Information

  • Document No.

  • ONEOK Business Segment

  • ONEOK Operation Site

  • Site Location

  • Conducted on

  • Prepared by

  • Location
  • Contractor

  • Prime Contractor on site (if applicable)

1. Contractor JSA

  • C1:1 - Is the scope appropriate for task/task covered?

  • C1:2 - Performed?

  • C1:3 - Reviewed?

  • C1:4 - Signed?

  • Comments:

2. Environmental/Emergency Response

  • C2:1 - Emergency Action Plan?

  • C2:2 - Spill Response Kit?

  • C2:3 - Certified CPR/First-aid?

  • C2:4 - First Aid kit?

3. Hazardous Communication

  • C3:1 - Safety Data Sheet Available?

  • C3:2 - Safety Data Sheet Reviewed?

  • C3:3 - Containers Labeled Properly?

  • C3:4 - Handling Procedures Followed?

4. PPE

  • C4:1 - Are Hard Hat worn correctly?

  • C4:2 - Eye/Face?

  • C4:3 - Hand?

  • C4:4 - Hearing?

  • C4:5 - Footwear?

  • C4:6 - Hi-Visibility Vest?

  • C4:7 - FRC?

  • C4:8 - Monitors Available, In USE, Calibrated (4 gas, H2S or Other)

  • C4:9 - Other:

5. Material Handling

  • C5:1 - Body Mechanics?

  • C5:2 - Manual Lifting Devices (Come-a-longs, Chain Falls, etc.)?

  • C5:3 - Safety Latch?

  • C5:4 - Sling?

  • C5:5 - Hooks & Shackles?

  • C5:6 - Wire Rope?

  • C5:7 - Lifting Chains?

  • C5:8 - Load Secure, Rigged Properly?

  • C5:9 - Tag Lines Used?

  • C5:10 - Other:

6. Worksite Protection

  • C6:1 - Signs and crosswalks available for pedestrians?

  • C6:2 - Adequate cushion/warning for drivers?

  • C6:3 - Flagger present if necessary?

  • C6:4 - Flagger is wearing/using proper PPE/Equipment-Hard Hat, Vest, Paddle?

  • C6:5 - Flagger positioning visible to drivers?

  • C6:6 - Signage is properly placed?

  • C6:7 - Cones are properly placed?

  • C6:8 - Retro reflective equipment and flashers in use at night?

  • C6:9 - Adequate clearance from overhead and other hazards?

7. Vehicle/Equipment/Crane

  • Is there mobile equipment on site?

  • C7:1 - Authorized/Qualified Operator?

  • C7:2 - Designated Signal Person?

  • C7:3 - Seatbelt Used?

  • C7:4 - Backup Alarm?

  • C7:5 - Daily/Weekly/Annual Inspection on Mobile Equipment?

  • C7:6 - Inspection Completed Properly?

  • C7:7 - Other:

8. Material Storage

  • Is there material stored on-site?

  • C8:1 - Material Stored Properly?

  • C8:2 - Flammable/Combustible Storage?

  • C8:3 - Piped Chocked?

  • C8:4- Other:

9. Fall Prevention/Protection

  • Is there any elevated work?

  • C9:1 - Access/Egress?

  • C9:2 - Fall Protection?

  • C9:3 - Fall Protection Inspected?

  • C9:4 - Scaffolds/Ladders - Proper Type?

  • C9:5 - Scaffolds/Ladders - Inspected?

  • C9:6 - Scaffolds/Ladders - Use

10. Hand/Power Tools

  • Are there hand/power tools on-site?

  • C10:1 - Condition?

  • C10:2 - Guards/Handles?

  • C10:3 - Proper for Job/Use?

  • C10:4 - Air tools/hose connections/pins in place?

11. Electrical

  • Are there any electrical tools?

  • C11:1 - GFCI/Assured Grounding Program?

  • C11:2 - Cords/Tools Inspected?

12. Hot Work

  • Is Hot work in the job scope

  • C12:1 - Fire Watch?

  • C12:2 - Gas Cylinder Management?

  • C12:3 - Leads/Hoses/Gauges?

  • C12:4 - Other:

13. Fire Protection & Prevention

  • C13:1 - Extinguisher inspection tag present and current?

  • C13:2 - Properly Rated/Size (BC versus ABC)?

  • C13:3 - Combustible/Flammable Material away from Hot Work?

  • C13:4 - Fire Extinguishers at least 25 feet away but no further than 75 feet away from fuel cells?

14. Excavation

  • Is excavation on-site?

  • C14:1 - Hand digging used when approaching/crossing buried facilities?

  • C14:2 - Spill kits on board and stocked?

  • C14:3 - Sloped properly?

  • C14:4 - Benched properly?

  • C14:5 - Trench box/Proper shoring?

  • C14:6 - Trench box certifications?

  • C14:7 - Access/Egress Points?

  • C14:8 - Spoil pile minimum of 2 feet away from excavation?

  • C14:9 - Signs, signals ,barricades?

  • C14:10 - One call made?

  • C14:11 - Utilities Identified?

15. Housekeeping/General Condition

  • C15:1 - Worksite free of clutter?

  • C15.2 - Trash picked-up?

  • C15:3 - Equipment, machines/tools do not block pathway?

  • C15:4 - Tripping and slipping hazards?

  • C15:5 - Tools properly stored/staged?

  • C15:6 - Crew trucks/Trailers clean and free of clutter?

  • C15:7 - Adequate lighting/visibility?

16. Ergonomics/Jobsite

  • C16:1 - Proper lifting techniques used?

  • C16:2 - Employees positioned away from hazards, moving parts and equipment?

  • C16:3 - Pinch points?

  • C16:4 - Proper body positioning?

17. Walking Surfaces

  • C18:1 - Pathways?

  • C18:2 - Trip Hazards?

  • C18:3 - Holes Guarded?

18. Overhead Powerlines

  • Are overhead powerlines present

  • C19:1 - Power lines marked with goal posts and signs?

  • C19:2 - Designated spotter?

  • C19:3 - Proper equipment for spotter (air horn, vest, etc.)?

19. Radiation Sources

  • Is there any X-ray sources on site?

  • C20:1 - Signs, signals, and barricades?

  • C20:2 - Film badges for X-ray crew?

20. Pressure Testing

  • Is there pressure testing taking place?

  • C21:1 - Equipment integrity?

  • C21:2 - Whip checks/Connections pinned?

  • C21:3 - Signs, signals, and barricades?

21. Confined Space

  • Is there permit required confined space taking place?

  • C21:1 - Permitted?

  • C21:2 - Personnel trained?

  • C21:3 - Emergency rescue plan?

  • C21:3 - Rescue/Retrieval Equipment (anklets, harness, life line, etc.)?

  • C21.4 - Attendant present?

22. Inspection Conclusion

  • Inspection Notes:

  • Positive Observation:

  • Prepared By:

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