Worksite Inspection - RHS

• Document No.

• Audit Title

• Client

  De Leon Consulting, LLC

  D&J Services

  Peerless Industrial Solutions

  ACME Oilfield Services

• Site Name

• Conducted on

  Date
• Location
  Address

• Personnel

General Overview

• Employees acknowledge at the entrance of site or shortly after entering site

  Yes

  No

  N/A

• Site Access Safe?

  Yes

  No

  N/A

• Muster Point Identified?

  Yes

  No

  N/A

• Is PPE being used? ( safety glasses, hard hats and gloves )

  Yes

  No

  N/A

• Is 4 Gas Monitor located in the respirable area?

  Yes

  No

  N/A

• All PPE kept in sanitary and reliable condition

  Yes

  No

  N/A

Documents

• JSA completed and onsite?

  Yes

  No

  N/A

• JSA reviewed and Updated?

  Yes

  No

  N/A

• JSA adequate for tasks?

  Yes

  No

  N/A

• Any other safety documents?

  Yes

  No

  N/A

• Which one?

  Hot Work

  Ground Disturbance

  Other

• Document JSA

  Media

• Are there equipment on location?

  Yes

  No

  N/A

• Document Inspection

  Media

Housekeeping

• Good General Housekeeping?

  Yes

  No

  N/A

• Is the location clear of tripping hazards?

  Yes

  No

  N/A

• Flammables stored / Labeled properly?

  Yes

  No

  N/A

• Enough Fire Extinguishers / Current inspections

  Yes

  No

  N/A

• Chemical stored / Labeled properly?

  Yes

  No

  N/A

• SDS onsite and available

  Yes

  No

  N/A

Hand & Power Tools

• Hand Tools in use?

  Yes

  No

  N/A

• Tools in proper working condition?

  Yes

  No

  N/A

• Has any tool being modified?

  Yes

  No

  N/A

• Proper equipment / Tools for task?

  Yes

  No

  N/A

• Mechanical guards in place

  Yes

  No

  N/A

Electrical

• Generators in good condition?

  Yes

  No

  N/A

• GFCI in use

  Yes

  No

  N/A

• Cords in good conditions

  Yes

  No

  N/A

• Cords in standing water?

  Yes

  No

  N/A

• Overhead / Underground power marked / Flagged / Signage

  Yes

  No

  N/A

• Elevated equipment working near overhead line?

  Yes

  No

  N/A

• Lightning policy understood

  Yes

  No

  N/A

Excavation & Trenching

• Is an Excavation done at this time?

  Yes

  No

  N/A

• Is one call in place and up to date?

  Yes

  No

  N/A

• ticket#

• Marks visible or offsets in place?

  Yes

  No

  N/A

• Mechanical excavation within 2' of a line

  Yes

  No

  N/A

• Trench inspection complete

  Yes

  No

  N/A

• Materials and equipment stored at least at 2" from the edge

  Yes

  No

  N/A

• Competent person on site?

  Yes

  No

  N/A

• Appropriate access / egress

  Yes

  No

  N/A

• Proper sloping/benching at the points of entrance?

  Yes

  No

  N/A

Fall Protection

• Is work being done above 4'

  Yes

  No

  N/A

Ladders

• Ladders in use?

  Yes

  No

  N/A

• Have ladders being inspected?

  Yes

  No

  N/A

• Document Inspection

  Media

• Ladders used correctly

  Yes

  No

  N/A

• Ladders tied off

  Yes

  No

  N/A

• Ladders extend 3' above surface

  Yes

  No

  N/A

Walking Working Surfaces

• Elevated walking surfaces free of hazards, toe boards used, tools tied off

  Yes

  No

  N/A

• Area below protected

  Yes

  No

  N/A

• All personal tied off

  Yes

  No

  N/A

• Fall Protection equipment inspected

  Yes

  No

  N/A

• All Fall Protection equipment used properly

  Yes

  No

  N/A

• Fall rescue in place

  Yes

  No

  N/A

Mechanical Lifting

• Is lift operation in process?

  Yes

  No

  N/A

• Appropriate machine

  Yes

  No

  N/A

• Machine inspected

  Yes

  No

  N/A

• Operator qualified

  Yes

  No

  N/A

• Rigging rated for load

  Yes

  No

  N/A

• Rigging inspected

  Yes

  No

  N/A

• Damaged / Improper rigging in use

  Yes

  No

  N/A

• Rigging use correctly

  Yes

  No

  N/A

• Tag lines in use

  Yes

  No

  N/A

• Clear communication established

  Yes

  No

  N/A

• JSA Addresses Mechanical lifting tasks

  Yes

  No

  N/A

Lock Out / Tag Out

• Any LOTO in use?

  Yes

  No

  N/A

• Is identified on the JSA?

  Yes

  No

  N/A

• LOTO sufficient for task?

  Yes

  No

  N/A

• Affected Persons have personal locks

  Yes

  No

  N/A

Hot Work

• Hot Work Permit required?

  Yes

  No

  N/A

• Hot work permit approved?

  Yes

  No

  N/A

• Customer rep on site

  Yes

  No

  N/A

• Continous monitoring required

  Yes

  No

  N/A

• Firewatch in place

  Yes

  No

  N/A

• Are there any concerning conditions?

  Yes

  No

  N/A

• Please describe below

  Media

• Please add a recommendation

• Has this audit been shared with Person in Charge?

  Yes

  No

  N/A

• Signature of Person in Charge

  Sign

• I hereby certify that all information is accurate and that an actual inspection was conducted.

• Auditor's name and signature

  Sign