Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
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Facility name:
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Facility current operation:
Demographics:
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Name:
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Picture of person as you walk up to them
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Title:
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Number of years on the job? SSE? Name of Mentor?
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Job at hand when walking up to person
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Location of interview on facility
Current PPE
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Hardhat, steel toes, safety glasses
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Ear plugs
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Gloves
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Face shield
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Apron
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Other PPE
Job task when you walked up to personnel (Section 3. JSA)
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Did s/he stop the job and make it safe to talk to you? (Picture)
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Is there a JSA Onsite for the job?
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Is the JSA complete with hazard mitigation, does it match the job at hand?
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Have all parties involved with the job signed the JSA?
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Describe "Stop the Job"
Section 1. General Provisions
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Describe SEMS?
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Where are the SEMS documents kept on the facility?
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Who enforces SEMS?
Section 2. Safety and Environmental Information
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What is the color code system for the Piping on your facility?
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Describe the waste handling of your facility
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Tell me about your facility's safety oberservation program
Section 3. Hazard Analysis
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Tell me about some of the safety signs that are posted around your facility
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Describe the information found on a MSDS sheet and where are they located
Section 4. Management of Change
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Describe an MOC?
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Give me an example of when you would use a Management of Change.
Section 5. Operating Procedures
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Tell me about an ESD
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Tell me about a permit to work.
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Where are you written work procedures stored
Section 6. Safe Work Practices
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Are you currently operating under a bridging document?
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Name an item that is on your bridging document.
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What would you do if you find yourself with two conflicting safety rules?
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How are your risks labeled around the platforms?
Section 7. Training
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Describe a lock out / tag out
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Tell about rigger training and when was the last time you attended?
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What safe work practices trainings have you attended?
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Are you on the fire team? When was your last training session? What information was covered?
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Are you first aid trained, can you use an AED?
Section 8. Mechanical Integrity
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Tell me about the maintenance of the facility's equipment
Section 9. Per-Startup Review
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What information is available if you come across a lock out / tag out?
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Tell me about the pre start up checks before you start a piece of equipment?
Section 10. Emergency Response and Control
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Describe the facility's alarms
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Do you have any roles during emergencies? What are they?
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Describe:
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Where is your muster point?
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How do you show accountability at the muster point?
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When and what was the last drill you were involved in?
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How is a man overboard handled?
Section 11. Investigate of Incidents
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After an incident who does the investigation for this facility?
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Describe root cause analysis?
Section 12. Audits
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What is the importance of reviewing your safety plan at regular intervals?
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Name some typical inspections and audits that happen on your facility.
Section 13. Records and Documents
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What is the typical length of time you must keep a document onboard your facility? (6years)
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After the job is complete where is the JSA stored?
Complete the interview
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Hand the interviewee a business card, inform them of our open door policy, and thank them for their time.
