VGS Worksite Safety Audit

• VGS Worksite Safety Audit

• Audit Location
  Address

• Description of Work Being Performed

• Worksite Personnel

• Audit Conducted on

  Date

• Audit Conducted by

General Photograph(s) of the Work Site

• Add media

  Media

Documentation & Qualification

• Pre-Job Observation (Safety Tailboard) Completed? If yes, attach photo of completed form below.

  Yes

  No

  N/A

• Employees performing pipeline functions wearing hard hat sticker verifying OQ/D&A status?

  Yes

  No

  N/A

• Pipeline Drug Program - No apparent evidence of impaired behaviors?

  Safe

  At Risk

  N/A

• If working within a VELCO right-of-way, employee(s) observed have participated in appropriate training (VELCO sticker on Hard Hat)?

  Yes

  No

  N/A

• Other Comments

• Document(s) Photos

  Media

Traffic Control & Worksite Setup

• Signage, cones and barricades are utilized and adequate?

  Yes

  No

  N/A

• Traffic control personnel are appropriately equipped and performing well?

  Yes

  No

  N/A

• Pedestrian & vehicular traffic monitored for safe passage?

  Yes

  No

  N/A

• Police utilized to direct traffic at traffic lights and busy intersections?

  Yes

  No

  N/A

• Other Comments:

• Noteworthy photos:

  Media

Personal Protective Equipment

• Hard hats worn at all times?

  Yes

  No

  N/A

• Proper footwear worn?

  Yes

  No

  N/A

• Appropriate high visibility apparel worn?

  Yes

  No

  N/A

• Eye and face protection worn or readily available?

  Yes

  No

  N/A

• Hearing protection used when noise exposure exist?

  Yes

  No

  N/A

• Other Comments:

• Noteworthy photos:

  Media

Excavations & Trenching

• Utilities located before excavating begins?

  Yes

  No

  N/A

• Trench box, sloping and/or benching utilized if excavation is 5 or more feet deep?

  Yes

  No

  N/A

• Spoil pile is at least 2 feet from the edge of the excavation?

  Yes

  No

  N/A

• Ladder used if the trench is deeper than 4 feet deep?

  Yes

  No

  N/A

• Water within excavation monitored and controlled?

  Yes

  No

  N/A

• Surface encumbrances identified and secured?

  Yes

  No

  N/A

• A competent person is on scene monitoring trench conditions?

  Yes

  No

  N/A

• Atmosphere monitored for O2 and flammability when a potentially hazardous atmosphere is likely to exist?

  Yes

  No

  N/A

• Other Comments:

• Noteworthy photos:

  Media

Tools & Equipment

• Chains and slings used for lifting have safe working load tags on them?

  Yes

  No

  N/A

• Air tools and hoses are secured with clips?

  Yes

  No

  N/A

• Ground fault circuit interrupters are available and/or in use?

  Yes

  No

  N/A

• Extension cords are in good shape and without taped splices, etc.?

  Yes

  No

  N/A

• Hand tools are in good condition (pipe wrench teeth, etc.)?

  Yes

  No

  N/A

• Guards on power tools are being used as required by the manufacturer?

  Yes

  No

  N/A

• Ladders in good shape and non-conductive?

  Yes

  No

  N/A

• Welding leads are in good shape and undamaged?

  Yes

  No

  N/A

• Other Comments:

• Noteworthy photos:

  Media

Fire Protection & First Aid

• A charged and functional dry chemical extinguisher is readily available ?

  Safe

  At Risk

  N/A

• Flammable liquids are stored in approved containers?

  Safe

  At Risk

  N/A

• CGI's are utilized to monitor the atmosphere when performing live gas operations?

  Safe

  At Risk

  N/A

• Other Comments:

• Noteworthy photos:

  Media

Hazardous Materials

• Containers are labeled?

  Yes

  No

  N/A

• SDS (Safety Data Sheets) on site or readily accessible?

  Yes

  No

  N/A

• Compressed gas cylinders are appropriately secured during storage and transport?<br>

  Yes

  No

  N/A

• Other Comments:

• Noteworthy photos:

  Media

Housekeeping & General Site Safety

• Jobsite is maintained in a neat and orderly fashion?

  Yes

  No

  N/A

• Pipe is chocked or otherwise secured to prevent accidental movement?

  Yes

  No

  N/A

• Tag lines used whenever pipe is being moved above shoulder height?

  Yes

  No

  N/A

• Other Comments:

• Noteworthy photos:

  Media

Motor Vehicles & Mechanized Equipment

• Seat belts, where provided, are being utilized?

  Yes

  No

  N/A

• Back up alarms are functional?

  Yes

  No

  N/A

• Vehicle wheels are chocked as required?

  Yes

  No

  N/A

• Employees remain clear of the backhoe boom swing radius while it is operating?

  Yes

  No

  N/A

• Other Comments:

• Noteworthy photos:

  Media

Miscellaneous

• NOTES:

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  Media