Information

  • Document No.

  • Audit Title

  • Conducted on

  • Prepared by

  • Location
  • Contractor

  • Project Name

  • Pipeline Spreads:

  • Contractor Superintendent/Supervisor

1. Work Permit/JSA

  • C1:1 - Appropriate for task/task covered?

  • C1:2 - Performed?

  • C1:3 - Reviewed?

  • C1:4 - Signed?

2. Environmental/Emergency Respone

  • C2:1 - Emergency Action Plan?

  • C2:2 - Spill Response Kit?

  • C2:3 - Certified Responders?

  • 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 - Hard Hat?

  • C4:2 - Hard Hat worn correctly?

  • C4:3 - Eye/Face?

  • C4:4 - Hand?

  • C4:5 - Hearing?

  • C4:6 - Footwear?

  • C4:7 - Hi-Visibility Vest?

  • C4:8 - FRC?

  • C4:9 - Monitors Available, In USE, Calibrated (4 gas, H2S or Other)

  • C4:10 - Other:

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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:

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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

  • C7:1 - Authorized/Qualified Operator?

  • C7:2 - Designated Signal Person?

  • C7:3 - Seatbelt Used?

  • C7:4 - Backup Alarm?

  • C7:5 - Daily/Weekly/Annual Inspection?

  • C7:6 - Inspection Completed Properly?

  • C7:7 - Other:

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8. Material Storage

  • C8:1 - Material Stored Properly?

  • C8:2 - Flammable/Combustible Storage?

  • C8:3 - Piped Chocked?

  • C8:4 - Other:

9. Fall Prevention/Protection

  • 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 Tools

  • C10:1 - Condition?

  • C10:2 - Guards/Handles?

  • C10:3 - Proper for Job/Use?

11. Electrical

  • C11:1 - GFCI/Assured Grounding Program?

  • C11:2 - Cords/Tools Inspected?

12. Hot Work

  • C12:1 - Permit?

  • C12:2 - Permit Conditions Followed?

  • C12:3 - Fire Watch?

  • C12:4 - Gas Cylinder Management?

  • C12:5 - Leads/Hoses/Gauges?

  • C12:6 - Other:

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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

  • 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. Signs/Barricades

  • C15:1 - Condition?

  • C15:2 - Proper type?

  • C15:3 - Marking hazards?

16. Housekeeping

  • C16:1 - Worksite free of clutter?

  • C16:2 - Equipment, machines/tools do not block pathway?

  • C16:3 - Tripping and slipping hazards?

  • C16:4 - Tools properly stored/staged?

  • C16:5 - Crew trucks/Trailers clean and free of clutter?

17. Ergonomics/Jobsite

  • C17:1 - Proper lifting techniques used?

  • C17:2 - Employees positioned away from hazards, moving parts and equipment?

  • C17:3 - Pinch points?

  • C17:4 - Proper body positioning?

18. Walking Surfaces

  • C18:1 - Pathways?

  • C18:2 - Trip Hazards?

  • C18:3 - Holes Guarded?

19. Overhead Powerlines

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

  • C19:2 - Designated spotter?

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

20. Radiation Sources

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

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

21. Pressure Testing

  • C21:1 - Equipment integrity?

  • C21:2 - Whip checks/Connections pinned?

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

22. Confined Space

  • C22:1 - Permitted?

  • C22:2 - Personnel trained?

  • C22:3 - Emergency rescue plan?

  • C22:3 - Rescue/Retrieval Equipment (anklets, harness, life line, etc.)?

23. Equipment/Tools

  • C23:1 - Availability and condition of tools?

  • C23:2 - Adequate lighting/visibility?

  • C23:3 - Grounding of tools/pipe/containers?

  • C23:4 - Air tools/hose connections/pins in place?

24. Inspection Conclusion

  • Inspection Notes:

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.