Statoil Bakken Business Unit / Commercial Construction Site Safety Report

• Conducted on

  Date

• Project Name:

• Location:
  Address

• WBS Number:

• Statoil Site Representative:

• Contractors on Location:

• Equipment on Location:

REQUIRED DOCUMENTATION

• OSHA Postings in Place

  Yes

  No

  N/A

• Worker's Comp Posters

  Yes

  No

  N/A

• Safety Program

  Yes

  No

  N/A

• Haz.Com / MSDS

  Yes

  No

  N/A

• Certificates of Insurance

  Yes

  No

  N/A

• Emergency Telephone List

  Yes

  No

  N/A

• Emergency Action Plan

  Yes

  No

  N/A

• Safety Meetings Documented

  Yes

  No

  N/A

• HAZCOM Training Documented.

  Yes

  No

  N/A

• Specialized Training Documented

  Yes

  No

  N/A

SITE / MISCELLANEOUS

• First Aid Kit on Site

  Yes

  No

  N/A

• Persons Trained in First-aid/CPR

  Yes

  No

  N/A

• Fire Extinguishers in Place and Charged (Around Site and Near to any Flammable Source)

  Yes

  No

  N/A

• Chemicals / Flammable Materials Properly Stored

  Yes

  No

  N/A

• All Hazardous Materials Properly Labeled

  Yes

  No

  N/A

• Warning Signs Prominently Displayed

  Yes

  No

  N/A

• Notices Posted at Entrances

  Yes

  No

  N/A

• Fuel Containments being Used and Kept Up

  Yes

  No

  N/A

• High Pressure Gas Cylinders Chained in Place

  Yes

  No

  N/A

• Fences Intact and Gates Lockable

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Everyone Wearing Hardhats

  Yes

  No

  N/A

• Safety / Work / Hard Toe Boots

  Yes

  No

  N/A

• Safety Glasses / Goggles / Face Shields as Required

  Yes

  No

  N/A

• Respirators / Dust Masks

  Yes

  No

  N/A

• Hearing Protection if Required

  Yes

  No

  N/A

HOUSEKEEPING

• Job Site Free of Accumulated Trash and Debris

  Yes

  No

  N/A

• Dumpsters on Site for Waste

  Yes

  No

  N/A

• Passageways and Walkways Clear

  Yes

  No

  N/A

• Forms and Materials Free of Protruding Nails and Screws

  Yes

  No

  N/A

• Portable Toilets Clean

  Yes

  No

  N/A

• Construction Materials Properly Stacked and Not Scattered

  Yes

  No

  N/A

• Spills, Leaks or Other Hazards

  Yes

  No

  N/A

EXCAVATIONS

• Competent Person on Site

  Yes

  No

  N/A

• Have Underground Utilities Been Located

  Yes

  No

  N/A

• Trenches / Excavations Properly Barricaded or Covered

  Yes

  No

  N/A

• Trench Protection for Excavations 5' Deep or Over

  Yes

  No

  N/A

• Ladders Properly Located to Surface (No more than 100' apart)

  Yes

  No

  N/A

ELECTRICAL

• Ground Fault System Operational and Being Used by All Contractors

  Yes

  No

  N/A

• Portable Generators GFCI Protected

  Yes

  No

  N/A

• All Extension Cords Marked With Owner's Name

  Yes

  No

  N/A

• Extension Cords in Good Condition

  Yes

  No

  N/A

• Power tools in Good Condition / Ground Prong in Place

  Yes

  No

  N/A

• Lighting Suitable for Work Areas

  Yes

  No

  N/A

• All Electrical Boxes Properly Covered

  Yes

  No

  N/A

PORTABLE HAND TOOLS

• Operators Properly Trained (Including powder actuated tools)

  Yes

  No

  N/A

• Powder Strips Picked Up

  Yes

  No

  N/A

• Cord and Tool in Good Condition

  Yes

  No

  N/A

• Guards In Place Where Required

  Yes

  No

  N/A

• Operators Wearing Personal Protective Gear

  Yes

  No

  N/A

MATERIAL HANDLING / FORKLIFTS / HEAVY EQUIPMENT

• Forklifts / Loaders in Operational Condition

  Yes

  No

  N/A

• Back-Up Alarms Working

  Yes

  No

  N/A

• Operators Properly Trained

  Yes

  No

  N/A

• Seat Belts Being Used by All Operators

  Yes

  No

  N/A

• Only Operator Riding on Equipment

  Yes

  No

  N/A

• Rollover Protection

  Yes

  No

  N/A

• Hoists / Elevators in Operational Condition

  Yes

  No

  N/A

CRANES

• Daily Crane Inspections

  Yes

  No

  N/A

• Operator Properly Trained

  Yes

  No

  N/A

• Swing Radius Properly Identified

  Yes

  No

  N/A

• Tag Line in Use

  Yes

  No

  N/A

• Chokers, Cables, Hooks in Good Condition

  Yes

  No

  N/A

FALL PROTECTION (HEIGHTS OF 6 FT. OR MORE)

• Guardrails in Place

  Yes

  No

  N/A

• All Guards and Rails Sufficient for Weight

  Yes

  No

  N/A

• Personal Fall Arrest System Being Used When Required

  Yes

  No

  N/A

• Harnesses in Good Condition with Proper Label

  Yes

  No

  N/A

• Openings in Floors and Roof Protected

  Yes

  No

  N/A

• Handrails on Stairs

  Yes

  No

  N/A

• Openings in Walls Protected

  Yes

  No

  N/A

• Impalement Prevention Devices in Place

  Yes

  No

  N/A

LADDERS

• Ladders extended 3 ft. Above landing

  Yes

  No

  N/A

• Ladder Tied Off

  Yes

  No

  N/A

• Field Ladders Properly Constructed

  Yes

  No

  N/A

• Commercial Ladders in Working Condition

  Yes

  No

  N/A

• Ladder Suitable for Job

  Yes

  No

  N/A

• Extension Ladders Properly Joined, Secured in Place at Top and Bottom

  Yes

  No

  N/A

• Adequate to Support Intended Use

  Yes

  No

  N/A

SCAFFOLDS

• Competent Person on Site

  Yes

  No

  N/A

• All Components Appear Damage Free

  Yes

  No

  N/A

• Ladder Provided

  Yes

  No

  N/A

• Proper Foundation and Footing

  Yes

  No

  N/A

• Working Levels Fully Planked / Proper Planking

  Yes

  No

  N/A

• Properly Secured - Tied Off at Required Intervals

  Yes

  No

  N/A

• Rails and Toe Boards Where Required

  Yes

  No

  N/A

• Rolling / Moveable Units Properly Supported

  Yes

  No

  N/A

WELDING & CUTTING

• Leads and Connections in Good Condition

  Yes

  No

  N/A

• Hoses in Operational Condition

  Yes

  No

  N/A

• Compressed Gas Cylinders Properly Stored

  Yes

  No

  N/A

• Gauges / Regulators in Working Order

  Yes

  No

  N/A

• Fire Extinguisher at all Welding/Cutting Locations

  Yes

  No

  N/A

Additional Findings:

• Additional Findings:

• Add media

  Media

• Additional Findings:

• Add media

  Media

• Additional Findings:

• Add media

  Media

Signatures:

• Contractor Foreman / Supervisor:

  Sign

• Statoil Site Representative:

  Sign