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am Project HSE Inspection Form <br /> Project Location Type of Project Contract No. <br /> Date Your Name Supt. <br /> Safe At N/A 1/H Safe At N/A I/H <br /> Risk Risk <br /> 1.0 GENERAL required? <br /> 1.1 All employees receive video HSE orientation 2.13 Approved lanyard connected at waist level or <br /> and trained in PIP? above to approved anchorage? <br /> 1.2 Safety Rule Book distributed with a sign off 2.14 Wire rope,independent lifelines used for each <br /> sheet retained as evidence of training? employee on suspended scaffold,painter's boom,air <br /> 1.3 HSE meetings held with supervisor and buggy and boatswains chairs? <br /> subcontractors every two weeks? 2.15 Supplied air helmet or hood used by all <br /> 1.4 HSE meetings held each week with work operators when abrasive blasting? <br /> crews? 2.16 Preventive injections provided for workers <br /> 1.5 Minutes of jobsite safety meetings recorded around raw sewage? <br /> and kept at jobsite? 2.17 Airline filtering devices functioning properly? <br /> 1.6 Competent contractor personnel assigned Carbon monoxide monitor installed after filter? Set <br /> responsibility to inspect jobsite for safety? at 10 PPM? Alarm checked and meter bump <br /> 1.7 Government(OSHA)sign posted? Form 300 up- checked daily with test as? <br /> to-date? 2.18 Protective skin cream provided and used by <br /> 1.8 Safety bulletins,accident prevention material, painters? <br /> safety rulesposted? 3.0 HAZARD COMMUNICATION <br /> 1.9 Weekly safety inspection reports by PROGRAM(OR RIGHT TO KNOW <br /> subcontractor personnel prepared and kept at PROGRAM) <br /> jobsite? 3.1 Written program on site? <br /> 1.10 Minimum two certified First Aid/CPR personnel 3.2 Personnel trained and logged in? <br /> er shift? 3.3 All material safety data sheets on site?(Current <br /> 1.11 Managing an Incident Poster complete and within 3yrs.) <br /> posted? 3.4 Containers labeled(other than container that <br /> 1.12 Approved and stocked First Aid Kit on jobsite? contents will be used up in one shift)? <br /> 1.13 Good housekeeping maintained? all 4.0 SANITATION/HEALTH/ <br /> 1.14 Employees informed on access to med.& ENVIRONMENT <br /> exposure records? 4.1 Marked&labeled portable containers used to <br /> 1.15 Provisions made for vessel to vent during off dispense drinking water? <br /> work hours? <br /> 1.16 Precautions taken to protect customer's co Single service cups used for drinking water, <br /> containers provided for new&used cups? <br /> property,employees,and visitors from paint spray& 4.3 Adequate number of toilet facilities provided& <br /> abrasive blasting materials? <br /> maintained? <br /> 1.18 Employees informed of any special site or <br /> customer HSE requirements? ha Special washing facilities provided for workers <br /> ealth?g materials which may be harmful to their <br /> 1.19 Subcontractors aware of Employer health. <br /> responsibilities? Complying with CBI requirements? <br /> 4.1.20 Protection over manwa s/doorsheets? shops) <br /> Illumination in work areas(including offices, <br /> sho s)adequate? <br /> 1.21 JSA being used to plan new or hazardous <br /> 'obs? Employees involved in process? 4.6 ventilation adequate? <br /> M <br /> 4.7 Means <br /> 1.22 Atmospheric monitoring performed where provided for waste removal? <br /> required? Documented? 4.8 Waterless hand cleaner,ettc.c.provided? <br /> 1.23 Vessels and/or pipelines 5.0 FLAMMABLE MATERIALS <br /> isolated/blinded/blanked? 5.1 In areas where flammables are stored or where <br /> 1.24 Appropriate manuals and proper instructions on operations present a fire hazard"NO Smoking or <br /> jobsite? Oen Flame"sinposted? <br /> 1.25 Dangerous openings fenced or covered? 5.2 Fuel containers posted? <br /> 1.26 Test water to come through clean lines? 5.3 Indoor and outdoor storage of flammables in <br /> 1.27 Employees informed of evacuation route? approved containers or cabinets with warning signs <br /> 1.28 All noise areasposted? posted? <br /> 2.0 PERSONAL PROTECTION 5.4 Form,scrap lumber&all other debris including <br /> combustible scrap/debris removed from work areas <br /> 2.1 Hearing protection provided and worn by all at regular intervals? <br /> where noise levels are excessive? 5.5 Containers provided for collection,separation <br /> 2.2 Hard hats and safety glasses(with ANSI Z87 or of waste&trash? <br /> equiv.side shieldsprovided for and worn by all? 5.6 Solvent waste,oily rags&flammable liquids <br /> 2.3 Appropriate work gloves worn by employees for kept in fire resistant covered containers until <br /> their assigned work? removed from worksite? <br /> 2.4 Additional eye and face protection provided for 5.7 Required portable fire-fighting equipment <br /> and worn by all where exposed to potential eye or available,properly located&maintained? Inspection <br /> face injury? to s up to date? <br /> 2.5 Adequate footwear worn by employees for their 5.8 Fuel operated equipment shut off for refueling <br /> assigned work? &bonded to fuel tank? <br /> 2.6 Have respirator users received a medical 5.9 Are Safety Cans used for flammables? <br /> evaluation? Fit-tested? 5.10 Fire extinguisher operational&available with <br /> 2.7 Written Respiratory Protection Program on 75'(23m)of each work area? Have monthly& <br /> site? annual inspection tag? <br /> 2.8 Are respirators,blast and paint hoods available 5.11 Fire extinguishers available within 50'(15m)of <br /> and used? each work area where flammable liquids are <br /> 2.9 Fresh air respirators used for internal spray used/stored? <br /> painting? 5.12 Safety-shutdown on stoves&excess flow <br /> 2.10 Personnel trained in wearing and inspection of valves on re-heater lines? <br /> PPE? Is PPE being inspected? 5.13 Gas manifolds marked&capped? <br /> 2.11 Are burning goggles/face shields available& 5.14 Stationary flammable containers grounded- <br /> used? bonded? Haves ill containment? <br /> 2.12 Are approved safety harnesses used where 5.15 Combustibles kept 50' 15m from weldin <br />