for these services.

• 2.2 Are emergency phone numbers posted?

  Yes

  No

  N/A

• 2.3 Are fully supplied first aid kits easily accessible to each work area, periodically inspected, and replenished as needed?

  Yes

  No

  N/A

• 2.4 Is there an eye wash station, or other means (single use bottles) available for quick drenching or flushing of the eyes?

  Yes

  No

  N/A

• 2.5 Are there special procedures needed to be implemented to expedite emergency response, patient care, or patient transport?

  Yes

  No

  N/A

• Describe:

• 3.1 Condition

  Yes

  No

  N/A

• 3.2 Proper Type

  Yes

  No

  N/A

• 3.3 Is the required safety signage posted?

  Yes

  No

  N/A

• 3.4 Marking Hazards

  Yes

  No

  N/A

• 4.1 SDS Available

  Yes

  No

  N/A

• 4.2 SDS Reviewed

  Yes

  No

  N/A

• 4.3 Containers Labeled Properly

  Yes

  No

  N/A

• 4.4 Handling Procedures Followed

  Yes

  No

  N/A

• 4.5 Employees Trained

  Yes

  No

  N/A

• 5.1 Emergency Action Plan

  Yes

  No

  N/A

• 5.2 Spill Response Kit

  Yes

  No

  N/A

• 5.3 Certified Responders

  Yes

  No

  N/A

• 5.4 First-Aid Kit

  Yes

  No

  N/A

• 6.1 Are the LODs adequately identified and marked?

  Yes

  No

  N/A

• 6.2 Are stream and waterway crossings identified and adequately marked?

  Yes

  No

  N/A

• 6.3 Are air bridges properly erected over live lines?

  Yes

  No

  N/A

• 7.1 Hard Hat

  Yes

  No

  N/A

• 7.1.1 Hard Hat worn correctly

  Yes

  No

  N/A

• 7.2 Eye/Face

  Yes

  No

  N/A

• 7.3 Hand

  Yes

  No

  N/A

• 7.4 Hearing

  Yes

  No

  N/A

• 7.5 Footwear

  Yes

  No

  N/A

• 7.6 Hi-Viz Vest

  Yes

  No

  N/A

• 7.7 FRC

  Yes

  No

  N/A

• 7.8 Respiratory protection

  Yes

  No

  N/A

• 7.9 Monitors Available, In Use, Calibrated (4-Gas, H2S or Other)

  Yes

  No

  N/A

• Have e

  Yes

  No

  N/A

• 7.10 Is PPE maintained in a sanitary condition and ready for use?

  Yes

  No

  N/A

• 7.11 Other:

  Yes

  No

  N/A

• 8.1 Is the OSHA Jobsite Poster Posted

  Yes

  No

  N/A

• 8.2 Adequate clearance from overhead and other hazards

  Yes

  No

  N/A

• 9.1 Power Lines Marked with Goal Post and Signs

  Yes

  No

  N/A

• 9.2 Designated Spotter

  Yes

  No

  N/A

• 9.3 Proper Equipment for Spotter (Air Horn, Vest, etc.)

  Yes

  No

  N/A

• 10.1 Pathways

  Yes

  No

  N/A

• 10.2 Trip Hazards

  Yes

  No

  N/A

• 10.3 Holes Guarded

  Yes

  No

  N/A

• 11.1 Are all ladders maintained in good condition, joints between steps and side rails tight, all hardware and fittings securely attached, and moveable parts operating freely without binding or undue play.

  Yes

  No

  N/A

• 11.2 Are non-slip safety feet provided on each metal or rung ladder, and are ladder rungs and steps free of grease and oil?

  Yes

  No

  N/A

• 11.3 Are employees required to face the ladder when ascending or descending?

  Yes

  No

  N/A

• 11.4 Used properly (not using top step, a frame ladders opened with side rails locked, etc.)?

  Yes

  No

  N/A

• 11.5 Ladder extend 3 feet or more above landing surface?

  Yes

  No

  N/A

• 11.6 Ladder secured from slipping or displacement?

  Yes

  No

  N/A

• 12.1 Worksite free of clutter

  Yes

  No

  N/A

• 12.2 Are all worksites clean, sanitary, and orderly?

  Yes

  No

  N/A

• 12.3 Equipment, machines/tools do not block pathway

  Yes

  No

  N/A

• 12.4 Tripping and slipping hazards

  Yes

  No

  N/A

• 12.5 Is combustible scrap, debris, and waste stored safely and removed from the worksite promptly?

  Yes

  No

  N/A

• 12.6 Are the minimum number of toilets and washing facilities provided and maintained in a clean and sanitary fashion?

  Yes

  No

  N/A

• 12.7 Tools properly stored/staged

  Yes

  No

  N/A

• 12.8 Crew Trucks/Trailers clean and free of clutter

  Yes

  No

  N/A

• 13.1 Material Stored Properly

  Yes

  No

  N/A

• 13.2 Flammable/Combustible Storage

  Yes

  No

  N/A

• 13.3 Flammable/Combustible Storage Signage Posted

  Yes

  No

  N/A

• 13.4 Pipe Chocked

  Yes

  No

  N/A

• 13.5 Other:

  Yes

  No

  N/A

• 14.1 Proper lifting techniques used

  Yes

  No

  N/A

• 14.2 Employees positioned away from hazards, moving parts and equipment

  Yes

  No

  N/A

• 14.3 Pinch points

  Yes

  No

  N/A

• 14.4 Proper body positioning

  Yes

  No

  N/A

15.1 Excavation Preparation Checklist

• 15.1.1 Hazards identified and marked?

  Yes

  No

  N/A

• 15.1.2 One Call Made (811 or equivalent)?

  Yes

  No

  N/A

• 15.1.2.1 Separate One-Call Tickets?

  Yes

  No

  N/A

• 15.1.3 Excavation or Ground Disturbance Permit Issued?<br>(Attach copy or photo of Permit)

  Safe

  At Risk

  N/A

• 15.1.4 Alignment Sheets or Station Drawings?

  Yes

  No

  N/A

• 15.1.5 PE Plan Required? (20' or deeper)

  Yes

  No

  N/A

15.2 During Excavation Checklist

• 15.2.1 Photo of Excavation/Site

  Media

• 15.2.2 Length (in feet)

• 15.2.3 Width (in feet)

• 15.2.4 Depth (in feet)

• 15.2.5 Soil Classification

  Stable Rock

  Class A

  Class B

  Class C (Default)

• 15.2.6 Sloping / Benching Requiements

  Stable Rock (None Required)

  Benching

  Class A - 1/2:1

  Class B - 1:1

  Class C - 1 1/2:1 (Default)

• 15.2.7 Protective Systems (Shoring or Shielding)

  Yes

  No

  N/A

• 15.2.7.1 Trench Box Certifications

  Yes

  No

  N/A

• 15.2.8 Protection for Edge of Excavation

  Yes

  No

  N/A

• 15.2.8.1 Spoil Pile Kept a Minimum of Two (2) Feet From Edge of Excavation, or Edge Protected by Vertical Wall?

  Yes

  No

  N/A

• 15.2.8.2 Materials and Equipment Kept Two (2) Feet or More From Edge of Excavation?

  Yes

  No

  N/A

• 15.2.9 All Mechanized Equipment Kept a Minimum of Two (2) Feet From Live Line at All Times?

  Yes

  No

  N/A

• 15.2.10 Hand digging used when approaching/crossing buried facilities? <br>Hand Excavate Around Live Lines from 2 to 5 Feet. <br>Columbia Pipeline Group Transmission Requires Hand Excavating Within Five (5) Feet.

  Yes

  No

  N/A

• 15.2.10.1 Five (5) Feet

• 15.2.10.2 Two (2) Feet

• 16.1 Do all stairs with four or more risers have standard stair rails or hand rails installed?

  Yes

  No

  N/A

• 16.2 Are all stairways at least 22 inches wide?

  Yes

  No

  N/A

• 16.3 Do stairs have landing platforms not less than 30 inches I the direction of travel and extend 22 inches in width at every 12 feet or less of vertical rise?

  Yes

  No

  N/A

• 16.4 Do stairs angle no more than 50 and no less than 30 degrees?

  Yes

  No

  N/A

• 16.5 Are step risers on stairs uniform from top to bottom?

  Yes

  No

  N/A

• 16.6 Are stairway handles capable of withstanding a load of 200 pounds, applied within 2 inches of the top edge in any downward or outward direction with no more than 3/4 inch of deflection?

  Yes

  No

  N/A

• 17.1 Is the local fire department familiar with the scope of work, work locations, and specific hazards?

  Yes

  No

  N/A

• 17.2 Extinguisher Inspection Tag Present and Current

  Yes

  No

  N/A

• 17.3 Extinguishers in place where needed/required?

  Yes

  No

  N/A

• 17.4 Properly Rated/Size (BC versus ABC/10lb versus 20lb)

  Yes

  No

  N/A

• 17.5 Combustible/Flammable Material Away from Hot Work

  Yes

  No

  N/A

• 17.6 Fire Extinguishers at least 25ft away but no further than 75ft away from Fuel Cells

  Yes

  No

  N/A

• 17.7 Extinguishers easily accessible and not blocked?

  Yes

  No

  N/A

• 17.8 Are portable fire extinguishers provided in adequate number an type in readily accessible locations?

  Yes

  No

  N/A

• 17.9 Office trailers on site?

  Yes

  No

  N/A

• 17.10 Are employees periodically instructed in the use of fire extinguishers and fire protection procedures?

  Yes

  No

  N/A

• Fire

  Yes

  No

  N/A

• 18.1 Permit

  Yes

  No

  N/A

• 18.2 Permit Conditions Followed

  Yes

  No

  N/A

• 18.3 Fire Watch

  Yes

  No

  N/A

• 18.4 Gas Cylinder Management

  Yes

  No

  N/A

• 18.5 Leads/Hoses/Gauges

  Yes

  No

  N/A

• 18.6 Other:

  Yes

  No

  N/A

• 19.1 GFCI/Assured Grounding Program

  Yes

  No

  N/A

• 19.2 Cords/Tools Inspected

  Yes

  No

  N/A

• 20.1 Condition

  Yes

  No

  N/A

• 20.2 Mushroomed heads

  Yes

  No

  N/A

• 20.3 Broken or fractured handles

  Yes

  No

  N/A

• 20.4 Worn or bent wrenches

  Yes

  No

  N/A

• 20.5 Proper handles used on files

  Yes

  No

  N/A

• 20.6 Guards/Handles

  Yes

  No

  N/A

• 20.7 Proper for Job/Use

  Yes

  No

  N/A

• 20.8 Are employees aware of hazards caused by faulty or improperly used hand tools?

  Yes

  No

  N/A

• 20.9 Availability and condition of tools

  Yes

  No

  N/A

• 21.1 Are grinders, saws, and similar equipment provided with appropriate safety guards?

  Yes

  No

  N/A

• 21.2 Are power tools used with proper shields, guards, or attachments, as recommended by the manufacturer?

  Yes

  No

  N/A

• 21.3 Are all guards in their proper position and operating properly (not wedged or blocked open)?

  Yes

  No

  N/A

• 21.4 Are rotating or moving parts of equipment guarded to prevent physical contact?

  Yes

  No

  N/A

• 21.5 Air tools/hose connections/pins in place

  Yes

  No

  N/A

22.1 Pipe Joining

• 22.1.1 Welding

  Yes

  No

  N/A

• 22.1.2 Butt Fusion

  Yes

  No

  N/A

• 22.1.3 Socket Fusion

  Yes

  No

  N/A

• 22.1.4 Electrofusion

  Yes

  No

  N/A

• 22.1.5 Mechanical Fitting

  Yes

  No

  N/A

22.2 Pipe Installation

• 22.2.1 OQs Valid for All Employees

  Yes

  No

  N/A

• 22.2.2 Material Inspection and Proper Pipe Handling/Storage

  Yes

  No

  N/A

• 22.2.3 Bore Installation

  Yes

  No

  N/A

• 22.2.4 Open Cut Installation

  Yes

  No

  N/A

• 22.2.5 Casing Installation

  Yes

  No

  N/A

• 22.2.6 Insertion Method

  Yes

  No

  N/A

• 22.2.7 Valve Installation

  Yes

  No

  N/A

• 22.2.8 Steel Pipe Bending

  Yes

  No

  N/A

• 22.2.9 Applying Corrosion Control

  Yes

  No

  N/A

• 22.2.10 Sloped Properly

  Yes

  No

  N/A

• 22.2.11 Backfilling

  Yes

  No

  N/A

• 22.2.12 Tracer Wire Installation

  Yes

  No

  N/A

• 23.1 Access/Egress

  Yes

  No

  N/A

• 23.2 Fall Protection

  Yes

  No

  N/A

• 23.3 Fall Protection Inspected

  Yes

  No

  N/A

• 23.4 Scaffolds/Ladders - Proper Type

  Yes

  No

  N/A

• 23.5 Scaffolds/Ladders - Inspected

  Yes

  No

  N/A

• 23.6 Scaffolds/Ladders - Use

  Yes

  No

  N/A

• 24.1 Body Mechanics

  Yes

  No

  N/A

• 24.2 Manual Lifting Devices (Come-a-Longs, Chain falls, etc…)

  Yes

  No

  N/A

• 24.3 Safety Latch

  Yes

  No

  N/A

• 24.4 Slings

  Yes

  No

  N/A

• 24.5 Hooks & Shackles

  Yes

  No

  N/A

• 24.6 Wire Rope

  Yes

  No

  N/A

• 24.7 Lifting Chains

  Yes

  No

  N/A

• 24.8 Load Secure, Rigged Properly

  Yes

  No

  N/A

• 24.9 Tag Lines Used

  Yes

  No

  N/A

• 24.10 Other:

  Yes

  No

  N/A

• 25.1 Authorized/Qualified Operator

  Yes

  No

  N/A

• 25.2 Designated Signal Person

  Yes

  No

  N/A

• 25.3 Seatbelt Used

  Yes

  No

  N/A

• 25.4 Inspection Completed Properly

  Yes

  No

  N/A

• 25.5 Daily/Weekly/Annual Inspection

  Yes

  No

  N/A

• 25.6 Backup Alarm

  Yes

  No

  N/A

• 25.7 Other:

  Yes

  No

  N/A

• 26.1 Signs and crosswalks available for pedestrians

  Yes

  No

  N/A

• 26.2 Adequate cushion/warning for drivers

  Yes

  No

  N/A

• 26.3 Flagger present if necessary

  Yes

  No

  N/A

• 26.4 Flagger positioning visible to drivers

  Yes

  No

  N/A

• 26.5 Flagger is wearing/using proper PPE/Equipment-hard Hat, Vest, Paddle

  Yes

  No

  N/A

• 26.6 Signage is properly placed

  Yes

  No

  N/A

• 26.7 Cones are properly placed

  Yes

  No

  N/A

• 26.8 Barrels/Drums are properly placed

  Yes

  No

  N/A

• 26.9 Retro reflective equipment and flashers in use at night

  Yes

  No

  N/A

• 27.1 Permitted

  Yes

  No

  N/A

• 27.2 Personnel Trained

  Yes

  No

  N/A

• 27.3 Emergency Rescue Plan

  Yes

  No

  N/A

• 27.4 Rescue/Retrieval Equipment (Anklets, Harness, Life Line, etc.)

  Yes

  No

  N/A

• Yes

  No

  N/A

• 28.1 Adequate lighting

  Yes

  No

  N/A

• 28.2 Clear safety glasses

  Yes

  No

  N/A

• 29.1 Signs, Signals & Barricades

  Yes

  No

  N/A

• 29.2 Film Badges for X-Ray Crew

  Yes

  No

  N/A

• 30.1 Purging

  Yes

  No

  N/A

• 30.2 Tie-in piping remediation

  Yes

  No

  N/A

• 30.3 Stop pipelines using a squeeze off device

  Yes

  No

  N/A

• 30.4 Stop pipelines using an inflatable bag/diaphragm stopper

  Yes

  No

  N/A

• 30.5 Tap pipelines using a drilling machine

  Yes

  No

  N/A

• 30.6 Tap pipelines using a self-tapping tee

  Yes

  No

  N/A

• 30.7 Pressure Testing/Hydro-testing Procedures

  Yes

  No

  N/A

• 30.8 Equipment Integrity

  Safe

  At Risk

  N/A

• 30.9 Whip Checks/Connections Pinned

  Safe

  At Risk

  N/A

• 30.10 Signs, Signals & Barricades

  Safe

  At Risk

  N/A