Statoil Bakken Business Unit / Pipeline Construction Safety Report Checklist

JSA / SJA Completed with Contractor Sign-in Sheet

Ground Disturbance Permit Completed

Hot Work Permit Completed

Confined Space Permit Completed and Posted

All Crew Members Wearing Proper PPE & FRC's

H2S Monitors Being Utilized

Fall Protection Being Utilized

First Aid Kit Available on Location

Fire Extinguishers On Location with Current Inspection

Crew Utilizing Proper Tools for Job

Crew Using Proper Lifting Techniques

Tools with Safety Guards in Place

Good Housekeeping with Work Area Clean and Organized

Crew Utilizing Proper Lockout / Tag Out

Are Pipe Thread Cuttings be Collected

Spotter Be Utilized while Equipment is in Operations

Backup Alarms on Equipment Working Properly

Roll Over Protection in Place with No Obvious Defects

Equipment on Location in Good Working Condition (No Fluid Leaks)

Does Contractor Equipment on Location Have Seat Belts (Being Utilized by Operator)

Rigging Equipment (Side Boom Pulleys, Pins, and Wire Rope) Appears to be in Good Working Condition

Inspected Tag Lines are Being Utilized when Lifting Loads

Proper Rigging Techniques are Being Utilized while Lifting Loads

Fire Watch Being Utilized

Utilizing Safety Glasses/Grinding Shields while Grinding

Are Compressed Cylinder Tanks (Oxygen/Acetylene) Labeled, Secured Upright, and Valve Caps in Place

Caution Tape / Barriers Fencing Off Around Open Pits and Trenches

All Bell Holes are Properly Sloped and/or Benched

Ladders, Steps, or Ramps Located in Bell Hole so No More than 25ft of Lateral Travel is Required

Excavated Soil, Other Material, Or Equipment are Stored at Least 2ft from the Edge of the Excavation

Is Operator Exposing Charged Line in Safe Manner (Potholing, Positive ID, Probing Etc..)

Are Warning Signs Being Utilized and Safe Distance Being Maintained for Hydro-Testing Area

Are Warning Signs Being Utilized and Safe Distance Being Maintained for X-Ray Area

Proper Respirators Being Utilized

All Material Contained (No Spills on Location)