<p> JO – CHESM Field Inspection Checklist</p><p>Joint Operations – CHESM Field Inspection Checklist</p><p>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 contractor’s 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 contractor’s 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 contractor’s representative immediately. It is then the contractor’s 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 company’s audit and evaluation of the contractor’s HES practices. Interviewing contractor site personnel during the tour is advised to avoid making two trips.</p><p>Version 1.0. Revised 23 May 2007. 1 Printed 7 April 2018. Uncontrolled when printed. JO02010607ed254efd499b5cf9f0ae534d.doc GU – CHESM Field Inspection Checklist</p><p>1. General Information</p><p>Inspection Participants </p><p>Location </p><p>Date </p><p>2. Contractor Information</p><p>Contractor Company Name </p><p>Project Name or Number </p><p>Joint Operations Department Sponsor</p><p>Number of Employees Supporting Joint Operations Operations</p><p>Company Director/Manager: Contractor Key Personnel Phone: Fax: email: </p><p>Site Supervisor: Phone: Fax: email: </p><p>HES Representative: Phone: Fax: email: </p><p>Version 1.0. Revised 23 May 2007. 2 02010607ed254efd499b5cf9f0ae534d.doc GU – CHESM Field Inspection Checklist</p><p>3. Work Site Condition and Work Practice Assessment </p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>General Work Site</p><p>1. Walkways clean and clear?</p><p>2. Proper lighting?</p><p>3. Work area clear of tripping hazards/obstructions?</p><p>4. Appropriate trash cans and disposal locations?</p><p>5. Proper containment of fluids? For example, no plastic buckets in use for containing hydrocarbon based liquid</p><p>6. Electronic communication devices in use within hot work guidelines?</p><p>7. Control of entry/exit on the work site?</p><p>8. Designated smoking areas?</p><p>Hazard Identification</p><p>9. JSA filled out before start of the work?</p><p>10. Did the whole crew participate in filling out the JSA and sign off?</p><p>11. New JSA filled out when a change occurred (weather, people, work tasks)?</p><p>Version 1.0. Revised 23 May 2007. 3 02010607ed254efd499b5cf9f0ae534d.doc JO – CHESM Field Inspection Checklist</p><p>3. Work Site Condition and Work Practice Assessment </p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>12. Task steps written out (not pre-filled in) to perform the job? Include site specific considerations? Procedure use?</p><p>13. Hazards identified and addressed?</p><p>14. Worker following the written steps or procedure?</p><p>15. Were other contractors included in the JSA or shared the JSA if working in the same area?</p><p>16. Are workers aware of the “stop work authority”?</p><p>Behavior-Based Safety</p><p>17. Critical behaviors identified?</p><p>18. Observations conducted?</p><p>19. Feedback given after observation?</p><p>20. Observation data communicated?</p><p>21. Observation data collected/analyzed/used to correct?</p><p>Short-Service Employee</p><p>22. SSEs are visibly identified?</p><p>23. Mentor assigned and available?</p><p>4 Version 1.0. Revised 23 May 2007. 02010607ed254efd499b5cf9f0ae534d.doc GU – CHESM Field Inspection Checklist</p><p>3. Work Site Condition and Work Practice Assessment </p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>24. Does the mentor know that he/she is assigned to the SSE and is responsible for the safety of the SSE?</p><p>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)</p><p>Fall Protection</p><p>26. Fall protection equipment inspected and in good condition?</p><p>27. Anchorage location specified?</p><p>28. Fall protection equipment properly worn?</p><p>29. Tied off properly to designated anchor?</p><p>30. Tie-off distance vs. lanyard length?</p><p>31. Appropriate rescue plan in JSA?</p><p>32. Proper rescue equipment available?</p><p>33. Is there at least one person not in a harness on location while the fall protection equipment is in use?</p><p>Electrical System</p><p>34. Lock-out/tag-out systems?</p><p>Version 1.0. Revised 23 May 2007. 5 02010607ed254efd499b5cf9f0ae534d.doc JO – CHESM Field Inspection Checklist</p><p>3. Work Site Condition and Work Practice Assessment </p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>35. Damaged cords?</p><p>36. Explosion-proof fixtures?</p><p>37. Overhead power line clearance?</p><p>38. Closed power panels?</p><p>Personal Protective Equipment</p><p>39. Head?</p><p>40. Hand?</p><p>41. Eye?</p><p>42. Foot?</p><p>43. Body (if required)?</p><p>44. Respiratory (if required)?</p><p>Manual and Power Hand Tools </p><p>45. Defective tools?</p><p>46. Grounded or double insulated?</p><p>47. Guards in place?</p><p>48. Appropriate tool used?</p><p>6 Version 1.0. Revised 23 May 2007. 02010607ed254efd499b5cf9f0ae534d.doc GU – CHESM Field Inspection Checklist</p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>Vehicles</p><p>49. Authorized to operate?</p><p>50. Speed limits understood and adhered to?</p><p>51. Do vehicle operators conduct a walk around hazard assessment before moving the vehicle?</p><p>52. Are vehicles being backed in or parked for first move forward?</p><p>Mobile Equipment</p><p>53. Crane certification?</p><p>54. Licensed/certified operators?</p><p>55. Rollover protective structures?</p><p>56. Movement warning devices (backup alarms)?</p><p>57. Tag lines used?</p><p>58. Load limits visibly identifiable?</p><p>59. Log books available and current?</p><p>Scaffold/Work Platform</p><p>60. Quality of assembly?</p><p>61. Secured against movement?</p><p>62. Safe access?</p><p>Version 1.0. Revised 23 May 2007. 7 02010607ed254efd499b5cf9f0ae534d.doc JO – CHESM Field Inspection Checklist</p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>63. Fall protection/provisions?</p><p>64. Are guard rails, mid-rails, and toe boards in place?</p><p>65. Scaffolds appropriately tagged?</p><p>Welding and Cutting</p><p>66. Gas bottles upright/secured?</p><p>67. Electric welders grounded?</p><p>68. Cables/hoses/fittings serviceable?</p><p>69. Standby fire watch/fire extinguisher?</p><p>70. Are flashback preventers in place?</p><p>Sanitation</p><p>71. Drinking water?</p><p>72. Toilet facilities?</p><p>73. Field accommodations?</p><p>74. Hygiene accommodations?</p><p>Material Storage</p><p>75. Materials are securely stored/stacked?</p><p>76. Clear access to materials?</p><p>77. Load rating for shelves?</p><p>8 Version 1.0. Revised 23 May 2007. 02010607ed254efd499b5cf9f0ae534d.doc GU – CHESM Field Inspection Checklist</p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>78. Stability of shelving?</p><p>Permit Systems</p><p>79. Lock-out/tag-out procedures?</p><p>80. Hot work permits?</p><p>81. Confined space entry?</p><p>82. Rescue procedures?</p><p>83. Rescue equipment?</p><p>84. Excavation permit process?</p><p>Emergency Systems</p><p>85. Emergency response plan?</p><p>86. Rescue equipment?</p><p>87. First aid materials?</p><p>88. Eye wash stations?</p><p>89. Fire protection?</p><p>90. Evacuation procedure?</p><p>91. Are workers familiar with alarms and emergency notification procedure?</p><p>Version 1.0. Revised 23 May 2007. 9 02010607ed254efd499b5cf9f0ae534d.doc JO – CHESM Field Inspection Checklist</p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>Excavations/Trenches/Pits</p><p>92. Shoring/Wall slope after five feet before entry?</p><p>93. Undermining?</p><p>94. Water problems?</p><p>95. Close proximity to power lines?</p><p>96. Underground utility locations?</p><p>97. Adequate means of access and egress?</p><p>98. Appropriate means to monitor breathing space?</p><p>Hazardous Openings</p><p>99. Guard-rail/barriers or coverings on or around?</p><p>100. Floor/Roof/Wall openings? </p><p>101. Tanks/Trenches/Excavations/Pits/Ditches?</p><p>Ladders/Safe Access</p><p>102. Ladders correctly placed/secured?</p><p>103. Ladder condition/construction?</p><p>104. Adequate access ramps and walkways? (minimum 30 inches wide)</p><p>105. Handrails on walkways/ramps?</p><p>10 Version 1.0. Revised 23 May 2007. 02010607ed254efd499b5cf9f0ae534d.doc GU – CHESM Field Inspection Checklist</p><p>Category Acceptable Improvement Comments or N/A Needed</p><p>Environment</p><p>106. Adequate lighting?</p><p>107. Adequate protection to noise level exposure</p><p>108. Toxic vapors/fumes?</p><p>109. Adequate protection to temperature extremes?</p><p>HazCom</p><p>110. Written HazCom program?</p><p>111. MSDS?</p><p>112. Labeling system?</p><p>Environmental Protection</p><p>113. Permit compliance?</p><p>114. Pollution prevention?</p><p>115. Waste management?</p><p>Total Score = Number of Acceptable and N/A divided by 115 × 100</p><p>Version 1.0. Revised 23 May 2007. 11 02010607ed254efd499b5cf9f0ae534d.doc JO – CHESM Field Inspection Checklist</p><p>Action Items</p><p>Needs Improvement/Not Corrective Action Required for Future Re-Selection Target Date Completion Acceptable</p><p>1.</p><p>2.</p><p>3.</p><p>4.</p><p>5.</p><p>6.</p><p>7.</p><p>Contract Owner: Date reviewed with Contract Owner: Corrective actions to be completed by: Contract firm informed of Yes No Name: Date: results? Contract firm to remain on re-selection bid list? Yes No Date:</p><p>12 Version 1.0. Revised 23 May 2007. 02010607ed254efd499b5cf9f0ae534d.doc</p>