MPW Water Blast Checklist

• Client / Site / Customer

• Conducted on

  Date

• Prepared / Completed by:

• Personnel on-site:

Water Blast Checklist

• Is the water blasting area properly barricaded and posted with caution / warning signs?

  Yes

  No

  N/A

• Is the work area a confined space?

  Yes

  No

  N/A

• Has a MPW Confined Space Permit been completed?

  Yes

  No

  N/A

• Has all moving equipment and other sources of hazardous energy been locked out LO/TO? (electrical, pneumatic, chemical, steam)

  Yes

  No

  N/A

• What Safety Guards are required for this job? (check all that apply)

  Yes

  No

  N/A

• Lance Stopper (hand guard)

• Anti-Withdraw Device

• Starter Rod 18 inches long (stinger)

• Double-dump shotgun

• Other

• Hands Free

• Have all fittings, guns,lances, nozzles, dump valves and other equipment been inspected prior to use?

  Yes

  No

  N/A

• Do high pressure hoses meet inspection criteria?

  Yes

  No

  N/A

• Are hoses color coded?<br>Jan - Mar = YELLOW<br>Apr - Jun = ORANGE<br>Jul - Sep = BLUE<br>Oct - Dec = GREEN

  Yes

  No

  N/A

• What Personal Protective Equipment (PPE) will be used for the water blasting work? (check all that apply)

  Yes

  No

  N/A

• Hard Hat

• Safety Glasses with side shields

• Goggles

• Face Shield

• Hearing Protection

• Rubber Gloves

• Rain / Blast Suit (yellow)

• Acid / Chemical Suit (green)

• Full Body Coveralls

• Full Metatarsal Blast Boots

• Chemical Overboots

• Respirator

• Other (specify)

• Have Emergency Showers and Eyewash Stations been identified and checked for operability?

  Yes

  No

  N/A

• Are water blast "Medical Alert" cards available on site?

  Yes

  No

  N/A

• Have on-site first aid, ambulance and off-site emergency medical facilities been identified?

  Yes

  No

  N/A

• Have emergency procedures, exits, evacuation routes and assembly points been identified?

  Yes

  No

  N/A

• Have emergency notification procedures been established / documented?

  Yes

  No

  N/A

• Have the crew members been informed of the emergency procedures?

  Yes

  No

  N/A

• Are equipment guards in place? (trigger guards, rotational guards)

  Yes

  No

  N/A

• Is there as hose safety shroud on each gun?

  Yes

  No

  N/A

• Are whip-checks in place and properly positioned? (hose - hose, hose -pump, hose - foot pedal)

  Yes

  No

  N/A

• Are all water blast operators properly trained? (MPW or other acceptable source)

  Yes

  No

  N/A

• Is lighting in the work and support areas adequate?

  Yes

  No

  N/A

• Are GFCI's in place and tested?

  Yes

  No

  N/A

• Are footing conditions firm?

  Yes

  No

  N/A

• Is the lance operator in control of the foot pedal?

  Yes

  No

  N/A

• Are proper sized rupture discs in place?

  Yes

  No

  N/A

• Are stainless steel fittings, NOT black iron fittings used in locations where failure could impact personnel?

  Yes

  No

  N/A

• Have the MSDS's or SDS's for hazardous materials in the work area been reviewed with the crew?

  Yes

  No

  N/A

• Has a Job safety Analysis (JSA) or Work Task Safety Requirement (WTSR) been prepared for this work?

  Yes

  No

  N/A

• Has the JSA or WTSR been reviewed with the crew?

  Yes

  No

  N/A

• Have the contents of this checklist been reviewed with the crew?

  Yes

  No

  N/A

• If critical safety requirements CANNOT be met has a variance been documented and approved? (which defines an alternate procedure that provides an equivalent level of safety)

  Yes

  No

  N/A

• Other Comments

  Yes

  No

  N/A

• Date: Time:

  Date

• Supervisor's Signature:

  Sign