MOP Worksite Safety Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Forms and Permits

• MOP Job Safety Analysis ( JSA ) Form

  Yes

  No

  N/A

• Pre-Job Safety Briefing Form (includes section for employee initials to verify injury during shift)

  Yes

  No

  N/A

• NiSource Gas Transmission and Storage Construction Safe Work Permit

  Yes

  No

  N/A

• NiSource Gas Transmission and Storage Ground Disturbance and Hazard Assessment Checklist

  Yes

  No

  N/A

Worksite Protection

• Cones are properly placed. OSHA 1926.202

  Yes

  No

  N/A

• Signage properly placed. OSHA 1926.202

  Yes

  No

  N/A

• Adequate cushion / warning for drivers. OSHA 1926.202

  Yes

  No

  N/A

• Signs and crosswalks available for pedestrians. OSHA 1926.202

  Yes

  No

  N/A

• Adequate clearance from overhead and other hazards. OSHA 1926.21(b)(2)

  Yes

  No

  N/A

• Flagger present if necessary. OSHA 1926.201(a)(1)

  Yes

  No

  N/A

• Flagger positioning visible to drivers. OSHA 1926.201(a)(1)

  Yes

  No

  N/A

• Flagger is wearing / using proper PPE / equipment ( Hard Hat, Vest, Paddle, Flag ) OSHA 1926.201(a) and 1926.95(a)

  Yes

  No

  N/A

• Retro-Reflective equipment and flashers in use at night. OSHA 1926.201and1926.202

  Yes

  No

  N/A

• Initial gas readings taken prior to entering excavation. OSHA 1926.55(a)(b) and 1926.651(g)

  Yes

  No

  N/A

Personal Protective Equipment ( PPE )

• Eye and Face Protection. OSHA 1926.102

  Yes

  No

  N/A

• Head Protection. OSHA 1926.100

  Yes

  No

  N/A

• Hearing Protection. OSHA 1926.101

  Yes

  No

  N/A

• Hand Protection / Gloves OSHA 1910.138

  Yes

  No

  N/A

• Hi-Vis Clothing. OSHA 1926.28(a)

  Yes

  No

  N/A

• Reflective Vests OSHA 1926.28(a)

  Yes

  No

  N/A

• Long Sleeve Clothing. OSHA 1910.132(d)

  Yes

  No

  N/A

• FR Clothing. OSHA 1910.132(d)

  Yes

  No

  N/A

• Foot Protection ( steel toes or equivalent ) OSHA 1926.96

  Yes

  No

  N/A

Respiratory Protection

• O2 monitors worn by employees in excavations with live gas mains. OSHA 1926.55(a)

  Yes

  No

  N/A

• Employees using respirators have been properly fit tested and trained. OSHA 1926.103 and 1910.134

  Yes

  No

  N/A

• Employees using respirators are clean shaven at the time of use. OSHA 1926.103 and 1910.134

  Yes

  No

  N/A

• Respirators properly inspected, cleaned, stored, and maintained. OSHA 1926.103 and 1910.134

  Yes

  No

  N/A

• Proper cartridges are being used and replacements are available on site for change out if necessary. OSHA 1926.103 and 1910.134

  Yes

  No

  N/A

• Standby employees are trained, equipped, and positioned appropriately. OSHA 1926.103 and 1910.134

  Yes

  No

  N/A

Worksite Housekeeping

• Worksite free of clutter and debris. OSHA 1926.25

  Yes

  No

  N/A

• Equipment, machines / tools do not block pathways or egress. OSHA 1926.250 and 1926.602(a)

  Yes

  No

  N/A

• Trip, slip, and fall hazards. OSHA 1926.20(b)

  Yes

  No

  N/A

• Tools properly stored / staged. OSHA 1926.250

  Yes

  No

  N/A

• Cables and hoses properly managed. OSHA 1926.250

  Yes

  No

  N/A

Job-site Ergonomics

• Proper lifting techniques being used. OSHA 1926.20(b)

  Yes

  No

  N/A

• Employees cognizant of and positioned away from hazards, moving parts and equipment. OSHA 1926.20(b)

  Yes

  No

  N/A

• Pinch points being observed. OSHA 1926.20(b)

  Yes

  No

  N/A

Equipment and Tools

• Grounding of tools, pipes, and containers. OSHA 1926.403 and 1926.404

  Yes

  No

  N/A

• Equipment inspection done before use and paperwork completed. OSHA 1926.601(b)(14)

  Yes

  No

  N/A

• Adequate lighting / viability. OSHA 1926.26

  Yes

  No

  N/A

• Air tool hoses and safety pins in place. OSHA 1926.302(b)

  Yes

  No

  N/A

• Manufacturers guards and safety components in place on power tools. OSHA 1926.300 (b)

  Yes

  No

  N/A

• Proper electrical cords and GFCI in use. OSHA 1926.403 and 1926.405

  Yes

  No

  N/A

Fire protection

• Placement of vehicles and ignition sources upwind / away from job-site. OSHA 1926.151

  Yes

  No

  N/A

• Extinguisher appropriate to work-site requirements. OSHA 1926.150

  Yes

  No

  N/A

• Extinguisher inspection tag present and current. OSHA 1926.150

  Yes

  No

  N/A

• If blowing gas, extinguisher is attended. 1926.150

  Yes

  No

  N/A

Trench /Excavation Safety

• Hand digging used when approaching / crossing buried facilities. OSHA 1926.651

  Yes

  No

  N/A

• Egress available: ladders, ramp or steps within 25 feet of workers (excavation depth of 4 feet)<br>

  Yes

  No

  N/A

• Shoring / sloping / step back / trench box in place at 5 foot excavation depth. OSHA 1926.651

  Yes

  No

  N/A

• Spoil pile / tools / equipment at least 2 feet away from excavation edge. OSHA 1926.651

  Yes

  No

  N/A

• Soil conditions and site checked after each break in work sessions. OSHA 1926.651

  Yes

  No

  N/A

Materials of Trade Compliance

• All containers / quantities below Hazmat placard requirements. 49 CFR 397

  Yes

  No

  N/A

• Containers correct for purpose and labeled properly. 49 CFR 173

  Yes

  No

  N/A

• Containers in good /safe condition. 49 CFR 173

  Yes

  No

  N/A

• Containers secured. 49 CFR 173

  Yes

  No

  N/A

• Spill kits on board and stocked. 49 CFR 173

  Yes

  No

  N/A

Vehicles and Trailers

• Commercial Motor Vehicle inspection completed before use and written proof available. 49 CFR 396.11

  Yes

  No

  N/A

• Insurance card and accident reporting packages on board and current. 49 CFR 381.1

  Yes

  No

  N/A

• Operators CDL available and current. 49 CFR 383

  Yes

  No

  N/A

• Drivers medical certification available and current. 49 CFR 391

  Yes

  No

  N/A

• Trailer hook ups and hitches, including hooks, chains, and binders.

  Yes

  No

  N/A

• Vehicle properly marked and equipped with required safety equipment. 49 CFR 392

  Yes

  No

  N/A