NCIG - PTO - Concrete Pumping

• Audit Title/Client/Date (reverse order)

• Prepared by

• Location
  Address

• Personnel

EVALUATION

• Are all activities performed in compliance with an accepted JSEA that is still adequate for the current tasks & conditions?

  Yes

  No

  N/A

• Do all persons appear to understand the requirements of the JSEA & have signed off?

  Yes

  No

  N/A

• Has the worker ensured that the pump is not positioned over or adjacent to any of the following?<br>- Previously disturbed ground that has been back-filled<br>- Excavations<br>- Trenches<br>- Inadequately compacted or soft ground

  Yes

  No

  N/A

• Has the pump unit been set up level?

  Yes

  No

  N/A

• Are exclusion zones implemented to prevent unplanned interaction with the hazards associated with the activity?

  Yes

  No

  N/A

• Do concrete delivery trucks have clear & safe access to approach & leave the receiving hopper of the pump, with a spotter used to direct the movement?

  Yes

  No

  N/A

• Did any personnel stand between the reversing truck & the hopper?

  Yes

  No

  N/A

• When laying a pipeline, were unnecessary bends avoided?

  Yes

  No

  N/A

• Are vertical lines positively secured to a structure that does not include a crane or hoist tower, scaffolding or formwork?

  Yes

  No

  N/A

• Are locking pins engaged to avoid accidental release of pipes?

  Yes

  No

  N/A

• Are enough anchor brackets & tie-downs used to adequately secure the system?

  Yes

  No

  N/A

• Are hands kept away from the hopper grate whenever the pump is running?

  Yes

  No

  N/A

• Is extreme care taken when using compressed air to clean the pipeline?

  Yes

  No

  N/A

• Were the following safety precautions taken when using compressed air?

• There is always a connection to atmosphere (air relief valve) as well as the air entry point to the pipeline

  Yes

  No

  N/A

• The rubber delivery hose at the end of the pipeline is removed before cleaning

  Yes

  No

  N/A

• A positive catchments device is attached to the discharge end of the pipeline to safely catch the cleaning device

  Yes

  No

  N/A

• No attempt is made to take a line apart to clean out a blockage or to dismantle it until after the pressure as been relieved

  Yes

  No

  N/A

• Before a person places any part of their body into a pump opening, the engine is shut down and the controls actuated to exhaust any hydraulic accumulators which can allow the elements to move or rotate with the engine stopped

  Yes

  No

  N/A

• Is the person cleaning a pipeline working alone?

  Yes

  No

  N/A

• Are there any other risks or issues associated with the activities observed?

  Yes

  No

  N/A

• If yes, provide details

• Location of Observation

• COMMENTS & RECOMMENDATIONS

• Comments & recommendations to be actioned by

• Signature of observer

  Sign