Observations

Inspection Element

Location 1

Location 2

Location 3

Location 4

Location 5

Wamsutter

Jayhawk

San Juan
South

San Juan
North

East Texas
Field

OGC STX
Field

OGC South
Louisiana

F&H CCDF

Totals

Electrical
Emergency Mgmt.
Energy Isolation
Fire Protection
Hazcom
Housekeeping
IH/PPE
Lifting
Machine Guards
Mechanical Integrity

19
23
4
4
10
35
9
4
15
14

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

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Stairways, Walkways,
Ladders
Training and Written
Programs
Totals

18

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159

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Inspection Element
Electrical
Emergency Mgmt.
Energy Isolation
Fire Protection
Hazcom
Housekeeping
IH/PPE
Lifting
Machine Guards
Mechanical Integrity
Stairways, Walkways,
Ladders
Training and Written
Programs
Totals

Totals
0
0
0
0
0
0
0
0
0
0
0
0
0

#REF!
#REF!
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#REF!

Electrical
Emergency Mgmt.
Energy Isolation
Fire Protection
Hazcom
Housekeeping
IH/PPE
Lifting
Machine Guards
Mechanical Integrity
Stairways, Walkways, Ladders
Training and Written Programs

Location

Category
Electrical

Best Practice Description

Monthly, Documented Electrical cord
inspections with date and inspector
name printed on tape & placed on the
cord.

Housekeeping

Housekeeping and organization in the

Sunray Gas Plant Warehouse is
exemplary.
Lifting chains and straps inspected
monthly

Lifting

Housekeeping

Housekeeping in Welding shop excellent

Housekeeping
Hazcom

Housekeeping in Warehouse excellent

Excellent labelling of tanks and
containers

Contact/ Owner

Date:
Facility:
Location:
Participants:
NA = Not Applicable, N = Needs Attention, CDW= Corrected During Walkthrough, BP=Beat Practice

Area

Element : Training and Written Programs

OSHA 300, 300A logs & OSHA 301, past three years,
Workers Comp First report of injury

Document Link Site Specific Orientation

Document Link Contractor Orientation/ SafeLandUSA
Document Link Incident Investigation Reports (Tr@ction)
Document Link Contractor Incident Reports (Tr@ction)
BP's SOC Page SOC
SOC for LeadersBehavior Based/ Stop the Job Observations
Tr@ction
Incident Investigation Reports
Document Link LOTO Annual Reviews and training
Reference Document
LOTO Tier Three, tier 4 documents (local policy)
Document Link LOTO permits reviewed for accuracy
Document Link Work permits review
Document Link PPE Hazard Asessment

PPE Training
Fall Protection/ PPE selection and inspections
Lifting Equipment Inspections ( slings, chains, clevices, etc..)
Ladder inspections
Gaurding Floor and Wall Openings
Electrical equipment inspections cords and tools
Drill documentation (internal)
Drill documentation: comprehensive, including emergency services such as
ambulance, air ambulance, fire & law enforcement officials as applicable
Means of Egress (Exit Signs)
Fire Protection

Portable Fire Extinguishers

Incident Management Plans and training (IMP):
EPA Risk Management Plan (RMP): Operators aware of worst case and actions
Validate IMP/RMP with control room operators
Chemical inventory and MSDS
OSHA Required Training
CoW training, competent person and risk registers
Federal, State, Local and company required posters and information posted in
easily accessable areas, up to date
Accurate Reporting, Observations: SOC: first aid, near miss
Contractor MSDS and JSEA
Fire and first aid equipment inspections
Written Procedures for equipment specific PM or energy isolation on file
Contractor Assessment
Contractor Oversight

-Eric shared three areas of interest from OSHA that he and Dustin will inco

oAre employees provided specific guidance and instruction on the re

oIs the company aware of the requirements for reporting to OSHA wo
oAre emergency response services, specific to the location, equipped

NA, N,
CDW, BP

Comments / Action

Resp. Party

Work Order

hat he and Dustin will incorporate into the check list:

and instruction on the reporting of workplace injuries or illnesses?

s for reporting to OSHA workplace fatalities/catastrophes?
c to the location, equipped and suitable for the performed operations?

Date:
Facility:
Location:
Participants:
NA = Not Applicable, N = Needs Attention, CDW= Corrected During
Walkthrough, BP=Beat Practice

Area

Element : Training and Written Programs

OSHA 300, 300A logs & OSHA 301, past three
years,

1904.32(a)(2) Create an annual summary of injuries and

illnesses recorded on the OSHA 300 Log;
1904.32(a)(3) Certify the summary; and 1904.32(a)(4)
Post the annual summary.
1904.32(b) Implementation.
1904.32(b)(1) How extensively do I have to review the
OSHA 300 Log entries at the end of the year? You must
review the entries as extensively as necessary to make
sure that they are complete and correct.

Comments / Action

o Are employees provided specific guidance and

instruction on the reporting of workplace injuries or
illnesses?
o Is the company aware of the requirements for
reporting to OSHA workplace fatalities/catastrophes?

Resp. Party

Work Order

Emergency Action Plans

Letter of Interpretation OSHA

Drill documentation: comprehensive, including emergency

services such as ambulance, air ambulance, fire & law
enforcement officials as applicable

Means of Egress (Exit Signs)

Fire Protection
Portable Fire Extinguishers
Incident Management Plans and training (IMP):
EPA Risk Management Plan (RMP): Operators aware of
worst case and actions
Validate IMP/RMP with control room operators
Chemical inventory and MSDS
OSHA Required Training
CoW training, competent person and risk registers
Federal, State, Local and company required posters and
information posted in easily accessable areas, up to date
Accurate Reporting, Observations: SOC: first aid, near
miss
Contractor MSDS and JSEA
Fire and first aid equipment inspections
Written Procedures for equipment specific PM or energy
isolation on file
Contractor Assessment
Contractor Oversight

Comments / Action

Are

emergency response services, specific to the

location, equipped and suitable for the performed
operations?

Date
Facility
Location
Participants
NA = Not Applicable, NC =Not Checked, OK, N = Needs Attention,CDW= Corrected During Walkthrough,
BP=Best Practice

Area

Element: LOTO, The Control of Hazardous Energy

Is there an equipment specific procedure for isolation Have all employees involved been
trained on those procedures?
Have all employees involved been trained on applicable LOTO procedures?
Is required re-training complete and up to date?
Have all energy sources and isolation points been identified and recorded on the Isolation
Log?
Has the Issuing Authority determined the monitoring requirements and have those
requirements and results been documented on the Isolation Log? Are the monitoring
points free of obstruction?
Does this isolation have an established procedure for normal shut down and start up of
equipment and/or process?
Have all Authorized Employees involved in this isolation reviewed the isolation?
If single block isolation is involved in this isolation, has the Single Block Isolation Hazard
Assessment and Form been completed?

Permit
Do you have an Isolation Permit for this isolation and is it filled out completely?
Does the scope of this isolation match the work being performed and are the conditions of
the Isolation Permit being met?
Has the Isolation Permit been signed by the Issuing Authority and all Performing
Authorities and a copy of both documents at the work site?

Execution
Have all Affected Employees been identified and notified of the isolation?
Do all Authorized Employees involved in this isolation have a personal lock applied?
Have all lockout/tagout points been locked and tagged out and blinds been tagged if
blinding is part of this isolation?
Has the isolation been verified (e.g. bump test)?
If this is a confined space, has positive isolation been achieved?
If this is an electrical isolation has a visual (physical break in the circuit) or metered
verification for the absence of voltage been completed?

Return to Service
Upon completion of the work and prior to the removal of the isolation has the area been
surveyed to make sure tools and individuals are no longer on the site?
Upon completion of the isolation has the Isolation Log been reviewed and a determination
all isolations have been removed?
Upon completion of the isolation has the Isolation Permit been reviewed and closed and
all Affected Employees notified?

Periodic Review of LOTO

Has a documented periodic review of the LOTO program been conducted?

LOTO Materials and Hardware

Standardized locks
Lock-out Devices are Durable
Lock-out devices are Substantial
Tag-out Devices
Tags completed and affixed properly

Group LOTO
LOTO locks and tags separate from Out of Service designation

NA,NC, OK,
N, CDW, BP

Comments / Action

Resp. Party

Work Order

Portable Ladder Ratings and Types:

Manufactured ladders are rated to the duty or service to which they will be put and the working load under
will be used in a standard inclined position. The following table provides the different grades of ladders an
are rated for:
Table 2. In-Line Load Ratings & Duty Type
(Wooden and Metal Ladders)
Duty Rating & Type Working Load (pounds)
Extra Heavy Duty Type IA 300 lb
Heavy Duty Type I 250 lb
Medium Duty Type II 225lb
Light Duty Type III 200lb
See OSHA Reference 29 CFR 1910 Subpart D - Walking-Working Surfaces
Ladder Inspection and Use - Recommended Practice

Electrical Work
Metal ladders (e.g. aluminium) should NEVER be used for electrical work, or in close proximity to overhe
lines and/or electrical circuits;
Wooden ladders with metal reinforcing rods shall NOT be used for electrical work, due to the danger of i
electrical contact;
Wooden ladders or fibreglass ladders are acceptable for using near or during electrical work, however th
completely dry;
Wooden ladders that are damp or wet can conduct electricity and should NOT be used when working on
around electrical equipment or electrical power sources
Ladder Inspection and Use - Recommended Practice

Ladder Inspections
Ladders should be inspected before each use for loose or damaged rungs, steps, rails or braces and to
obvious signs of damage or deterioration. If they can be moved by hand, they are too loose;
Check the ladder rungs to be sure that they are free of any slippery material;
Ladder Inspection and Use - Recommended Practice

Suggested Inspection Criteria

Ensure that stepladder spreaders are sturdy, tight and can be properly locked in place;
Check all ladder hardware, nuts, bolts, spreaders, etc. for tightness and good repair with particular atten
mechanisms;
Check pulleys on extension ladders for good condition and proper lubrication. If pulleys are damaged, th
replaced;
Check ropes on extension ladders and replace any frayed or worn ropes;
Check for damaged or excessive wear on the non-slip feet;
Check ladders for twisted or distorted rails. Do not attempt to straighten, or allow to remain in use, any b
metal ladder;
In wooden ladders, check for rot, decay, or warped rails;
Check for missing identification and/or warning labels; (minimum labels: load rating and manufacturer, a
extention ladder)

 Where damage to or deterioration of any ladder is encountered, a qualified person must determine whet
ladder can still be used;
Ladders cannot be safely repaired. If the damage is significant enough to affect the safety of the unit, the
be immediately removed from service, destroyed, and replaced as soon as possible;
Ladders should also be thoroughly examined/inspected once every three (3) months and a record of tho
should be kept on file for future reference
Ladder Inspection and Use - Recommended Practice

Ladder Maintenance
The feet of ladders, especially straight or extension ladders, should be equipped with slip-resistant surfa
Untreated wooden ladders should be stored in dry areas to prevent moisture or water absorption;
Wooden ladders must not be painted, since this may hide serious defects that may develop. A wood pre
clear finish coating (e.g. varnish) should be used to protect the ladder;
Avoid painting the rungs/steps with anything, even clear coatings, unless a non-slip material has been a
prevent slipping;
Ladders constructed from fibreglass should be cleaned and sprayed lightly with a clear or pigmented lac
wax once every three (3) months to reduce deterioration (weathering);
When transported on a vehicle, ladders should be properly supported and secured using proper tie dow
Avoid using rubber bungy cords unless the travel distance is short;

Scaffolding Inspections and Fall Protection

Construction
1. Does each scaffold and scaffold
component

YNN/A
??

support (without failure) its own weight and

at least 4 times the maximum intended
load?
[29 CFR 1926.451(a)(1)]
Note: The stall load of any scaffold hoist
must not exceed 3 times its rated load
[29 CFR 1926.451(a)(5)]. Appendix A of
the OSHA regulations gives directions for
constructing scaffolds.
2. Are all working levels on scaffolds fully
planked or decked between the front
uprights
and the guardrail supports?
[29 CFR 1926.451(b)(1)]

YNN/A
??

3. Are scaffold platform spaces 1inch or less YNN/A

??
between adjacent units and the uprights?
[29 CFR 1926.451(b)(1)(i)]
Note: Spaces up to 9 1/2 inches wide are
permitted around uprights. If platforms are
used only as walkways or during erecting or
dismantling, the employer may establish
the space between planking as necessary
to
provide safe working conditions.
4. Are all scaffold platforms at least
18 inches wide?
[29 CFR 1926.451(b)(2)]

Note: Scaffold platforms less than

18 inches wide are permitted if wider
platforms are not possible. However,
students and employees who use these

YNN/A
??

platforms must be protected by

guardrails or personal fall arrest
systems.
5. Is the distance between the front edge of YNN/A
??
the scaffold platform and the face of the
work 14 inches or less, unless guardrail
systems are put along the front edge, or
personal fall arrest systems are used?
[29 CFR 1926.451(b)(3)]
Note: Exceptions are permitted under
special situations. Consult the OSHA
regulations for details. The maximum
distance from the face for plastering and
lathing operations is 18 inches.
6. Does the end of each scaffold platform
extend over the centerline of its support at
least 6 inches unless cleated or otherwise
restrained by hooks or equivalent means?
[29 CFR 1926.451(b)(4)]

YNN/A
??

7. If the scaffold platform is 10 feet or less

in
length, does the end of the scaffold
platform
extend 12 inches or less over its support?
[29 CFR 1926.451(b)(5)(i)]

YNN/A
??

Note: The end of the scaffold platform may

extend more than 12 inches over its
support
if the platform is designed and installed so
that the cantilevered portion of the platform
can support workers or materials without
tipping, or a guardrail blocks worker access
to the cantilevered end.
8. On scaffolds where planks are abutted to YNN/A
form
??

a long platform, does each plank end rest

on
a separate support surface?
[29 CFR 1926.451(b)(6)]

YNN/A
??

Note: Common support members, such as

"T" sections, may be used to support
abutting
planks. Hook-on platforms designed to rest
on common supports may also be used.
9. On scaffolds where platforms overlap to
form a long platform, does the overlap
occur over supports? Is the overlap at
least 12 inches unless the platform is
nailed together or otherwise restrained
to prevent movement?
[29 CFR 1926.451(b)(7)]

YNN/A
??

10. At points of a scaffold where the

platform
changes direction, is this procedure
followed?
[29 CFR 1926.451(b)(8)]

YNN/A
??

Step 1: Lay the platform that rests on a

bearer at an angle other than a right angle.
Step 2: Lay the platform that rests at
right angles over the same bearer, on
top of the first platform.
11. Is it prohibited to cover wood platforms
on scaffolds with opaque finishes?
[29 CFR 1926.451(b)(9)]
Note: Platform edges may be covered or
marked for identification. Wood platforms
may be coated periodically with wood
preservatives, fire-retardant finishes,
and slip-resistant finishes; however, the
coating may not obscure the top or
bottom wood surfaces.

YNN/A
??

12. Do scaffold components from different

manufacturers fit together without force
and
maintain the scaffold's structural integrity?
[29 CFR 1926.451(b)(10)]

YNN/A
??

13. Are scaffold components from different

manufacturers modified ONLY if a
competent person determines that the
scaffold made of the 'mixed' parts is
structurally sound?
[29 CFR 1926.451(b)(10)]

YNN/A
??

YNN/A
14. Are scaffold components made of
dissimilar
metals used together ONLY if a competent ??
person has determined that galvanic
action
will not reduce the strength of any
component to an unacceptable level?
[29 CFR 1926.451(b)(11)]
Criteria for Supported Scaffolds
15. Are supported scaffolds with a height YNN/A
??
to
base width ratio of more than 4 to 1
restrained from tipping by guying, tying,
bracing, or equivalents?
[29 CFR 1926.451(c)(1)]
Note: Install guys, ties, and braces at
locations where horizontal members
support both inner and outer legs. Install
Guys, ties, and braces according to the
scaffold manufacturer's recommendations
or at the closest horizontal member to
the 4 to 1 height. Repeat vertically at
locations of horizontal members every
20 feet or less thereafter for scaffolds
3 feet wide or less, and every 26 feet or
less thereafter for scaffolds greater than
3 feet wide. Place the top guy, tie, or

brace of completed scaffolds no further

than the 4 to 1 height from the top. Install
guys, ties, and braces at each end of
the scaffold and at horizontal intervals
30 feet or less (measured from one end
[not both] towards the other). Use ties,
guys, braces, or outriggers to prevent
tipping when there is an eccentric load,
such as a cantilevered work platform.
16. Are supported scaffold poles, legs,
YNN/A
posts,
frames, and uprights placed on base plates ??
and mud sills or other firm foundation?
[29 CFR 1926.451(c)(2)]
17. Are footings level, sound, and rigid? Can YNN/A
they
support the loaded scaffold without settling ??
or
displacement?
[29 CFR 1926.451(c)(2)(i)]
18. Is it prohibited to use unstable objects
for
supporting scaffolds and platform units?
[29 CFR 1926.451(c)(2)(ii)]

YNN/A
??

19. Is it prohibited to use unstable objects

as
working platforms?
[29 CFR 1926.451(c)(2)(iii)]

YNN/A
??

20. Is it prohibited to use front-end loaders

and
similar pieces of equipment to support
scaffold
platforms, unless they were designed by
the
manufacturer for such use?
[29 CFR 1926.451(c)(2)(iv)]

YNN/A
??

21. Are supported scaffold poles, legs,

posts,
frames,plum and braced to prevent
and uprights
swaying and displacement?
[29 CFR 1926.451(c)(3)]

YNN/A
??

Access
22. Are ladders, stairs, ramps, or walkways
provided
to access scaffold platforms more than 2
feet
above or below a point of access?

YNN/A
??

[29 CFR 1926.451(e)(1)]

Note: Cross-braces must not be used as a
means of access.
23. Are portable, hook-on, and attachable
ladders
positioned to prevent the scaffold from
tipping?
[29 CFR 1926.451(e)(2)(i)]

YNN/A
??

24. Are hook-on and attachable ladders

positioned
so
the bottom rung is not more than 24
inches
above the scaffold supporting level?
[29 CFR 1926.451(e)(2)(ii)]

YNN/A
??

25. Are hook-on and attachable ladders

designed
for the scaffold in use?
[29 CFR 1926.451(e)(2)(iv)]

YNN/A
??

26. Do hook-on and attachable ladders

have
lengthrung
of at least 11 1/2 inches?
[29 CFR 1926.451(e)(2)(v)]

YNN/A
??

27. Do hook-on and attachable ladders

have
uniformly spaced rungs with a maximum
spacing between rungs of 16-3/4 inches?
[29 CFR 1926.451(e)(2)(vi)]

YNN/A
??

28. Is the bottom step of stairway-type

ladders
24 inches or less above the scaffold
supporting
level?

YNN/A
??

[29 CFR 1926.451(e)(3)(i)]

29. Do stairway-type ladders have rest
platforms

YNN/A
??

at 12-foot maximum vertical intervals?

[29 CFR 1926.451(e)(3)(ii)]
30. Do stairway-type ladders have a step
width
of16 inches?
at least
[29 CFR 1926.451(e)(3)(iii)]

YNN/A
??

YNN/A
??

Note: Mobile scaffold stairway-type ladders

may have a minimum step width of 11 1/2
inches.
31. Do stairway-type ladders have slipresistant
treads on all steps and landings?
[29 CFR 1926.451(e)(3)(iv)]

YNN/A
??

32. Do ramps and walkways 6 feet or more

above lower levels have guardrails?
[29 CFR 1926.451(e)(5)(i)]

YNN/A
??

33. Are ramps and walkways inclined with a YNN/A

??
slope less than 1 vertical to 3 horizontal
20 degrees above the horizontal?
[29 CFR 1926.451(e)(5)(ii)]
34. Do ramps and walkways that are
YNN/A
steeper
than
??
1 vertical
in 8 horizontal have cleats 14
inches
(or less) apart that are securely fastened to
the
planks to provide footing?
[29 CFR 1926.451(e)(5)(iii)]
35. Are integral prefabricated scaffold
YNN/A
access
frames constructed for use as ladder rungs? ??
[29 CFR 1926.451(e)(6)(i)]
36. Do integral prefabricated scaffold
access
frames have rung lengths of at least 8
inches?
[29 CFR 1926.451(e)(6)(ii)]

YNN/A
??

YNN/A
??

37. Do students and employees have fall

YNN/A
protection
??
if integral prefabricated scaffold access
frames
with rungs less than 11 1/2 inches are used
as work platforms?
[29 CFR 1926.451(e)(6)(iii)]

38. Are integral prefabricated scaffold

access
frames
uniformly
spaced within each frame
section?
[29 CFR 1926.451(e)(6)(iv)]

YNN/A
??

YNN/A
39. Do integral prefabricated scaffold
access
have a frames
maximum spacing between rungs of ??
16-3/4 inches?
[29 CFR 1926.451(e)(6)(v)]

Note: Non-uniform rung spacing caused by

joining end frames together is allowed,
provide
the resulting spacing is 16-3/4 inches or
less.
40. Do steps and rungs of ladder and
stairway-type

YNN/A
??

access line up vertically with each other

between rest platforms?
[29 CFR 1926.451(e)(7)]
41. Is the horizontal distance 14 inches (or YNN/A
less)
and the vertical distance 24 inches (or less) ??
between two surfaces used to provide direct
access between them?
[29 CFR 1926.451(e)(8)]
42. During erecting and dismantling of
supported
scaffolds, does a competent person
provide

YNN/A
??

YNN/A
??
and evaluate safe means of access?
[29 CFR 1926.451(e)(9)(i)]
43. During erecting and dismantling of
supported

YNN/A
??

scaffolds, are hook-on or attachable

ladders
installed as soon as they can be used
safely?
[29 CFR 1926.451(e)(9)(ii)]

44. During erecting and dismantling of

supported
scaffolds, are the ends of tubular welded
frame
scaffolds used as climbing devices for
access

YNN/A
??

only if the horizontal members are parallel,

level,
and 22 inches apart (or less) vertically?
[29 CFR 1926.451(e)(9)(iii)]
45. During erecting and dismantling of
supported

YNN/A
??

scaffolds, is it prohibited to use the cross

braces
on tubular welded frame scaffolds for
access
or exit?
[29 CFR 1926.451(e)(9)(iv)]

Use
46. Are scaffolds and scaffold components
loaded
below their maximum intended loads or
rated

YNN/A
??

capacities (whichever is less)?

[29 CFR 1926.451(f)(1)]
47. Is the use of shore or lean-to
scaffolds prohibited?
[29 CFR 1926.451(f)(2)]

YNN/A
??

48. Does a competent person inspect

YNN/A
scaffolds
and scaffold components for visible defects ??
before each work shift, and after any
occurrence
that could affect a scaffold's structural
integrity?
[29 CFR 1926.451(f)(3)]
49. Are parts of a scaffold that are damaged YNN/A
or
??
weakened immediately repaired, replaced,
braced, or removed from service until
repaired?
[29 CFR 1926.451(f)(4)]
50. Is the horizontal movement of a scaffold YNN/A
prohibited while workers are on the scaffold ??
(unless the scaffold is designed for
movement
by a registered professional engineer, or is
a
mobile scaffold meeting OSHA standards)?
[29 CFR 1926.451(f)(5)]
51. Are proper clearances (as shown in
Tables 1
and 2) between scaffolds and power lines
always maintained?
[29 CFR 1926.451(f)(6)]

Note: Scaffolds and materials may be

closer
to power lines if such clearance is
necessary,
and only after the utility company or
electrical
system operator has been notified, and the
utility company or electrical system
operator
has deenergized the lines, relocated the
lines,
or installed protective coverings to prevent
contact with the lines.

YNN/A
??

Table 1: Insulated Power Lines

Insulated Lines
Voltage
Less than 300 volts
300 volts to 50 kv
More than 50 kv

Table 2: Uninsulated Power Lines

Uninsulated Line

Voltage
Less than 50 kv
More than 50 kv

52. Are scaffolds erected, moved,

YNN/A
dismantled,
??
or altered only under the supervision and
direction of a competent person qualified
in
scaffold erection, moving, dismantling,
or alteration?
[29 CFR 1926.451(f)(7)]

53. Are scaffolds erected, moved,

dismantled,
or altered only by experienced and trained
employees selected for such work by the
competent person?
[29 CFR 1926.451(f)(7)]

YNN/A
??

54. Is it prohibited to work on scaffolds

covered
with snow, ice, or other slippery material,
except as necessary to remove such
materials?
[29 CFR 1926.451(f)(8)]

YNN/A
??

55. If swinging loads are hoisted onto or

near

YNN/A
??

scaffolds, are tag lines or equivalent

measures
used to control the loads?
[29 CFR 1926.451(f)(9)]
56. Is working on scaffolds during storms or YNN/A
high winds prohibited unless a competent ??
person has determined that it is safe for
workers to be on the scaffold and workers
are protected by a personal fall arrest
system or wind screens?
[29 CFR 1926.451(f)(12)]
57. Is debris removed from platforms?

YNN/A
??

[29 CFR 1926.451(f)(13)]

58. Are makeshift devices, such as boxes
and
barrels, prohibited on scaffold platforms
for increasing the working level height?

YNN/A
??

[29 CFR 1926.451(f)(14)]

59. Is it prohibited to use ladders on
scaffolds
to increase the working level height?

YNN/A
??

YNN/A
??
[29 CFR 1926.451(f)(15)]

Note: Ladders may be used on large area

scaffolds if certain conditions are met.
Consult the OSHA regulations for the
required conditions.

60. Are scaffold platforms used only if they

deflect
1/60 of the span (or less) when loaded?
[29 CFR 1926.451(f)(16)]

YNN/A
??

Definitions:

Competent person: one who can identify hazards in the surroundings or working conditions tha

Lean-to scaffold: a supported scaffold that is kept erect by tilting it toward and resting it agains

Personal fall arrest system: a system used to stop an employee's fall. It consists of an anchora

Shore scaffold: a supported scaffold that is placed against a building or structure and held in pla

Supported scaffold: one or more platforms supported by outrigger beams, brackets, poles, legs

Comments/Corrective action:

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National Institute for Occupational

Safety and Health

Fall Protection
1. Are workers on scaffolds that are more than Y N
10 feet
N/A ??
above a lower level protected from falling by
one
of the following measures:

a. a personal fall arrest system for

workers
on ladder jack scaffolds.
[29 CFR 1926.451(g)(1)(i)]

b. a guardrail system installed within

9 1/2 inches of and along at least one
side of the walkway for workers on a
walkway located within a scaffold.
[29 CFR 1926.451(g)(1)(v)]

c. a personal fall arrest system or

guardrail
system to protect workers doing overhand
bricklaying from a supported scaffold
from falling off open sides and ends of
the scaffold (except at the side next to
the wall being laid)?
[29 CFR 1926.451(g)(1)(vi)]

d. a personal fall arrest system or

guardrail
system for workers on all other scaffolds.
[29 CFR 1926.451(g)(1)(vii)]
2. Does a competent person determine the
feasibility
and safety of providing fall protection for
workers
erecting or dismantling supported
scaffolds?
[29 CFR 1926.451(g)(2)]

Y N
N/A ??

3. Do workers erecting or dismantling

supported

Y N
N/A ??

scaffolds use fall protection when it is safe

and feasible?
[29 CFR 1926.451(g)(2)]
4. Are personal fall arrest systems used on Y N
scaffolds
N/A ??
attached by a lanyard to a vertical lifeline,
horizontal lifeline, or scaffold structural
member?
[29 CFR 1926.451(g)(3)]
5. When vertical lifelines are used, are they
fastened to a fixed safe point of anchorage,
independent of the scaffold, and protected
from sharp edges and abrasion?
[29 CFR 1926.451(g)(3)(i)]

Y N
N/A ??

Note: Safe points of anchorage include

structural members of buildings, but do not
include standpipes, vents, other piping
systems, electrical conduit, outrigger
beams, or counterweights.
6. When horizontal lifelines are used, are
they
secured to two or more structural members
of the scaffold?
[29 CFR 1926.451(g)(3)(ii)]

Y N
N/A ??

7. Is it prohibited to attach vertical lifelines

and independent support lines to one
another, to the same point of anchorage,
and to the same point on the scaffold or
personal fall arrest system?
[29 CFR 1926.451(g)(3)(iv)]

Y N
N/A ??

8. When guardrail systems are required, are

they installed along all open sides and

Y N
N/A ??

Y N
N/A ??
ends of platforms?
[29 CFR 1926.451(g)(4)(i)]
Note: Guardrails systems must be installed
before the scaffold is used by workers
other than erecting or dismantling crews.
9. If the scaffolds were manufactured or
Y N
placed
N/A ??
in service after January 1, 2000, is the top
edge height of toprails (or equivalent
member) on supported scaffolds between
38 and 45 inches above the platform surface?
[29 CFR 1926.451(g)(4)(ii)]
Note: When necessary, the height of the
top edge may exceed 45 inches if the
guardrail meets all OSHA requirements.
10. If scaffolds were manufactured or placed
in service before January 1, 2000, is the
top edge height of toprails (or equivalent

Y N
N/A ??

member) on supported scaffolds between

36 and 45 inches above the platform surface?
[29 CFR 1926.451(g)(4)(ii)]
Note: When necessary, the height of the
top edge may exceed 45 inches if the
guardrail meets all OSHA requirements.
11. Are midrails, screens, mesh, intermediate
vertical members, and solid panels (or
equivalent structural members) installed
between the top edge of the guardrail
system and the scaffold platform?
[29 CFR 1926.451(g)(4)(iii)]

Y N
N/A ??

12. When midrails are used, are they installed Y N

N/A ??
approximately midway between the top
edge of the guardrail system and the

Y N
N/A ??
platform surface?
[29 CFR 1926.451(g)(4)(iv)]
13. When screens and mesh are used, do they Y N
N/A ??
extend from the top edge of the guardrail
system to the scaffold platform, and along
the entire opening between the supports?
[29 CFR 1926.451(g)(4)(v)]
14. When intermediate members (such as
balusters or additional rails) are used, are
they installed 19 inches or less apart?
[29 CFR 1926.451(g)(4)(vi)]

Y N
N/A ??

15. Can each toprail (or equivalent member)

of a guardrail system withstand (without
failure) a 200-pound force applied in any
downward or horizontal direction at any
point along its top edge?
[29 CFR 1926.451(g)(4)(vii)]

Y N
N/A ??

Note: Appendix A of subpart L of the OSHA

regulations gives directions for constructing
acceptable guardrail systems.
16. When a 200 pound force is applied in a
downward direction on the toprail (or
equivalent member) of a guardrail system,
does the top edge still maintain the OSHA
required height (see questions 9 and 10)?
[29 CFR 1926.451(g)(4)(viii)]

Y N N/A ??

17. Can midrails, screens, mesh, intermediate Y N

vertical members, solid panels, and equivalent N/A ??
structural members of a guardrail system
withstand (without failure) a 150-pound force
applied in any downward or horizontal
direction at any point along the midrail
or other member?

[29 CFR 1926.451(g)(4)(ix)]

18. Are guardrails surfaced to prevent
snagging
of clothing and injury from punctures or
lacerations?
[29 CFR 1926.451(g)(4)(xi)]

Y N
N/A ??

19. Is it prohibited for rails to overhang the

terminal posts, except when such overhang
does not constitute a projection hazard?
[29 CFR 1926.451(g)(4)(xii)]

Y N
N/A ??

20. Is the use of steel or plastic banding for

toprails or midrails prohibited?
[29 CFR 1926.451(g)(4)(xiii)]

Y N
N/A ??

21. If manila, plastic, or other synthetic rope is Y N

N/A ??
used for toprails or midrails, is it inspected
by a competent person as necessary to
ensure that it continues to meet the OSHA
strength requirements?
[29 CFR 1926.451(g)(4)(xiv)]
22. If crossbracing is used to replace a midrail, Y N
is
the crossing point of the two braces between N/A ??
20 and 30 inches above the work platform?
[29 CFR 1926.451(g)(4)(xv)]
23. If crossbracing is used to replace a toprail, Y N
is
the crossing point of the two braces between N/A ??
38 and 48 inches above the work platform?
[29 CFR 1926.451(g)(4)(xv)]
24. If crossbracing is used to replace a midrail Y N
or
N/A ??
toprail, are the end points at each upright
48 inches apart or less?
[29 CFR 1926.451(g)(4)(xv)]
Falling Object Protection

25. Do workers on scaffolds wear hardhats?

[29 CFR 1926.451(h)(1)]

Y N
N/A ??

26. Are workers protected from falling hand

tools,

Y N
N/A ??

debris, and other small objects by toeboards,

screens, guardrail systems, debris nets, catch
platforms, or canopy structures that contain
or deflect the falling objects?
[29 CFR 1926.451(h)(1)]
27. If objects are too large, heavy, or massive Y N
N/A ??
to
be contained or deflected, are they moved
away from the edge of the surface from which
they could fall and secured?
[29 CFR 1926.451(h)(1)]
28. If tools, materials, or equipment could fall
from a scaffold and strike workers, are one of
the following protective measures used?
[29 CFR 1926.451(h)(2)]

Y N
N/A ??

a. The area below the scaffold to which

objects can fall is barricaded, and
workers are not permitted to enter
the hazard area.

b. A toeboard is erected along the edge

of platforms more than 10 feet above
lower levels for a distance sufficient
to protect workers below.
29. If tools, materials, or equipment are piled
higher
than the top edge of the toeboard, are one of
the following protective measures used?
[29 CFR 1926.451(h)(2)]

Y N
N/A ??

Y N
N/A ??

a. Paneling or screening extending from

the toeboard or platform to the top of the
guardrail is erected for a distance
sufficient to protect the workers below.

b. A guardrail system is installed with

openings small enough to prevent
passage of falling objects.

c. A canopy structure, debris net, or catch

platform strong enough to withstand
the impact forces of the falling objects
is erected over the workers.
30. If canopies are used to protect workers,
are
they installed between the falling object
hazard and the workers?
[29 CFR 1926.451(h)(3)(i)]

Y N
N/A ??

31. If toeboards are used to protect workers,

can
they withstand (without failure) a force of at
least 50 pounds applied in any downward or
horizontal direction at any point along the
toeboard?

Y N
N/A ??

[29 CFR 1926.451(h)(4)(i)]

Note: Appendix A of Subpart L of the OSHA
regulations provides directions for
constructing
acceptable toeboards.
32. If toeboards are used to protect workers,
are they
at least 3-1/2 inches high from the top edge of
the

Y N
N/A ??

Y N
N/A ??

toeboard to the level of the walking/working

surface?
[29 CFR 1926.451(h)(4)(ii)]
33. If toeboards are used to protect workers,
are they

Y N
N/A ??

securely fastened in place at the outermost

edge
of the platform? Do they have 1/4-inch or less
clearance above the walking or working
surface?
[29 CFR 1926.451(h)(4)(ii)]
34. If toeboards are used to protect workers,
are they

Y N
N/A ??

solid or with openings of 1inch or less in the

greatest dimension?
[29 CFR 1926.451(h)(4)(ii)]
Pole Scaffolds
35. When platforms are moved to the next
level, are

Y N
N/A ??

existing platforms left undisturbed until the

new
bearers have been set in place and braced?
[29 CFR 1926.452(a)(1)]
36. Is crossbracing installed between the inner Y N
and
N/A ??
outer set of poles on double pole scaffolds?
[29 CFR 1926.452(a)(2)]
37. Is diagonal bracing that is installed in both Y N
N/A ??
directions across the entire inside face of
double-pole scaffolds used to support loads
equivalent to a uniformly distributed load of
50 pounds or more per square foot?
[29 CFR 1926.452(a)(3)]
38. Is diagonal bracing installed in both
directions
across the entire outside face of all double-

Y N
N/A ??

Y N
N/A ??
and single-pole scaffolds?
[29 CFR 1926.452(a)(4)]
39. Are runners and bearers installed on
edge?

Y N
N/A ??

[29 CFR 1926.452(a)(5)]

40. Do bearers extend at least 3 inches over
the

Y N
N/A ??

outside edges of the runners?

[29 CFR 1926.452(a)(6)]
41. Do runners extend at least over two
poles? Are

Y N
N/A ??

they supported by bearing blocks that are

securely attached to the poles?
[29 CFR 1926.452(a)(7)]
42. Is it prohibited to splice braces, bearers, Y N
and
N/A ??
runners between poles?
[29 CFR 1926.452(a)(8)]
43. If wooden poles are spliced, are they
square? Does
the upper section rest squarely on the lower
section?
[29 CFR 1926.452(a)(9)]
Note: Wood splice plates must be on at least
two
adjacent sides, and must extend at least 2
feet
on either side of the splice, overlap the
abutted
ends equally, and have at least the same
cross-sectional areas as the pole. Splice plates
of
other materials of equivalent strength may be
used.

Y N
N/A ??

Tube and Coupler Scaffolds

44. When platforms are moved to the next
level, are

Y N
N/A ??

existing platforms left undisturbed until the

new
bearers have been set in place and braced?
[29 CFR 1926.452(b)(1)]
45. Are transverse braces that form an "X"
across the

Y N
N/A ??

width of the scaffold installed at the scaffold

ends
and at least at every 3rd set of posts
horizontally
(measured form one end) and every 4th
runner
vertically?
[29 CFR 1926.452(b)(2)]
46. Dose bracing extend diagonally from the
inner or

Y N
N/A ??

outer posts or runners upward to the next

outer
or inner posts or runners?
[29 CFR 1926.452(b)(2)]
47. Are building ties installed at the bearer
levels

Y N
N/A ??

between the transverse bracing?

[29 CFR 1926.452(b)(2)]
48. On straight run scaffolds, is longitudinal
bracing
across the inner and outer rows of posts
installed
diagonally in both directions? Does bracing
extend from the base of the end posts upward
to
the top of the scaffold at approximately a 45
angle?
[29 CFR 1926.452(b)(3)]
Note: On scaffolds whose length is greater
than
their height, such bracing must be repeated
beginning at least at every 5th post. On
scaffolds

Y N
N/A ??

whose length is less than their height, such

bracing must be installed from the base of the
end posts upward to the opposite end posts,
and
then in alternating directions until reaching
the
top of the scaffold. Bracing must be installed
as
close as possible to the intersection of the
bearer and post or runner and post.

49. If bracing cannot be attached to posts, is it Y N

N/A ??

attached to the runners as close to the post

as possible?

[29 CFR 1926.452(b)(4)]

50. Are bearers installed transversely
between posts?
When coupled to the posts, does the inboard

Y N
N/A ??

Y N
N/A ??
coupler bear directly on the runner
coupler?
[29 CFR 1926.452(b)(5)]
Note: When the bearers are coupled to the

runners, the couplers must be as close to

the

posts as possible.

51. Do bearers extend beyond the posts and

runners,

Y N
N/A ??

and provide full contact with the coupler?

[29 CFR 1926.452(b)(6)]
52. Are runners installed along the length of
the
scaffold, on both the inside and outside
posts at level heights?
[29 CFR 1926.452(b)(7)]

Y N
N/A ??

Y N
N/A ??

Note: When tube and coupler guardrails and

midrails are used on outside posts, they may
be
used in place of outside runners.
53. Are runners interlocked on straight runs
to form

Y N
N/A ??

continuous lengths, and coupled to each post?

[29 CFR 1926.452(b)(8)]
Note: Install bottom runners and bearers as
close to the base as possible.
54. Are couplers made of structural metal,
such as

Y N
N/A ??

drop-forged steel, malleable iron, or structural

grade aluminum?
[29 CFR 1926.452(b)(9)]
Note: The use of gray case iron is prohibited.
Fabricated Frame Scaffolds
55. When moving platforms to the next level,
are
existing
platforms left undisturbed until the
new
end frames have been set in place and
braced?
[29 CFR 1926.452(c)(1)]

Y N
N/A ??

56. Are frames and panels braced by cross,

horizontal,

Y N
N/A ??

or diagonal braces (or combinations thereof),

to
secure vertical members together laterally?
[29 CFR 1926.452(c)(2)]
Note: The cross braces shall be long enough
to
automatically square and align vertical
members
so that the erected scaffold is plumb, level,
and
square. All brace connections must be
secured.

57. Are frames and panels joined together

vertically

Y N
N/A ??

by coupling or stacking pins or equivalent

means?
[29 CFR 1926.452(c)(3)]
58. Are frames and panels locked together
vertically

Y N
N/A ??

by pins or equivalent means at points where

uplift
could displace scaffold end frames or panels?
[29 CFR 1926.452(c)(4)]
Bricklayers' Square Scaffolds
59. Are wood scaffolds reinforced with
gussets on

Y N
N/A ??

both sides of each corner?

[29 CFR 1926.452(e)(1)]
60. Are diagonal braces installed on all sides
of
each square?
[29 CFR 1926.452(e)(2)]

Y N
N/A ??

61. Are diagonal braces installed between

squares on

Y N
N/A ??

the rear and front sides of the scaffold, and do

they
extend from the bottom of each square to the
top
of the next square?
[29 CFR 1926.452(e)(3)]
62. Are scaffolds three tiers or less in height?
Are they
constructed so that one square rests directly
above
the other?
[29 CFR 1926.452(e)(4)]

Y N
N/A ??

Note: The upper tiers shall stand on a

continuous
row of planks laid across the next lower tier,
and
shall be nailed down or otherwise secured to
prevent displacement.
Horse Scaffolds
63. Are scaffolds less than 10 high? Are they
two tiers

Y N
N/A ??

high or less?
[29 CFR 1926.452(f)(1)]
64. When horses are arranged in tiers, is each Y N
horse
N/A ??
place directly over the horse in the tier below?
[29 CFR 1926.452(f)(2)]
65. When horses are arranged in tiers, are the Y N
legs of
N/A ??
each horse nailed down or otherwise secured
to
prevent displacement?
[29 CFR 1926.452(f)(3)]
66. When horses are arranged in tiers, is each Y N
tier
N/A ??
crossbraced?
[29 CFR 1926.452(f)(4)]
Ladder Jack Scaffolds
67. Are all ladder jack scaffolds 20 feet or less Y N
above
N/A ??
the ground?
[29 CFR 1926.452(k)(1)]
68. Are ladders that are used to support
ladder jack
scaffolds in compliance with OSHA regulations
(see

Y N
N/A ??

Y N
N/A ??

subpart X of this part)? - Stairways and

Ladders.
[29 CFR 1926.452(k)(2)]
69. Are ladder jacks designed and constructed Y N
so that
N/A ??
they will bear on the side rails in addition to
the ladder rungs?
[29 CFR 1926.452(k)(3)]
Note: If bearing on rungs only, the bearing
area
shall be at least 10 inches on each rung.
70. Are ladders that are used to support
ladder jacks

Y N
N/A ??

placed, fastened, or equipped with devices to

prevent slipping?
[29 CFR 1926.452(k)(4)]
71. Is it prohibited to bridge scaffold platforms Y N
one
N/A ??
to another?
[29 CFR 1926.452(k)(5)]
Training Requirements
72. Are workers trained to recognize the
hazards associated

Y N
N/A ??

with the type of scaffold used and to

understand the
procedures to control or minimize those
hazards?
[29 CFR 1926.454(a)]
Note: Consult the OSHA regulations for the
specific
training areas that must be covered.
73. Are trainers qualified in the subject
matter?
[29 CFR 1926.454(a)]

Y N
N/A ??

Y N
N/A ??
74. Are workers who erect, disassemble,
move, operate,

Y N
N/A ??

repair, maintain, or inspect a scaffold trained

to
recognize hazards associated with the work?
[29 CFR 1926.454(b)]
Note: Consult the OSHA regulations for the
specific training areas that must be covered.
75. Are trainers who train the workers
mentioned in

Y N
N/A ??

question 74 competent?
[29 CFR 1926.454(b)]
76. Are workers retrained when they show a
lack of skills

Y N
N/A ??

or understanding needed for safe work

involving
erecting, using or dismantling scaffolds?
[29 CFR 1926.454(c)]

Definitions:

Bearer (putlog): a horizontal transverse scaffold member supported by ledgers or

Brace: a rigid connection that holds one scaffold member in a fixed position with respect to anoth

Competent person: one who can identify hazards in the work area or conditions that are unsani
Coupler: a device for locking together the tubes of a tube and coupler scaffold.
Gusset: a metal plate used for connections.

Personal fall arrest system: a system used to stop an employee's fall. It consists of an anchora

Lifeline: a component consisting of a flexible line that connects to an anchorage at one end to h

Qualified: a person who, by a recognized degree, certificate, or professional standing; or by exte

Runner (ledger or ribbon): the lengthwise horizontal spacing or bracing member that support

Supported scaffold: one or more platforms supported by outrigger beams, brackets, poles, legs

Comments/Corrective action:

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National Institute for Occupational Safety

and Health

by ledgers or runners. The scaffold platform rests on the bearer, and the bearer joins scaffold uprights, posts, p

sition with respect to another member, or to a building or structure.

conditions that are unsanitary, hazardous, or dangerous, and who has the authority to take prompt corrective m

all. It consists of an anchorage, connectors, a body belt or body harness, and may include a lanyard, deceleratio

anchorage at one end to hang vertically (vertical lifeline), or that connects to anchorages at both ends to stretch

sional standing; or by extensive knowledge, training, and experience, has successfully demonstrated an ability

cing member that support the bearers.

eams, brackets, poles, legs, uprights, posts, frames, or similar rigid support.

ins scaffold uprights, posts, poles, and similar members.

y to take prompt corrective measures to eliminate them.

nclude a lanyard, deceleration device, lifeline, or combinations of these.

orages at both ends to stretch horizontally (horizontal lifeline). The lifeline serves connects other components of

ully demonstrated an ability to solve problems related to a subject matter, work, or project.

onnects other components of a personal fall arrest system to the anchorage.

Area

Reference

29 CFR 1926.503
29 CFR 1926 Subpart M, App. C
OSHA Letter of Interpretation
Integrity Management - OMS
29 CFR 1926 Subpart M, App. C
Fall Protection - Defined Practice
31 CFR 1926 Subpart M, App. C

Date
Facility
Location
Participants
NA = Not Applicable, N = Needs Attention, CDW= Corrected During Walkthrough, BP=Best Practice

Element: Fall Protection

Training by competent person recorded in training database
Re-training as necessary following an event or observation
Proper equipment for task
Proper tie off point
Rescue Plan in place
Fall Protection equipment listed on safety critical equipment list
Inspected by competent person
Proper fit
Type and length of lanyard for the task

NA, N,
CDW, BP

Comments / Action

Resp. Party

Work Order

Area

Reference

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice
Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice
Lifting Operations - Defined Practice

Lifting Operations - Defined Practice

Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice
Lifting Operations - Defined Practice

Date
Facility
Location
Participants
NA = Not Applicable, N = Needs Attention, CDW= Corrected During Walkthrough, BP=Best Practice

Element: Lifting
Crane Operator
Has the Crane Operator presented evidence of competency card?
Is the Crane Operators evidence of competency card criteria sufficient to operate the
crane to be utilized?

Lift Information (Crane Operator/IA)

Do you know the capacity of the crane at this configuration?
Do you know the weight of the load?
Do you know the gross load on the crane?
Do you have a load chart available in the crane cab?
Do you know what percentage is this load of gross capacity?

Rigging (All)
Was the rigging performed by a competent rigger?
Do all slings have a legible load rating attached?

People (All)
Is the Lift Leader/Issuing Authority present at the lift site?
Have the crane operator and rigger signed the lift permit?
Have non-essential personnel in the vicinity of the lifting operations who are not directly
involved with the lift been controlled to stay out of the area of maximum boom radius?

Critical Lift Criteria (All)

Will the Crane/Hoist Operator lose sight of BOTH the load and signal person at any time
during the lift?
Are you lifting over energized or pressurized equipment?
Is the crane within twice the maximum swing radius of the crane, plus the required
clearance?
Does the lift exceed 80% of the lifting equipment capacity?

Crane Condition (IA)

Has the daily visual inspection been completed?

NA, N,
CDW, BP

Is yearly Crane/Hoist inspection current?

Were any deficiencies found during the prior to use inspection?
Is the anti-two block functional

Tag Lines
Use of tag line avoided if possible to eliminate risk
Discussion of hand signals including stop the job signal during lift planning
Lift plan including travel path discussed with crane operator and spotter including walking
surfaces, ground condition, obstructions and escape route
Tag lines appropriate length to avoid potential fall zone
Tag lines inspected and attached securely
Apropriate number of tag lines to stabilize load
Reminder to walking forward only
Spotter hand signals understood and followed
Workers clear of equipment during lifting away or landing

Comments / Action

Resp. Party

Work Order

Area

Reference

Date
Facility
Location
Participants
NA = Not Applicable, N = Needs Attention, CDW= Corrected During Walkthrough, BP=Beat Practice

Element: Hot Work

Permitting
Did everyone participate in the JSEA?
Was the Permit completed on location?
Does the description of Hot Work activities identified on the permit cover the current
tasks being performed?
Has the Permit been reviewed with the Performing Authority?
Has the Permit been signed by the Issuing Authority?
Are any additional permits required for this job? (Can be Yes or No depending on scope
of work)
Are the energy isolation points properly identified, isolated and documented?
Monitoring
Can hot work be conducted when the LEL is greater than 10%?
Is documentation available to verify that the atmospheric monitor has been calibrated per
manufacturers requirements?
Has the Issuing Authority determined the monitoring requirements?
Is continuous atmospheric monitoring required when performing open flame hot work?
Controls
Is a Fire Watch required when performing open flame hot work?
Has the Fire Watch been identified on the Permit and signed in the appropriate area?
(Can be Yes or No depending whether a Fire Watch was required on Lines 6 & 7.)
Is appropriate fire extinguishing equipment identified and readily available? (Yes if open
flame hot work.)
Are alarms and shutdowns by-passed an if so, is it properly documented? (Can be Yes
or No depending on location.)
Can a hot work permit be closed while a Fire Watch is still on duty?
Can a motor vehicle be operated within 10 of hydrocarbon equipment or piping without a
hot work permit?
Documentation
Are hot work permits valid for more than one shift?
Can a completed permit be retained for less than 30 days?
Can an Issuing Authority close a hot work permit without returning to the site?

NA, N,
CDW, BP

Comments / Action

Resp. Party

Work Order

Area

Compressed Gas and Air - Recommended Practice

Rick, can you verify this. The reg says 25-50

feet unless a firewall is used at which point is
1 foot.

Group Defined Practice - Inspection and Testing of Equipment in Service

Group Defined Practice - Inspection and Testing of Equipment in Service

Date
Facility
Location
Participants

Inspection Element
NA = Not Applicable, N = Needs Attention, CDW= Corrected During Walkthrough, BP=Beat Practice
Housekeeping
Walkways clear
Equipment stored properly
Shelving anchored
D. WELDING-CUTTING EQUIPMENT AND COMPRESSED GAS CYLINDERS (Safety)
Proper PPE (welder eye protection, gloves, long sleeve shirts, etc.) worn when performing
welding.
Instructions covering the operation/maintenance of oxygen/fuel gas supply equipment
available.
Compressed gas cylinders are legibly marked as to their contents.
Compressed gas cylinders secured in an upright position to prevent against falling (on or
off the vehicles).
Valve protective caps are in place when cylinders are not connected for use.
In buildings, cylinders stored in well-ventilated, dry locations, away from sources of heat
and at least 20 ft from highly combustible material such as oil.
Cylinders shall be located in assigned areas where they will not be damaged or tampered
with.
Oxygen stored at least 20 feet from combustible material, acetylene, carbide cylinders or
other fuel-gas cylinders when not in use, or a firewall can separate the two.
Oxygen cylinders, valves, regulators, etc., must be free from grease or oily substances.
Cylinder valves closed before moving cylinders and when work is finished.
Valves on empty cylinders closed and capped.
Oxygen-acetylene torch handle and welding torches equipped with flashback protection
valves.
Worn / cracked hoses been replaced.
Cylinders are regularly checked for dents and corrosion.
Gas hoses stored with pressure bled off.
Compressed gas cylinders legibly marked, color coded and segregated by contents.
Cylinders stored away from heat and sources of ignition.
Gas cylinder gauges read zero psi when not in use.
Electric Welder
Welding cables free of defects. No repairs within 10' of stinger
Welding equipment proper slicing at clamp connections.

Bench Grinder
Cord free from splices and damage, proper ground, factory end

NA, N, CDW,
BP

Wheels inspected and ring tested, proper speed rating, grinding wheel dressed
Tool Rest <1/8" from wheel
Tongue guard < = 1/4" space
Eye shield adjusted, clear
Face protection available and used
Original guard in place, properly adusted, tight
Normal RPM ( motor brushes good condition)
Dust mask utilized as per hazard assessment
Portable Grinder
Cord free from splices and damage, proper ground, factory end
Wheels inspected and ring tested, proper speed rating for machine
Eye and face protection available and used
Original guard in place, properly adusted, tight
Handle installed and used for control
Dust mask utilized as per hazard assessment
Electric Cut-off saw
Cord free from splices and damage, proper ground, factory end
Wheels inspected and ring tested, proper speed rating for machine
Eye and face protection available and used
Original guard in place, properly adusted, tight
Handle installed and used for control
Dust mask utilized as per hazard assessment
Drill Press
Cord free from splices and damage, proper ground, factory end
Proper bit for material

Electric Band saw

Electric Hydraulic Punch Press

Hydraulic system
Hydraulic hoses
Guard in place
Electrical cord proper grounding, stress relief, cracking and wear
Electric Threader
Electrical cord proper grounding, stress relief, cracking and wear
Machine guard(s)
non-portable units bolted to floor
Portable Electric Drill

Inspect electrical cord for wear, splices and proper grounding

Inspect for proper 90 degree handle for high torque work
Inspect brushes for wear
Vise
Inspected for proper mounting
inspect jaws and handles for wear,cracks, bent parts& misuse.
Hand Tools
Wooden handles inspected for cracks, splits and defects, secure at end
Metal tools inspected for wear, misuse
Metal tool handles damage, bent or cracked
Plastic handles inspected for cracks, defects
Air Compressor
Secured to floor
Machine guard(s) in place
PRV tested
Electrical cord inspected for defects, stress relief
Proper grounding
Tank inspected
Condensed fluid removed periodically
Air hoses inspected

Comments / Action

Resp. Party

Work Order

Date
Facility
Location
Participants
NA = Not Applicable, N = Needs Attention, CDW= Corrected During Walkthrough, BP=Beat Practice

Area

Element Electrical Equip. Inspection

Each cord set, attachment cap, plug and receptacle of cord sets, and any
equipment connected by cord and plug, except cord sets and receptacles which
are fixed and not exposed to damage, shall be visually inspected before each
day's use for external defects, such as deformed or missing pins or insulation
damage, and for indications of possible internal damage.
Equipment found damaged or defective shall not be used until repaired.
Repairs of electrical cords on portable double insulated equipment such as
electrical drills is not permitted except by replacement of the cord as per
manufacturer's specifications
Free from grease, oil or other substances which may degrade outer coverings
( follow manufacturer's recommendations)
Flexible cords shall be used only in continuous lengths without splice or tap. Hard
service flexible cords No. 12 or larger may be repaired if spliced so that the splice
retains the insulation, outer sheath properties, and usage characteristics of the
cord being spliced.
This provision precludes the repair of flexible cords smaller than No.12 (the
higher the number, the smaller the cord). Since hand power tools typically have
flexible power cords smaller than No.12, those cords are not permitted to be
spliced. Heavier cords -- those No. 12 or larger (that is, with a lower gauge
number), may be repaired with a molded or vulcanized splice as long as the
repair returns the cord to at least the equivalent of its original specifications.
Repairs are made by qualified personnel
Cords and electrical tools stored properly, to protect from potential UV,excessive
heat, contact and strain damage.
Extension cords not used for permanent wiring
Extension cords proper guage for load and length
Operator understands guage and load requirement
Damaged cord(s) are tagged out and not used until repaired by a qualified person
Breaker boxes 3' clear for emergency management
Switches are marked as to equipment they control unless obvious
Switches, panels and breakers labelled with arc-flash labels as appropriate
Wall receptacle covers are tightly secured with proper covers
Wall receptacles used near water sources have ground-fault protection
Ground fault receptacles and breakers are tested periodically

NA, N,
CDW, BP

Comments / Action

Resp. Party

Work Order

Date
Facility
Location
Participants
NA = Not Applicable, N = Needs Attention, CDW= Corrected During Walkthrough, BP=Beat Practice

Area

Element: Production Facility (Developed by Anadarko OS)

AnadarkoMinimumWellSiteStandardChecklist

Well Name:

Date Performed:

Structural Defects
SD-001

Areallguards(beltguards,machineguards,weightguards)inplacewithadequatemachineguardingandin
goodworkingorder?

SD-002

Areguardspinned/bolted(notwelded)toallowremovalforLOTO/Service?

SD-003

Arethereguardsandcautionsignageinplacearoundhot(>140F)piping/equipment(e.g.compressor
discharge/exhaustpiping,firetubes,etc.)?

SD-004

Areallautomationandelectricallinesproperlytiedinandsecuredwithnoexposedwiring?

SD-005

Areallproductionlinesproperlytiedinandsecuredtoproductionequipmentandtanks?

Fixed Ladders
L-001

Arealltankladders,landingssecured,level,withallboltsandbracinginplace?

L-002

Areladdersthatexceed24feetequippedwithacageorladdersafetydevice?

L-003

Istheladderproperlyangledtopreventslipping?

L-004

Arefixedladdersangledatnomorethan90fromtheground?

L-005

Aretheladderstepsproperlyspaced(nolessthan10inchesandnomorethan14inches)?

L-006

Istheladdermountedatleast7inchesandnotmorethan12inchesawayfromthewall/tank/fixturebehindit?

L-007

Areladderswithoutcagesatleast15inchesawayfromtheneareststructure?

L-008

Istheladderareacompletelyunobstructed?

Stairs
S-001

Arehandrails,mid-rails,andtoeboardsinplaceandsecure/stable?

S-002

Aretherehandrailsonallstairshavingfourormorerisers?

S-003

Arethestairsatleast22incheswide?

S-004

Dostairsanglebetween30and50fromtheground(horizontal)?

S-005

Arestairwayhandrailslocatedbetween34and37inchesabovetheleadingedgeofstairtreads?

S-006

Aresteprisersonstairsuniformfromtoptobottom(variationnotmorethan1/4)?

S-007

Arestepsonstairsslipresistant(designedorprovidedwithanon-slipsurface)?

S-008

Areelevatedsurfacesprovidedwithstandard4inchtoeboards(bottomoftoeboardnomorethanabove
landing)?

S-009

Arethereanycatch/snagpointsonhandrails?

S-010

Isthestairwaypathcompletelyunobstructed?

Proper Equipment Foundations

EF-001

Areallfoundationslevel?

EF-002

Aretherewashoutsorerosionunderequipment?

Equipment Inspection for Integrity

I-001

Checkforleakingorseepingtanks,valves,piping,holesintankroof

I-002

Checkforwaterpoolingaroundequipment

I-003

Cracks,splits,brokenwelds

I-004

ThreadedMasterValvewithPlungerOps(YESorNO)

Tanks
T-001

Islateralventlocatedatleast10ftfrompublicroadwayandventingawayfromignitionsource(gasfired
productionunits,etc.)?

T-002

Visuallyinspectseams,valves,piping,loadlinesfordamageorleaks

T-003

Checkheatertreater,separator,orproductionunitforcorrectoperation(e.g.:liquidlevel,dumpoperation,
temperaturecontroller,etc.).

T-004

Areenvironmentalpotsinplaceontankloadlineanddrainline(empty,withlidclosedandpinned)?

T-005

Dotheloadlineshavebullplugs?

T-006

Isthecontainmentringstructurallysound(noholesinpanelforaformerorexistingloadline,nomissingnuts
andboltsalongtheseams)?

T-007

Anyerosionfeaturesthatwouldallowreleasedfluidstoeasilybypassthesecondarycontainment?

T-008

Allhammerunionsondumplinesandwatertransferlinessecure?

T-009

Isthethiefhatchclosedandlatchedproperly?

T-010

Doesthethiefhatchsealproperly(lidisalignedtoallowproperseatingonrubberseal)?

T-011

Isthetankcleanandfreeofoilstains(overfilledorblewoiloutthiefhatch)?

T-012

Isthemanwaycoverfreeofanyseepsandallnutsandboltsareinplace?

T-013

Allopeningsonfiberglasstanksproperlyprotectedtopreventbirdtaking?

T-014

Arethetanks,valves,andassociatedpipingstructurallysound(nodiscoloration,drips,seeps,cracks,etc.)?

T-015
T-016

Doallfiberglasstankshavesolidfiberglasstop?
ArefiberglasstanksinwaterserviceONLY?

T-017

Iffiberglasstankhasnettedtop,isitingoodcondition?(noholesgreaterthan1)

Pumping Units
PU-001

Checkunitfluidsforcorrectlevels(e.g.:lubeoil,coolingwater,lubricatorbox,daytank,etc.).Donotneed
tocheckgearbox(partofpm).

PU-002

Checkstuffingboxforleaksandtightenorreplacepackingasrequired.

PU-003

Listentounitforanyunusualnoises

PU-004

Visuallycheckunitformechanicalfunctionandstructureintegrity(alignment,cracking,etc.)

Flammable and Combustible Materials

Flam-001

Areapprovedcontainersandtanksusedforthestorageandhandlingofflammableandcombustibleliquids?

Flam-002

Areallflammableliquidskeptinclosedcontainerswhennotinuse?

Flam-003

Arestoragetanksguardedtopreventdamagefromvehicles?

Flam-004

Areallconnectionsondrumsandcombustibleliquidandvaporpipingtight?

Flam-005

Arestoragetanksadequatelyvented,includingbeingequippedwithemergencyventing?

Valves and PSVs

PSV-001

ArethereanyblockvalvesbelowaPSVupstream? (If yes, notify team leader immediately).

PSV-002

ArethereweathercapsinplaceonPSVoutletlinesandmeterrunventingstackstoatmosphere?Arevalve
plugsinplaceonallweathercapvalvesandline?

PSV-003

AreallPSVdischargeventsproperlyroutedoutsideofenclosureorbuildingandaboveridgelineof
enclosure/building?

PSV-004

ArethePSVventsextendedtoasafeelevation(7ft)awayfrompersonnelandbracedtopreventanypossible
rotationduringanemergencyrelease?

PSV-005

AreallPSVsinstalledintheverticalposition?

PSV-006

Doallsightglasseshaveguardsinstalled?

PSV-007

Areallgaugesinworkingcondition(ifnotneeded,removeandinstallplug)?

PSV-008

Canlocationbeisolatedwithdoubleblockandbleed?

Proper Site Maintenance

SM-001

Isthereadequateweedandgrasscontrolonimmediateleaselocation?Shutinwellforanyunsafecondition
onwellsite(firehazards,snakes,unabletocompletejobsafetyduetovegetation)

SM-002

Identifyidleequipment(specify).(Shutinforunsafeworkingoperations).

SM-003

Removealljunkfromlocation(specify).(Shutinforunsafeworkingoperations).

SM-004

Anysinkholes,uncoveredwellheadcellars,etc?

SM-005

Isthereanystainedsoilareaaroundtanksorproductionequipment?

SM-006

Isthereatopdoorframeofatleast68highand24wideontheexitofanywellsitefence?

Identify Electrical Hazards

Ele-001

Arethereanylooseorbarewires,includingpowerlines?

Ele-002

Istherelowoverheadwiringthatcreatesanunsafehazard?

Ele-003

Arethereanybrokengroundwires,includingpowerlines?

Ele-004

Areelectricboxdoorsopenorbroken?

Ele-005

Isthedistanceofanyequipmentfrompowerlines<10ft(CAUTION: Visibly determine. DO NOT

MEASURE).

Ele-006

Allproductionunits,tanks,pumpingunits,compressors,separators,flarestacks,dehys,automationRTUs,
heatertreatersandelectricalmotorsproperlygroundedusingexternalgroundwiretogroundrod.

Ele-007

Inspectautomationpolesforstructuraldamage.

Ele-008

Arecoverpanelsonelectricalcontrolboxesinstalledandclosed?

Ele-009

Areallelectricalcontrolsmarkedandlegible?

Ele-010

Istheconditionofelectricalwiringgood?

Ele-011

Areelectricalwiresproperlystrungandsecured?

Proper Signage
Sgn-001

AreH2Swarningsignsposted(ifwell>10ppm)?

Sgn-002

AreLeasesignspostedatleaseentry,wellhead,andtankbattery?

Sgn-003

IsUnitstartsautomaticallysignpostedifappropriate?

Sgn-004

Aretankcontentsw/hazardwarningsposted?

Sgn-005

Arehighvoltagesignserectedifappropriate?

Sgn-006

AreUndergroundburiedpipemaybepresentsignsposted?

Sgn-007

Arewarningsignscleanandvisible?

Sgn-008

AreNoSmokingareasdesignatedandposted?

Sgn-009

Arehearingprotectionsignsposted?

Sgn-010

Areriganchormarkersinplace?

Sgn-011

Areemergencyphonenumbersposted?

Labeling of Containers
Lbl-002

Arebarrels,tanks,orothermovablecontainersproperlylabeled?
Arethelabelslegibleandprominentlydisplayed?

Lbl-003

Doesthelabelincludethenameofthechemical,thehazardassociatedwiththechemicalandthetargetorgan
affectedbythechemical?

Lbl-001

Compressors
C-001

Areairfiltersinstalledonthecompressorintake?

C-002

Checkunitoperatingconditionsatcontrolpanel(e.g.:suction/dischargepressures,rpm,oilpressure,coolant
temperature,etc.)

C-003

Checkforgasandliquidleaks.

C-004

Checkfluidlevelinscrubbers.

C-005

Checkdistance-piecedripcontainerforfluidanddrainasrequired.

C-006

Confirmscrubberdumpsoperatingcorrectly.

C-007

Listentounitforanyunusualnoises.

C-008

Visuallycheckunitformechanicalfunctionandstructureintegrity(e.g.:excessivevibration,crackednipples,
etc.).

C-009

Checkunitfluidsforcorrectlevels(e.g.:lubeoil,coolingwater,lubricatorbox,daytank,etc.).

C-010

Aresafetydevicesoncompressedairsystemscheckedfrequently?

C-011

Areenvironmentalskidsinstalled?Dotheyneedtobeemptied?

General Housekeeping
Hou-001

ProperTool/EquipmentPlacement?

Hou-002

Aretriphazardsremovedand/oradequatelymarked(paintedyellow,etc.)?

Hou-003

Isallequipmentpaintedconsistently?

Hou-004

Alltanks,separators,wellheads,paintedBPtan,ontanksbottomstepandtopstep,handrails6inon
tipssafetyyellow

Hou-005

Allfencepanelsbrownandsafetyyellow.(ifpaintedBptanandsafetyyellow18infromgroundup)
Donotpaintbrownandyellowpanels

Hou-006

BPownedcompressorsBPgreen

Hou-007

PumpingunitGasfiredmotorsBPgreenorBptan(allgasfiredmotorsreplacedBPgreen)

Hou-008

PumpingunitsBPtan,weightsandhorsesheadhavetopaintedsafetyorange6inontipsasOSHA
requires

Hou-009

AlltrippinghazardsSafetyyellow

Hou-010

Allabovegroundpipingnotfencedinwithpanels,safetyyellowbelow6feet,BPtanabove6feet

Hou-011

Allpiping,walkoversandguardsnotfencedinwithpanels,safetyyellowbelow6feet,BPtanabove6
feet(iffencedinwithpanelsBPtanorsafetyyellowfortrippinghazards)

Hou-012

IstheWindSockpresentandreadilyvisiblefromatsiteswith>10ppm?

Hou-013

Lockout/Tagout:Doesallequipmentrequiredtobede-energizedordisengagedandblockedhavethedesign
tobelockedout?

Other
O-001

Doallflangedconnectionshaveboltsinallholeswith2threadspastthenut?

O-002

IfHuberheadispresent,dovisualinspection.

O-003

LubeoiltankspecificationsEnsureappropriatetankheight,labeling,andsecondarycontainment.

O-004

Isrolllinepresent?

O-005

Arepanelsinplaceandproperlysecured,ingoodshape?

O-006

Doallreservoirsonlocationhavecontainment?

O-007

Isallsecondarycontainmentfreeoftrash,debris,andliquids?

O-008

Doallstackshaveabirdbarrier?

O-009

Any Other Safety or Environmental Concerns?

All Findings: specify equipment for required work order and discuss with team leader

Any finding that would be deemed safety critical Call Team Leader immediately and discuss
Signature:___________________________________________
Revision Log

Revision
Authority
Date
2/4/2006 DanLawson
10/10/2006 DanLawson

3/30/2008 DanLawson
6/17/2008 DanLawson

NA, N,
CDW, BP

Comments / Action

Resp. Party

Needs Attention

Comments

Work Order

StandardChecklist

Check Off

Guages
PSV caps

Check Off

Needs Attention

Comments

Check Off

Needs Attention

Comments

Check Off

Needs Attention

Comments

Check Off

Needs Attention

Comments

Check Off

Needs Attention

ely and discuss

Date:______________

Comments

Custodian

Revision Details

PattiJones
GaylaI
Guenther

Newprocedure
GeneralRequirementsreworded.
ProcedureTookoutlinethat
statedwewouldstoreforone
year.

GaylaI
Guenther

CheckListMultipleentries
added

GaylaI
Guenther

ChangestoCheckListdueto
S&OAudit

Date
Facility
Location
Participants
NA = Not Applicable, N = Needs Attention, CDW= Corrected During Walkthrough, BP=Beat Practice

Area

Element: Ground Disturbance

Pre-Job
Did everyone participate in the JSEA
Was the JSEA completed on location with actual site hazards identified and control
measures applied?
Has a One Call been made and been cleared ?
Did the IA fill and sign the Ground Disturbance Permit?
Is the Ground Disturbance Permit on location?
Have all involved with the excavation read and signed the permit?
Was the search zone marked with white paint or white flags?
Has an Emergency Response Plan been reviewed and available at the work site?
Has a plot plan/drawing of the site been completed?
Have all lines to be crossed been positively identified?

During the Job

What are the hazards at this site?
Is the Issuing Authority on site during the excavation.
Was a sweep performed prior to excavation?
Are there other permits involved with this excavation?
What type of Ground Disturbance training have you received?
Are you comfortable stopping the job if you are unsure about potentially unsafe acts or
conditions?

NA, N,
CDW, BP

Comments / Action

Resp. Party

Work Order

Date:
Facility Location Participants NA

OK

NA = Not Applicable N = Needs Attention

1.0 Fire & Emergency Equipment
1.1 Portable Extinguishers: Visible (placard/marking),
mounted; unobstructed access; monthly inspection
completed. CFR 1910.157/ NFPA10
1.2 First Aid Kits: All contents present; and weekly
inspections completed. HSE-DOC-30009-4/55008-4
1.3 Fire Containment: Fire control doors closed and sealed
1.4 Halon System: Zone in normal dump mode; all heads
connected; N2 pull stations charged; all module switches
labeled; and separation doors for Halon systems closed.
NFPA 12A
1.5 Fire Hoses: Inspected in last 5 years; nozzles and
fittings in place; block valves in normal position. NFPA20,
1911,1921
1.6 Emergency Showers & Eye Wash: Charged & monthly
inspection conducted. Protective eyepiece covers in place.
CFR1910/ANSI / HSEDOC-00332-4
1.7 SCBA (Air Packs): All packs, masks, etc. in place; air
bottles full; monthly inspection conducted; enclosure sealed.
CFR 1910.134

NA

OK

2.0 Safety Devices/HVAC

2.1 Critical Valves: All PSVs in service; valve handles and
car-seals in place; defeated devices logged. HSE-DOC00202-4/ASH
2.2 Heating & Ventilation Systems: Exhaust fans running (if
needed); switches in correct position; and louvers operating
correctly to maintain air balance switches in correct position;
and louvers operating correctly to maintain air balance
2.3 Emergency Shut Down Valves: All hydraulic/pneumatic
lines open; and defeated devices logged. ASH

NA

OK

2.4. Defeated Devices: Flagged, tagged and properly

logged. HSE-DOC00202-4/ASH
2.5 Signage: Current and appropriate for the hazards
present.
3.0 Physical Safety & Mechanical Concerns
3.1 Hand Tools: Condition, storage and proper use. CFR
1910.24,.244
3.2 Housekeeping: Aisles/stairs/floors clear; drips and spills
cleaned up; trash cans empty and are free of food waste.
CFR1926.25, AK F&G
3.3 Ladders & Climbing Devices: Condition; storage; proper
use; chains/ gates closed. CFR1910.26/ASH

3.4 Walking/Working Surfaces: Dry, unobstructed, clean,

openings guarded. Slipping/Tripping hazards. CFR 1910.22
3.5 Exits: Marking, visibility, lighting, unobstructed access,
exterior stairs cleared of snow/ice, no overhead hazards
(snow and Ice). CFR 1910.37/1910.145
3.6 Machinery: Guards/shields in place; belts, pulleys,
gears, shafts; maintenance and oil leakage; nuts, bolts,
flanges tight. CFR1910.211/.219
3.7 Scaffolding: Secured, properly tagged and load rated.
Toe-boards and handrails installed. CFR1926.451/HSEDOC-00044-3, BPGR
3.8 Electrical: Plugs intact; switch covers in place; circuit
breakers identified; circuit panels unobstructed; no open
blanks in box; proper extension cords (GFI). CFR
1910.147/ASH
3.9 Pressure Equipment: Bull plugs installed, valves properly
positioned, proper utility fittings in place. 18AAC 75
3.10 Materials Handling Equipment & Lifting Devices: Load
rating on cranes, hoists, beams, trolley posted; cranes
stored in proper position; slings and wire ropes are in good
repair and not frayed and annual inspection done and color
coded. Stacked materi
3.11 Permanent Handrails, grating, & elevated walkways:
Structural integrity intact (Impact and/or weather
damage)and , grating clips in place.
3.12 Hoses and fittings: Correct application
(service/pressure), signs of damage (hose, fitting, clamping
device), whip-checks in use, working pressure noted on
hose. CFR1926.302
3.13 Compressed Gas Cylinders, properly secured (not tied
off to process lines, chains in place), acetylene cylinders
placed upright, cylinders stored outside or in approved area,
protective caps in place. BP Group N2 Guidelines CFR
1910.101 /ASH
NA

OK

4.0 Hazardous/Flammable Material Control

4.1 Housekeeping: Accumulation of combustible materials
(i.e. oily rags). CFR 1926.25
4.2 Ventilation: No toxic fumes, vapors, mists, smoke and
gases. CFR 1910.1000
4.3 Caustic, Corrosive, & Hazardous Materials: container
labels, MSDS available, storage, disposal, and spill cleanup. Oxidizers not stored with organic materials. Material
containing Asbestos identified and Warning signs posted.
ASH/HSE-DOC-00153-4 / 00

4.4 Flammable Liquid Storage & Transfer: Ground straps in

use; approved containers used and labeled; containers
provided with self closing valve; drums/container/vessels
labeled (NFPA 704M label) where required; and MSDS
posted. CFR1910.106
5.0 Personal Protective Equipment (PPE)
5.1 PPE: Hard hats, safety shoes, fire retardant clothing,
hand protection and proper eye protection (safety
glasses/side shields). CFR 1910.135 1910.133/ASH
5.2 Fall Protection: Proper equipment being used correctly
when working at heights of 6 or greater, inspections
completed. CFR 1926.502/ASH BPGR
5.3 Noise Exposure: Areas posted; hearing protection used
(double hearing protection in required areas). CFR
1910.95 /ASH
5.4 Respiratory protection: Correct respirator and cartridge
used; and maintained and stored properly. CFR 1910.134
/ASH

NA

OK

5.5 Gas Meters: Gas/oxygen/H2S/Benzene meters

available, calibrated and charged. ASH
6.0 Permits and Procedures
6.1 Emergency Response Plan: Available and understood;
drills completed; Alarms functional. CFR 1910.120
6.2 Energy Isolation: Energy Isolation List completed and
available; devices tagged, flagged and locked out. CFR
1910.147 /ASH, BPGR.
6.3 Work Permits & Fluid Transfer: Properly completed,
conditions being followed. Fluid Transfer List being followed
for fluid transfers 18AAC 75, 40CFR 112 ASH, BPGR

NA

OK

6.4 Hazard Recognition Process: Critical activities identified.

Hazards noted. Are Safeguards in place?
7.0 Waste Management
7.1 No more than 55 gallons of hazardous waste (per waste
stream) at one SAA. 40 CFR 262
7.2 SAA containers labeled hazardous waste and kept
closed. 40 CFR 262
7.3 All containers or tanks with recyclable hydrocarbons are
labeled as Used Oil. 40 CFR 279
7.4 Waste is segregated (oily waste, metal, other for landfill)
before delivery to solid waste site or before placing in
dumpster. 40 CFR 262
7.5 Oily waste properly bagged. No chemicals are mixed in
oily waste bags or in oily waste dumpster. 40 CFR 262
8.0 Spills / Spill Prevention / Storm Water Management

8.1 Use of Surface Liner / Drip Pan Procedure observed. NS

Environmental Field Handbook, NS Unified Procedure
8.2 Are there any hydrocarbon leaks (greater than 4 drops
per min.) or damaged equipment that could cause a leak?
Hydrocarbon Leak Procedure
8.4 Is standing water present in secondary containment,
cellar, or well house? 18AAC75, NPDESAKR-00-A022
8.5 No visible contamination on pad, equipment,
impoundments with potential to contact storm water.
18AAC75, NPDESAKR-00-A022

NA

OK

NA

OK

8.7 Fluid Transfer equipment in good order. 18AAC75,

NPDESAKR-00A022
9.0 Air Quality Management
9.1 Are copies of applicable Air Quality Permit to Operate,
Construction Permits, and Title V Permits posted?.
18AAC50
10.0 Housekeeping
10.1 Excess materials and equipment removed
10.2 Storage bins / shelves secure
10.3 Heavy objects stored on lower shelves
10.4 Objects stored on shelves securely
10.5 Objects hanging on walls stored securely
10.6 Walkways and aisles clean, clear of obstructions and
dry
10.7 Permanent aisles and passageways appropriately
marked.
10.8 Elevated storage areas ( above offices, etc.) weight
limit posted and adhered to.
10.9 Elevated Storage areas neat and clean
10.10 4 toeboards where tools or materials might fall on
people or equipment
10.11 No materials stored in elevated storage next to railings
unless guarded
10.12 Stairways have standard handrails 30-34from tread
and 3 away from walls, and mid-rails. Platforms have
handrails at min. 42, mid-rails in center and 4 toeboards.
Handrails and stair rails shall withstand a 200 pound force in
all directions.

10.13 Lighting fixtures guarded when less than 7 feet or that

can be damaged when carrying or moving supplies or tools.
10.14 Overhead hazards marked and cushioned as needed

NA

OK

10.15 Protruding hazards are removed or guarded.

11.0 Electrical
11.1 Electrical panels labeled with purpose, voltage
11.2 Breakers and switches labeled

11.3 3 clear access around electrical panels, no

combustibles
11.4 Wiring in conduit, not pulled from stress relief
11.5 No extension cords used for permanent wiring
11.6 Extension cords inspected, properly stored
12.0 Flammables and Chemicals
12.1 Flammable materials stored in flammable cabinets
12.2 Flammable cabinets properly vented
12.3 Chemicals other than household quantity
labeled/MSDS
Repairs / Corrections must
be completed by (date)
Repairs / Corrections from
the above have been
completed:
Supervisor

________________________________________________
_

Comments

Owner

Date:
____________________________

PSM Site Name

Sunray Gas Plant

Hemphill Gas Plant
Block 31 Gas Plant
Crane Gas Plant
Midland Compressor
F&H CCDF
Red Oak Central
Bayfield
Florida River
Pascagoula Gas plant
Wattenburg Gas Plant
Jayhawk Gas Plant
Wamsutter Stab Plant
Judge Digby (VPP Site)
Morganza (VPP Site)
Port Hudson (VPP Site)

Operations Site

Anardarko
Anardarko
Permian
Permian
Permian
Arkoma
Arkoma
San Juan North
San Juan North
Southern
Wattenburg
Hugoton
Wamsutter
S. La.
S. La.
S.La.

Last PSM Audit

Last SPU
Compliance
Inspection

20 June, 2008
9-Jun-10
3 June, 2010
3 June, 2010
6 Nov, 2008
5 April, 2008
5 April, 2008
1 Jul, 2009
1 Jul, 2009
23 June, 2010
2 Aug, 2010
13 Aug,2009
7 May, 2010
12 Oct, 2009
12 Oct, 2009
25 Feb, 2009

Feb. 15-17, 2011

Feb. 15-17, 2011
Aug 31-Sept.3
Aug 31-Sept.3
Aug 31-Sept.3
Oct.4-6, 2010
Oct.4-6, 2010
Sept.13-17 2010
Sept.13-17 2010
Sept. 21-22, 2010
Sept. 28-29, 2010
Jan 24-27, 2011
July 26, 2010
Jan. 11-13, 2011
Jan. 11-13, 2011
Jan. 11-13, 2011
Confirmed

NON-PSM Operations Site

Name

Operations Area

Last Compliance
(S&O) Audit

Last SPU
Compliance
Inspection

OSHA
Compliance,
PSM Review,
VPP
O,P
O
O,P
O, P
O, P
O, P
O, P
O, P, VPP
O, P, VPP
O
O, P
O, P, VPP
O
O, VPP
O,VPP
O,VPP

Scheduled
Inspection
Preparation
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete

Contact: PSM

Dallis Pletcher
Dallis Pletcher
Jay Warren
Jay Warren
Jay Warren
Dale Fisher
Dale Fisher
Bob McKibbin
Bob McKibbin
Brian Kay/Johnny Oliver
Frank Velasquez
Justin Anderson
Diane Sagan/Mark Tanner
Gordon Raines
Gordon Raines
Gordon Raines

Contact:HSE

Gerry Corder
Gerry Corder
Joe Montez
Joe Montez
Joe Montez
Van Mason
Van Mason
Doug Mitchel, Tracy M.
Doug Mitchel, Tracy M.
Joe Zurovec
Craig Powell
Nahum Manzano
Garreth Ratchford
Randy Comeaux
Randy Comeaux
Randy Comeaux

Tentative

OSHA
Next Scheduled
Compliance,
Inspection
PSM Review
VPP Prep

Contact: OSM

Contact: HS Team
Leader

Manager

Eric Fletcher
Eric Fletcher
K. Mortensen
K. Mortensen
K. Mortensen
Carl Dupuy
Carl Dupuy
Jon Lowe
Jon Lowe
Richard Rose
Mike Deherrera
Len Sisk
Fred Lemond
Doug Woodrow
Doug Woodrow
Doug Woodrow

Date:
Facility:
Location:
Participants:
NA = Not Applicable, N = Needs
Attention, CDW= Corrected During
Walkthrough, BP=Best Practice

Area

Element

NA, N,
CDW, BP

Comments / Action

Resp. Party

Work Order

Inspection
Element

Electrical
Emergency Mgmt.
Energy Isolation
Fire Protection
Hazcom
Housekeeping
IH/PPE
Lifting
Machine Guards
Mechanical
Integrity
Stairways,
Walkways,
Ladders
Training and
Written Programs
Total

Location: