COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

W.O.# NW1-2353288 Tanknology Inc. Policy 100-29-A 11000 N. Nfopac Expressway. Suite 500 Austin, Ta 75759 (SM) 964.0010 JOB CLEARANCE FORM & SITE SAFETY CHECKLIST — OVF RevRevc Rccisrd: 2/1 1/2019 dd Namelr: F — �y I ( Street Addres r,010�V_L e 11 0v 6k W.O. N mval!me: GeGahu�e ' -- ravel Time hers m site: oc) i 2'� Scope of Work and Tasks P rformed (JS ust be va''at'e loc a'! tads'. A tsk Repairs to EqTipmeni or Parts Pro ed: Follow-up actions required; equipment isolated: comments: PPE - PERSONAL PROTECT E EQUIPMENT REQUIRED Teck ✓items used or mark -if nota livable afety Vest Safety Glasses I ocGloves Hearing Protection Steel Toe Boots Splash Goggles Hard Hat Other ,1 -,,-PRE-TEST PROCEDURES Check ✓each item completed or mark - if not applicable 1. e Discuss safety procedures with site personnel. Nearest hospital: 2. ❑ r to fuel deliveries the UST system must be placed back into working order. 3. re entire work area with barricades (cones, flags, and extension bars, caution tape, pennant flags, or other perimeter guard). 4. P Place fire extinguishers and "No Smoking" signs in the work area. 5. ❑ Confined Space Entry — If required complete separate CSE Checklist. If NO CSE REQUIRED check the following reason: No CS's.-CS's not opened —No entry only visual -No entry - used tools '_work from prone position w/o risk of falling in 6. ❑ Implement LockoutlTagout per API 1646 (when accessing product piping during tasks) Secure nozzles with "Out of Service" bags and nylon ties. _ Secure the circuit breaker(s) with lockout devices and tags. Close ball valves or check valves on product piping. _ Disconnect electrical "bayonet" connector from the STP(s). All applicable equipment disabled during testis). - V ' y LO is co plete by tryin to perate pumps. SIGN IN Lead Tech an N e ad Technician Signature General Safety Checks: All site personnel have been informed. Is a fuel delivery due today? Site Representative Name Site Representative Signature LOTO procedures have been discussed. Work areas barricaded to protect workers, staff & public. ✓ POST-TEST PROCEDURES (Check -each item completed or mark - if not applicable) 1. Remove all "Lockout/Tagout" devices and nozzle bags/ties. 2. Run all pumps and verify there are no leaks: Impact Valve Test Ports under dispensers Leak Detector Threads on STP's Functional Elements & Relief Screws 3. lead wire seal on all test plugs & leak detectors that were serviced. zlnhtall Count LD threads: L1 L2 L3 L4 _ L5 L6 4. eck following components operational: ATG probes, sensors, & caps fall floats, dry breaks & caps fdfhodic protection operational /. feantainment sumps are dry /Dispensers & POS operational penser panels are replaced op tubes, flapper valves, fill adapters & caps /eDi ak detectors & vent tubes / anhole covers and sump lids Monitoring system is operational / Shear valves are open Siphon lines and manifold valves open Spill containers & drain valves STP fittings and bayonet connectors Vents & Extractors (not capped, plugged or isolated) 5. Remove barricades. SIGN OUT & Operator Verification of Work (OVF) ead Techni N e ead echnician ignaturo General Safety Checks: Work area has been left clean & safe. Site staff aware of work status including any remaining isolation. Si Representative Name SiteRepresentauve ignawre Changes to equipment are documented and communicated. All incidents, near incidents, and unsafe situations reported. Sae Representative Comments: COMPANY CONFIDENTIAL D Tanknology Inc., 2019. All Rights Re-in,,l ranted copies of this document are uncontrolled The current version is mailable in the Tanknology On Une Ool.ument Control Svsiew