Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Store Number

  • Store Personnel on site

  • Contractor

  • Work/Job performed

  • Contractor Competent Person:

  • Audit Date and Time:

  • Tesoro Inspecting Representative:

Background

  • This checklist is to be used to document contractor compliance to Federal/State/Local EH&S requirements, Tesoro Retail Operations Safety and contractors own Safety Plan. The procedure is to first check in with Store personnel, and then introduce self to on-site competent person or crew foreman. Without impeding contractors work, conduct audit. If possible perform audit with Contractors submitted Safety Plan for any discrepancies. If element is N/A (not applicable) - write in comments.

1.0 Job Site Compliance/Conditions/Behaviors

  • 1.1 Work area is appropriately coned/taped/barricaded

  • 1.2 Work area is clean of debris, trash, oily rags<br>

  • 1.3 All personnel in high visibility wear.<br>

  • 1.4 Work conditions (lighting, weather, available space) adequate and do not create any unsafe conditions.<br>

  • 1.5 Competent Person on-site.<br>

  • 1.6 Other PPE in use where appropriate (eye protection, fall protection, gloves, respirators, hearing protection, hard hats etc).<br>

  • 1.7 Safety signage in place for site requirements (eye protection, hard hats) and conditions (danger, warning, and caution).<br>

  • 1.8 Safety equipment in obvious locations and well marked (eye wash, fire extinguishers, hazmat disposal, and chemical storage).<br>

  • 1.9 Safety documentation available and accurate ( site safety plan with evacuation and emergency procedures, site safety training, hot work permits, MSDS sheets, confined space entry permits, lock-out tags, fall protection work plans).<br>

  • 1.10 Briefly review area for any unsafe conditions (open manholes, unprotected work at elevation, unprotected energized systems in work).<br>

2.0 Safety Processes

  • 2.1 Proper lockout-tag out process followed.<br>

  • 2.2 If there is is work over 6'-fall protection system in place.<br>

  • 2.3 Applicable permits adhered to (confined space, hot work).<br>

  • 2.4 Chemical labeling appropriate.<br>

  • 2.5 Site Safety Plan is specific to site and adhered to.<br>

  • 2.6 Overhead work safety plan utilized where appropriate (spotter, hard hats, barricaded).<br>

  • 2.7 Workers have had safety briefing on site specific issues.<br>

  • 2.8 Workers know procedures for reporting accidents and injuries.<br>

3.0 Safety Equipment

  • 3.1 Appropriate guarding on any rotating/reciprocating equipment/machinery.<br>

  • 3.2 Minimum 2, 25 lb ABC Fire extinguishers.<br>

  • 3.3 Fall protection equipment and system in good condition and appropriate for elevated work.<br>

  • 3.4 Lock-out/tag-out devices in good repair and in use.<br>

  • 3.5 Chemical storage and HazMat storage containers labeled and closed (self locking lids).<br>

4.0 Work Equipment

  • 4.1 Contractor equipment/trucks have back up beepers where required, safety belts and other safety equipment.<br>

  • 4.2 Ladders are clean and in good repair.<br>

  • 4.3 Ladders appropriate for work, correct ladder for job.<br>

  • 4.4 Scaffolding ridged, on secure footing, capable of supporting 4X loads, with safe means to gain access.<br>

  • 4.5 Scaffolding with platforms at 10' or greater utilize guard railing, toe boards, and/or wire mesh to protect all open sides and ends.<br>

  • 4.6 Electrical equipment is grounded.<br>

  • 4.7 Extension cords used with electrical quip meant are in good repair with ground fault interrupt capability.<br>

5.0 General Observations:

6.0 Signatures

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The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.