Laserfiche WebLink
W.O.# AST-6700693 <br /> _ Tanknology Inc. Policy l0(1-29-A <br /> 11000 N.MOPac Express—Y,Suite 500 A,-tin,TX 73759 (300)9640010 Rev:D <br /> JOB CLEARANCE FORM& Revised:1/24/2014 <br /> SITE SAFETY CHECKLIST-OVF <br /> Street Address: W.O.# <br /> Site Name\l#� ` ll^6, -701 <br /> ers 1Folnlate:: Date <br /> Anival Time ep ure Time: Travel inI <br /> Scope of Work and Tasks Pe need(JSA's must be availeble for all tasks): <br /> R . V\5 <br /> Repairs to Equipment oklParts Provided: <br /> Follow-up actions required;equipment isolated:comments: <br /> PPE-PERSONAL PR CTPIE EQUIPMENT REQU! Check items used or mark I if nFleanng Protection <br /> L- Safety VestPP <br /> Safety Glasses Gloves <br /> Steel Toe Boots ❑ Splash Goggles <br /> Hard Hat ❑ other <br /> PRE-TEST PROCEDURES (Check each item completed or mark Knot a livable <br /> 1_ P Discuss safety procedures with site personnel. Nearest hospital: <br /> 2. 0 Prior to fuel deliveries the UST system must be placed back into working order. <br /> 3, Secure entire work area with barricades(cones,flags,and caution tape,pennant flags,or other perimeter guard). <br /> 4. !j Place fire extinguishers and'No Smoking"signs in the work area. <br /> 5. r Implement Lockout/Tagout per API 1646(when accessing product piping during tasks) <br /> ❑ All applicable equipment disabled during test(s). [I Secure the circuit breaker(s)with lockout devices and tags. <br /> Secure nozzles with"Out of Service"bags and nylon ties. ❑ Verity LOTO Is complete by trying t orate Pumps. <br /> C <br /> Close ball valves or check valves on product piping. L� Disconnect electrical'bayonet"con r from the STP(s). <br /> Lead n n IN ad edinkian ignature <br /> General Safety Checks: U f17pV�rA{� <br /> All site personnel have been Informed. ne Rep sa Jadve name a ep e e Signa e <br /> Fuel delivery has been informed. <br /> Is a fuel delivery due today? Go- t D-17 <br /> – <br /> LOTO procedures have been discussed and agreed. <br /> Work areas barricaded to protect workers,staff&public. <br /> ✓ POST-TEST PROCEDURES Check each Item cortt toted or marls - if nota ucahle <br /> 1. ] Remove all"Lockout/ragout"devices. ValveImpact dispensers <br /> w _ o <br /> 2. ❑ Run all pumps and verify there are no leaks: Functional Ele tints&Relief Screws 'w 5 NIB <br /> ❑ Leak Detector Threads on STP's <br /> 3. ❑ Install lead wire seal on all test plugs&leak detectors that were serviced. <br /> L6 <br /> Count LD threads: L1. L2_ L3 J L4_ L5_ _ <br /> 4. ❑ Check following components operational: ❑ ATG probes,sensors,&caps Fn1TA�- EALTH <br /> [I Ball floats,dry breaks&caps Cathodic protection operational ;IONM <br /> Li Containment sumps are dry Dispensers&POS operational pEPARTMEN <br /> Dispenser panels are replaced ❑ Drop tubes,fill adapters&caps <br /> CLeak detectors&vent tubes I ❑ Manhole covers and sump lids <br /> —I Shear valves are open <br /> ❑ Monitoring system is operational <br /> F Siphon lines and manifold valves C Siphon lines and manifold valves <br /> STP fittings and bayonet connectors <br /> ❑ Vents(not capped,plugged or elect) <br /> 5. L Remove barricades. Lead Te 9aa ame d Techmcmn Signature <br /> General Safety Checks: <br /> Work area has been left tidy&safe. Sit I sgna <br /> Site staff are aware of work status including any remaining isolation. s to Rep esen a ve Mame <br /> Changes to equipment are documented and communicated. L, <br /> All incidents,near incidents,and unsafe situations reported. <br /> Site Representative comments: <br /> C Tanlsology Inc_,2011.All Rights Rcxrved. <br /> COMPANY CONFIDENTIAL <br /> rinted copies of this document are uncontrolled. The current version is available in the Taaknolo On-Line Documevt Control S <br />