Information
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Location
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Supervisor/Crew Leader
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Job description
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Conducted on
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Prepared by
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Personnel
Work order
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Tailgate safety topic is specific to the job performed
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JHSA signed by all crew members
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Pre job inspection done on equipment/vehicles
Safety controls
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Crew is aware of all hazards and how to avoid them
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LOTO done correctly
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MSDS SHEETS CORRECT
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All permits filled out correctly (Confined Space etc)
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Barricade and tags properly placed
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All PPE present and properly used
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Is working area clean and free of hazards
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Are ladders, scaffold, fall protection in use
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Are the ladders, scaffolds, man lifts and fall protection being properly used
Hydroblasting
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Whip checks in place
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Blast hose inspected
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Blast hose in good repair
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10k
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20k
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40k
Lancing
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Job on elevated floor.
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Is blast hose properly tied off
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Anti withdrawal device in place
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Is anti-withdrawal device properly mounted
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Is stinger and nozzle 1.5X the diameter of the pipe being cleaned?
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Is lance in good repair
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Is employee operating his own foot pedal
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Is foot pedal in proper working order
Shotgun
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Shotgun appropriate length
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Does shot gun have a hose shroud
Vacuuming
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Is job on an elevated floor
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Is vac hose properly tied off
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Is there a hose break in use
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If necessary, is vac truck properly bonded
Vehicle/equipment
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Is fire extinguisher in place and inspected
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Is vehicle/equipment clean
Comments and corrections
Observations
Corrective Action
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Auditor
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Crew Leader/Supervisor