GU CHESM FieldInspectionChecklist

GU CHESM Field Inspection Checklist
Global Upstream CHESM Field Inspection Checklist

This checklist provides a format for the recording of observations at work sites visited during the inspection. Use this information for completing the inspection and providing the score required for the contractors health, environment and safety (HES) qualification rating. The summary of the inspection findings and detailed information about the areas needing improvement (not the scoring) shall be communicated to the contractors site representative. After completing this form, turn it in to your local HES representative and provide a copy to the work site supervisor/leader. Company representatives observe the work site and work practices of the contractor. The contractor is an independent contractor responsible for the safe and timely completion of the work in accordance with applicable industry standards and the contract and company specifications. If the work site or practices of a contractor are unsafe, stop the work and notify the contractors representative immediately. It is then the contractors responsibility to evaluate the situation, take any necessary corrective or remedial action and restart the work when it is safe to do so. The company should not direct the work or provide any work instructions or corrective measures directly to the contractor personnel, except for situations where imminent danger exists. Other than stopping any unsafe work practices, limit inspections to obtaining information for the companys audit and evaluation of the contractors HES practices. Interviewing contractor site personnel during the tour is advised to avoid making two trips.
Version 1.0. Revised 23 May 2007. Printed 3 June 2008. Uncontrolled when printed. GU_CHESM_FieldInspectionChecklist.doc
1. General Information
Inspection Participants
Location Date
2. Contractor Information
Contractor Company Name Project Name or Number Chevron Department Sponsor Number of Employees Supporting Chevron Operations Contractor Key Personnel Company Director/Manager: Phone: Site Supervisor: Phone: HES Representative: Phone: Fax: email: Fax: email: Fax: email:
3. Work Site Condition and Work Practice Assessment Category General Work Site Acceptable Improvement or N/A Needed Comments
1. 2. 3. 4. 5.
Walkways clean and clear? Proper lighting? Work area clear of tripping hazards/obstructions? Appropriate trash cans and disposal locations? Proper containment of fluids? For example, no plastic buckets in use for containing hydrocarbon based liquid Electronic communication devices in use within hot work guidelines? Control of entry/exit on the work site? Designated smoking areas?
6.
7. 8.
Hazard Identification
9.
JSA filled out before start of the work?
10. Did the whole crew participate in filling out the JSA and sign off? 11. New JSA filled out when a change occurred (weather, people, work tasks)?
3. Work Site Condition and Work Practice Assessment Category Acceptable Improvement or N/A Needed Comments
12. Task steps written out (not pre-filled in) to perform the job? Include site specific considerations? Procedure use? 13. Hazards identified and addressed? 14. Worker following the written steps or procedure? 15. Were other contractors included in the JSA or shared the JSA if working in the same area? 16. Are workers aware of the stop work authority?
Behavior-Based Safety
17. Critical behaviors identified? 18. Observations conducted? 19. Feedback given after observation? 20. Observation data communicated? 21. Observation data collected/analyzed/used to correct?
Short-Service Employee
22. SSEs are visibly identified? 23. Mentor assigned and available?
24. Does the mentor know that he/she is assigned to the SSE and is responsible for the safety of the SSE? 25. Crew in compliance? (0 SSE on 1 person crew, 1 SSE on 2-4 person crew, and no more than 20% on 5+ person crew or an approved variance is in place)
Fall Protection
26. Fall protection equipment inspected and in good condition? 27. Anchorage location specified? 28. Fall protection equipment properly worn? 29. Tied off properly to designated anchor? 30. Tie-off distance vs. lanyard length? 31. Appropriate rescue plan in JSA? 32. Proper rescue equipment available? 33. Is there at least one person not in a harness on location while the fall protection equipment is in use?
Electrical System
34. Lock-out/tag-out systems?
35. Damaged cords? 36. Explosion-proof fixtures? 37. Overhead power line clearance? 38. Closed power panels?
Personal Protective Equipment
39. Head? 40. Hand? 41. Eye? 42. Foot? 43. Body (if required)? 44. Respiratory (if required)?
Manual and Power Hand Tools
45. Defective tools? 46. Grounded or double insulated? 47. Guards in place? 48. Appropriate tool used?
Category Vehicles
Acceptable Improvement or N/A Needed
Comments
49. Authorized to operate? 50. Speed limits understood and adhered to? 51. Do vehicle operators conduct a walk around hazard assessment before moving the vehicle? 52. Are vehicles being backed in or parked for first move forward?
Mobile Equipment
53. Crane certification? 54. Licensed/certified operators? 55. Rollover protective structures? 56. Movement warning devices (backup alarms)? 57. Tag lines used? 58. Load limits visibly identifiable? 59. Log books available and current?
Scaffold/Work Platform
60. Quality of assembly? 61. Secured against movement? 62. Safe access?
Version 1.0. Revised 23 May 2007. Printed 3 June 2008. Uncontrolled when printed. GU_CHESM_FieldInspectionChecklist.doc 7
Category
Comments
63. Fall protection/provisions? 64. Are guard rails, mid-rails, and toe boards in place? 65. Scaffolds appropriately tagged?
Welding and Cutting
66. Gas bottles upright/secured? 67. Electric welders grounded? 68. Cables/hoses/fittings serviceable? 69. Standby fire watch/fire extinguisher? 70. Are flashback preventers in place?
Sanitation
71. Drinking water? 72. Toilet facilities? 73. Field accommodations? 74. Hygiene accommodations?
Material Storage
75. Materials are securely stored/stacked? 76. Clear access to materials? 77. Load rating for shelves?
8 Version 1.0. Revised 23 May 2007. Printed 3 June 2008. Uncontrolled when printed. GU_CHESM_FieldInspectionChecklist.doc
Category
Comments
78. Stability of shelving?

Permit Systems
79. Lock-out/tag-out procedures? 80. Hot work permits? 81. Confined space entry? 82. Rescue procedures? 83. Rescue equipment? 84. Excavation permit process?
Emergency Systems
85. Emergency response plan? 86. Rescue equipment? 87. First aid materials? 88. Eye wash stations? 89. Fire protection? 90. Evacuation procedure? 91. Are workers familiar with alarms and emergency notification procedure?
Category Excavations/Trenches/Pits
Comments
92. Shoring/Wall slope after five feet before entry? 93. Undermining? 94. Water problems? 95. Close proximity to power lines? 96. Underground utility locations? 97. Adequate means of access and egress? 98. Appropriate means to monitor breathing space?
Hazardous Openings
99. Guard-rail/barriers or coverings on or around? 100. 101. Floor/Roof/Wall openings? Tanks/Trenches/Excavations/Pits/Ditches?
Ladders/Safe Access
102. 103. 104.
Ladders correctly placed/secured? Ladder condition/construction? Adequate access ramps and walkways? (minimum 30 inches wide) Handrails on walkways/ramps?
105.
10
Category Environment
Comments
106. 107. 108. 109.
Adequate lighting? Adequate protection to noise level exposure Toxic vapors/fumes? Adequate protection to temperature extremes?
HazCom
110. 111. 112.
Written HazCom program? MSDS? Labeling system?
Environmental Protection
113. 114. 115.
Permit compliance? Pollution prevention? Waste management?
Total Score = Number of Acceptable and N/A divided by 115 100
11
Action Items Needs Improvement/Not Acceptable Corrective Action Required for Future Re-Selection Target Date Completion
1. 2. 3. 4. 5. 6. 7. Contract Owner: Date reviewed with Contract Owner:
Corrective actions to be completed by: Contract firm informed of results? Yes No Name: Yes No Date: Date:
Contract firm to remain on re-selection bid list?
12

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