Information
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Document No.
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Audit Title
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Conducted on
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Prepared by
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Location
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Contractor
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Project Name
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Pipeline Spreads:
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Contractor Superintendent/Supervisor
1. Work Permit/JSA
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C1:1 - Appropriate for task/task covered?
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C1:2 - Performed?
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C1:3 - Reviewed?
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C1:4 - Signed?
2. Environmental/Emergency Respone
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C2:1 - Emergency Action Plan?
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C2:2 - Spill Response Kit?
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C2:3 - Certified Responders?
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C2:4 - First Aid kit?
3. Hazardous Communication
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C3:1 - Safety Data Sheet Available?
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C3:2 - Safety Data Sheet Reviewed?
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C3:3 - Containers Labeled Properly?
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C3:4 - Handling Procedures Followed?
4. PPE
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C4:1 - Hard Hat?
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C4:2 - Hard Hat worn correctly?
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C4:3 - Eye/Face?
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C4:4 - Hand?
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C4:5 - Hearing?
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C4:6 - Footwear?
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C4:7 - Hi-Visibility Vest?
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C4:8 - FRC?
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C4:9 - Monitors Available, In USE, Calibrated (4 gas, H2S or Other)
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C4:10 - Other:
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5. Material Handling
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C5:1 - Body Mechanics?
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C5:2 - Manual Lifting Devices (Come-a-longs, Chain Falls, etc.)?
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C5:3 - Safety Latch?
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C5:4 - Sling?
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C5:5 - Hooks & Shackles?
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C5:6 - Wire Rope?
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C5:7 - Lifting Chains?
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C5:8 - Load Secure, Rigged Properly?
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C5:9 - Tag Lines Used?
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C5:10 - Other:
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6. Worksite Protection
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C6:1 - Signs and crosswalks available for pedestrians?
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C6:2 - Adequate cushion/warning for drivers?
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C6:3 - Flagger present if necessary?
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C6:4 - Flagger is wearing/using proper PPE/Equipment-Hard Hat, Vest, Paddle?
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C6:5 - Flagger positioning visible to drivers?
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C6:6 - Signage is properly placed?
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C6:7 - Cones are properly placed?
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C6:8 - Retro reflective equipment and flashers in use at night?
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C6:9 - Adequate clearance from overhead and other hazards?
7. Vehicle/Equipment/Crane
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C7:1 - Authorized/Qualified Operator?
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C7:2 - Designated Signal Person?
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C7:3 - Seatbelt Used?
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C7:4 - Backup Alarm?
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C7:5 - Daily/Weekly/Annual Inspection?
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C7:6 - Inspection Completed Properly?
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C7:7 - Other:
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8. Material Storage
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C8:1 - Material Stored Properly?
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C8:2 - Flammable/Combustible Storage?
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C8:3 - Piped Chocked?
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C8:4 - Other:
9. Fall Prevention/Protection
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C9:1 - Access/Egress?
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C9:2 - Fall Protection?
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C9:3 - Fall Protection Inspected?
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C9:4 - Scaffolds/Ladders - Proper Type?
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C9:5 - Scaffolds/Ladders - Inspected?
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C9:6 - Scaffolds/Ladders - Use
10. Hand Tools
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C10:1 - Condition?
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C10:2 - Guards/Handles?
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C10:3 - Proper for Job/Use?
11. Electrical
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C11:1 - GFCI/Assured Grounding Program?
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C11:2 - Cords/Tools Inspected?
12. Hot Work
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C12:1 - Permit?
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C12:2 - Permit Conditions Followed?
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C12:3 - Fire Watch?
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C12:4 - Gas Cylinder Management?
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C12:5 - Leads/Hoses/Gauges?
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C12:6 - Other:
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13. Fire Protection & Prevention
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C13:1 - Extinguisher inspection tag present and current?
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C13:2 - Properly Rated/Size (BC versus ABC)?
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C13:3 - Combustible/Flammable Material away from Hot Work?
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C13:4 - Fire Extinguishers at least 25 feet away but no further than 75 feet away from fuel cells?
14. Excavation
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C14:1 - Hand digging used when approaching/crossing buried facilities?
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C14:2 - Spill kits on board and stocked?
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C14:3 - Sloped properly?
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C14:4 - Benched properly?
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C14:5 - Trench box/Proper shoring?
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C14:6 - Trench box certifications?
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C14:7 - Access/Egress Points?
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C14:8 - Spoil pile minimum of 2 feet away from excavation?
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C14:9 - Signs, signals ,barricades?
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C14:10 - One call made?
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C14:11 - Utilities Identified?
15. Signs/Barricades
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C15:1 - Condition?
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C15:2 - Proper type?
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C15:3 - Marking hazards?
16. Housekeeping
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C16:1 - Worksite free of clutter?
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C16:2 - Equipment, machines/tools do not block pathway?
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C16:3 - Tripping and slipping hazards?
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C16:4 - Tools properly stored/staged?
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C16:5 - Crew trucks/Trailers clean and free of clutter?
17. Ergonomics/Jobsite
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C17:1 - Proper lifting techniques used?
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C17:2 - Employees positioned away from hazards, moving parts and equipment?
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C17:3 - Pinch points?
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C17:4 - Proper body positioning?
18. Walking Surfaces
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C18:1 - Pathways?
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C18:2 - Trip Hazards?
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C18:3 - Holes Guarded?
19. Overhead Powerlines
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C19:1 - Power lines marked with goal posts and signs?
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C19:2 - Designated spotter?
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C19:3 - Proper equipment for spotter (air horn, vest, etc.)?
20. Radiation Sources
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C20:1 - Signs, signals, and barricades?
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C20:2 - Film badges for X-ray crew?
21. Pressure Testing
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C21:1 - Equipment integrity?
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C21:2 - Whip checks/Connections pinned?
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C21:3 - Signs, signals, and barricades?
22. Confined Space
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C22:1 - Permitted?
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C22:2 - Personnel trained?
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C22:3 - Emergency rescue plan?
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C22:3 - Rescue/Retrieval Equipment (anklets, harness, life line, etc.)?
23. Equipment/Tools
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C23:1 - Availability and condition of tools?
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C23:2 - Adequate lighting/visibility?
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C23:3 - Grounding of tools/pipe/containers?
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C23:4 - Air tools/hose connections/pins in place?
24. Inspection Conclusion
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Inspection Notes: