Water Takepoints and Boosters Safety Audit

• Audit Title

• Pad

• CHK Rep

• Location
  Address

• Conducted on

  Date

• Contractors Onsite

• Prepared by

EHS POLICY 101: HAZCOM

• SDS'S available and accessible at all times

  Yes

  No

  N/A

• All containers in work area properly labeled with NFPA and HMIS labels

  Yes

  No

  N/A

EHS POLICY 102: PPE

• FR clothing worn properly by crew, buttoned, zipped and sleeves down

  Yes

  No

  N/A

• Safety glasses with side shields used by crew

  Yes

  No

  N/A

• Hard hats used by crew

  Yes

  No

  N/A

• Hard toed shoes used by crews

  Yes

  No

  N/A

• Hand protection used when necessary

  Yes

  No

  N/A

• Hazardous jewelry not worn by crew

  Yes

  No

  N/A

• Long hair contained

  Yes

  No

  N/A

• Proper PPE worn while handling chemicals, based in SDS/HMIS

  Yes

  No

  N/A

EHS POLICY 104: HEARING PROTECTION

• High noise areas present and marked

  Yes

  No

  N/A

• Proper hearing protection available

  Yes

  No

  N/A

EHS POLICY 105: LOTO

• LOTO being used

  Yes

  No

  N/A

• Locks and tags available to crew

  Yes

  No

  N/A

EHS POLICY 109: FIRST AID ANID CARDIOPULMONARY RESUSCITATION

• First aid training provided

  Yes

  No

  N/A

• First aid supplies available onsite

  Yes

  No

  N/A

• Adequate 2-way radio or cell phone communication available

  Yes

  No

  N/A

• Emergency phone numbers posted

  Yes

  No

  N/A

• Provisions made for workers with known allergies

  Yes

  No

  N/A

• Provisions made for prompt medical attention

  Yes

  No

  N/A

EHS POLICY 111: CHEMICAL, FLAMMABLE AND COMBUSTABLE LIQUIDS/MATERIALS

• When not in use, flammable and combustibles are stored in designed area or cabinets

  Yes

  No

  N/A

• All containers are grounded and bonded, conforming to manufacturers specifications when dispensing flammable or combustable liquids

  Yes

  No

  N/A

EHS POLICY 112: HEAT AND COLD STRESS

• All workers taking precautions for heat and cold

  Yes

  No

  N/A

• Heat stress and cold stress training provided

  Yes

  No

  N/A

EHS POLICY 113: FIRE PROTECTION

• Fire extinguisher available is vehicles and all work areas

  Yes

  No

  N/A

• Annual inspection tag present

  Yes

  No

  N/A

• Monthly inspection tags present on each extinguisher

  Yes

  No

  N/A

EHS POLICY 114: ELECTRICAL SAFETY

• Electrical equipment 600V or greater labeled as HIGH VOLTAGE

  Yes

  No

  N/A

• Work clearance of 36" maintained in front of electrical equipment

  Yes

  No

  N/A

• Fixed equipment and portable equipment connect by cord grounded

  Yes

  No

  N/A

• Only 3 wire cords in good condition used onsite

  Yes

  No

  N/A

EHS POLICY 115: POWERED AIND INDUSTRIAL TRUCKS (FORKLIFTS AND TELEHANDLERS)

• Forklift operators certified and certificate available

  Yes

  No

  N/A

• Seatbelt provided (per manufacturer)

  Yes

  No

  N/A

• Backup alarm working

  Yes

  No

  N/A

• Auxiliary lighting working

  Yes

  No

  N/A

• Horn working

  Yes

  No

  N/A

• Rated lifting capacity

  Yes

  No

  N/A

• Pre-use inspection checklist completed

  Yes

  No

  N/A

• Tires in good condition

  Yes

  No

  N/A

• Refueling and hydraulic lines checked with engine off

  Yes

  No

  N/A

• No damage to windows or mirrors

  Yes

  No

  N/A

• Parked with brake on, key removed and forks grounded

  Yes

  No

  N/A

EHS POLICY 118: LIFTING AND CARRYING SAFETY

• Proper lifting and carrying techniques being used

  Yes

  No

  N/A

EHS POLICY 119: WALKING AND WORKING SURFACES

• Any working surfaces above 4' from the ground must be protected by a work platform with guardrails at least 42" above platform, have a mid-rail and toe-boards or personal fall protection

  Yes

  No

  N/A

• Fall arrest system must have full body harness, deceleration device and a lifeline

  Yes

  No

  N/A

• Anchorage for fall arrest equipment must be capable of supporting 5,000lbs

  Yes

  No

  N/A

• All walking/working surfaces are clear of debris and tripping hazards and/or tripping hazards have been identified

  Yes

  No

  N/A

EHS POLICY 120: LADDER SAFETY

• No wooden ladders allowed onsite

  Yes

  No

  N/A

• Metal ladders must have a warning label for electrical caution

  Yes

  No

  N/A

• Ends or feet of ladder must be fitted with insulated non-slip material

  Yes

  No

  N/A

• Extension ladders must extend 3' past the landing if used to access another working surface and secured

  Yes

  No

  N/A

• 3 points of contact utilized by workers while on ladder

  Yes

  No

  N/A

• Fixed ladders and cellar ladders are inspected and in good condition

  Yes

  No

  N/A

• Portable ladders inspected monthly and noted on monthly ladder inspection

  Yes

  No

  N/A

EHS POLICY 121: BLOOD BORNE PATHOGENS EXPOSURE CONTROL

• Blood borne pathogen kit available onsite

  Yes

  No

  N/A

• Blood borne pathogen exposure training complete

  Yes

  No

  N/A

EHS POLICY 122: PRE JOB SAFETY ASSESSMENT

• Pre PJSA safety tour of site conducted

  Yes

  No

  N/A

• Daily safety meeting being conducted

  Yes

  No

  N/A

• Accidents, if any, are discussed during safety meetings

  Yes

  No

  N/A

• PJSA filled out properly and completely

  Yes

  No

  N/A

• Individual contractors conducting JSA to identify task-specific hazards

  Yes

  No

  N/A

GENERAL

• Proper incident reporting procedure known and utilized by workers

  Yes

  No

  N/A

• Stop Work Authority in use

  Yes

  No

  N/A

• Adequate communication between contractors onsite

  Yes

  No

  N/A

• Emergency response plan understood

  Yes

  No

  N/A

• Smoke point identified outside of gate

  Yes

  No

  N/A

Takepoint/Booster Site

• Containment in good condition

  Yes

  No

  N/A

• No visible leaks on pumps

  Yes

  No

  N/A

• Pumps are manned while running

  Yes

  No

  N/A

• Air compressor line secured with whipcheck

  Yes

  No

  N/A

• Tires chocked on wheeled units

  Yes

  No

  N/A

• Access road in good condition, no dirt/debris left on public roadway

  Yes

  No

  N/A

• Temporary fence in place when necessary at impoundment takepoints

  Yes

  No

  N/A

ADDITIONAL COMMENTS

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