SICIM-ROADBRIDGE SENIOR MANAGEMENT SAFETY AUDIT - (SWSOS) Cluden to Brighouse Bay Gas Pipeline

• AUDIT TITLE:

• DOCUMENT NO.:

• SITE:

• AREA INSPECTED:

• CONDUCTED ON:

  Date
• LOCATION:
  Address

• AUDIT TEAM:

• PREPARED BY:

WHAT WAS THE CONDITION OF THE SITE IN RESPECT TO -

• Documentation & SICIM-Roadbridge Management System compliance

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• EXCAVATIONS

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• SITE WALKWAYS/ACCESS

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPOSIBILITY OF:

• PLANT & MACHINERY

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• HOUSEKEEPING?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• MATERIAL HANDLING / STORAGE?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• SCAFFOLDING

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• ELECTRICAL EQUIPMENT?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• TOOLS?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• LADDERS / STAIRS?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• CRANES / LIFTING?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• LIGHTING?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• WORK PERMITS?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• PERSONAL PROTECTIVE EQUIPMENT?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• UNSAFE PRACTICES?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• COMMUNICATIONS?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• FIREFIGHTING EQUIPMENT / PLANNING?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• BARRIERS & SIGNS?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• SANITATION & HYGIENE?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• VENTILATION / FUMES / DUST ETC.?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• WORKING AT HEIGHT?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• ENVIRONMENTAL PROTECTION?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

• MEDICAL / HEALTH FACILITIES?

  Safe

  At Risk

  N/A

• ACTION REQUIRED:

• RESPONSIBILITY OF:

SUMMARY:

• GENERAL COMMENTS FROM THE AUDIT:

• Add media

  Media

NAMES OF AUDIT TEAM MEMBERS:

• SIGN:

  Sign

• SIGN:

  Sign

• SIGN:

  Sign

• CLOSE OUT DATE OF ACTIONS:

  Date