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ASSESSMENT PROFILE SHEET
ASSESSMENT DATE: Check One With "X"
SUB:
OPER. CO.: SELF PERFORM:
CLIENT NAME:CONSTRUCTION MGMT (CM)
ASSESSOR(S) LABOR POSTURE ACTIVITY
Type Name/Location Here OPEN SHOP CONSTRUCTION
Type Name/Location Here MERIT SHOP MAINTENANCE
Type Name/Location Here UNION
Type Name/Location Here OTHER
PROJECT INFORMATION
PROJECT NAME:
PROJECT NUMBER:
PROJECT MANAGER:
SITE MANAGER:
SAFETY MGR/REP:
PROJECT LOCATION:
CITY:
STATE:
ZIP: COUNTY
PROJECT REGION
Check With "X"
AMERICAS AFRICA EAST US NLA CANADA
ASIA PACIFIC EUROPE WEST US SLA CARIBBEAN
AUSTRAILIA MID EAST CENTRAL US CENTRAL AMER. OTHER
ASSESSMENT TYPECheck One With "X"
GENERAL REQUESTED BY PROJECT
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Score Summary 04/18/201032564844.xls
FINAL SCORE SHEET
PROJECT NAME:
PROJECT MANAGER: DISTRIBUTION (NAME/LOCATION)
DISTRIBUTION (NAME/LOCATION)
PROJECT NUMBER: DISTRIBUTION (NAME/LOCATION)
DISTRIBUTION (NAME/LOCATION)
ASSESSOR(S)
FINAL SCORE
91.85 MAX POSSIBLE ASSESSED TOTAL
ADMINISTRATIVE 296.0 291.00 98.31 YES
FIELD EXECUTION 647.0 575.10 88.89 YES A. = 0
SUBTOTAL 943.0 866.10 91.85 YES B. = 129.92
IDR POINTS (SUBTRACT) 0.00 C. IDR Points ( A x B ) = 0.00
TOTAL 943.0 866.10 91.85 YES
COMPLIANCESCORE
COMPLIANCESTANDARDACHIEVED
Imminent Danger Instances
15% of AssessedSubtotal
ASSESSMENT SCORE SUMMARY
ASSESSMENT SCORE SUMMARYIMMINENT DANGER REDUCTION
( IDR )
IMMINENT DANGER REDUCTION( IDR )
MTH/DAY/YR
MTH/DAY/YR
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Administration Summary 3 04/18/201032564844.xls
SAFETY AUDIT
DETAILED ASSESSMENT SCORE SUMMARYADMINISTRATION
SCORE SET STANDARD REDUCTION
SECTION SECTION NAME
1 Occupational health & safety policy statement 14.0 14.0 11.2 MET 0 0
2 Safety and medical recordkeeping practices 22.0 22.0 17.6 MET 0 03 Emergency preparedness 28.0 28.0 22.4 MET 0 0
4 Infectious diseases 30.0 30.0 24.0 MET 0 0
5 Hazard communication program 42.0 38.0 33.6 MET 0 0
6 Mobil Equipment 28.0 28.0 22.4 MET 0 0
7 Inspection Procedures 24.0 24.0 19.2 MET 0 0
8 Respiratory protection 12.0 11.0 9.6 MET 0 0
9 Enforcement and discipline 10.0 10.0 8.0 MET 0 0
10 Education and training 18.0 18.0 14.4 MET 0 011 Performance indicators 17.0 17.0 13.6 MET 0 0
12 Accident / incident investigation 9.0 9.0 7.2 MET 0 0
13 Contractors 22.0 22.0 17.6 MET 0 0
14 Safety Task Assignment (STA) 9.0 9.0 7.2 MET 0 0
15 Regulatory agency inspection / contact 8.0 8.0 6.4 MET 0 0
16 Claims Management 3.0 3.0 2.4 MET 0 0
17 Process Safety Management (PSM) 0.0 0.0 0.0 MET 0 0
18 Substance Abuse Program 0.0 0.0 0.0 MET 0 019 Strategic Initiatives 0.0 0.0 0.0 MET 0 0
TOTALS 296.0 291.0 207.2 MET 0 0
MAXIMUMPOSSIBLE
ASSESSEDTOTAL
MINIMUMSTANDARD
MET /NOT MET
REPEATDEFICIENCY
IMMINENTDANGER
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE4 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTS
1
A Policy statement is in writing. 1.0 1.0 100.0%B Policy statement is dated. 1.0 1.0 100.0%
C A site specific safety plan has been developed. 1.0 1.0 100.0%
D Health & Safety objectives are clearly stated. 1.0 1.0 100.0%
E Health & Safety responsibilities are defined. 1.0 1.0 100.0%
F 1.0 1.0 100.0%
G 2.0 2.0 100.0%
H 1.0 1.0 100.0%
I 2.0 2.0 100.0%
J 1.0 1.0 100.0%
MAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
OCCUPATIONAL HEALTH &SAFETY POLICY STATEMENT
The Site Specific Safety Plan has beenapproved / accepted by project management.
All contractors have been given a copy of theSite Specific Safety Plan.
Management commitment to safety is stated and communicated to all employees.
A current and complete copy of the Corporate APS manual is located on site and available toall members of management and supervision.
The project has implemented a safety incentive
program for all site employees, including contractors and subcontractors.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE5 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
1
K 1.0 1.0 100.0%
L 1.0 1.0 100.0%
M Other 0.0 0.0
TOTAL 14.0 14.0 100.0% 0 0
OCCUPATIONAL HEALTH &SAFETY POLICY STATEMENT
(cont'd)
The projects' safety incentive plans are in writing and have been approved by project management
The Pre-job accident prevention planning checklist (Corp. APS Manual) has been properly utilized.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE6 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
2
A 1.0 1.0 100.0%
B
1 2.0 2.0 100.0%
2 The previous years records are available. 2.0 2.0 100.0%
3 2.0 2.0 100.0%
4 1.0 1.0 100.0%
C 2.0 2.0 100.0%
D First Aid log utilized / current / accurate. 1.0 1.0 100.0%
E 2.0 2.0 100.0%
F 2.0 2.0 100.0%
G 2.0 2.0 100.0%
SAFETY AND MEDICALRECORDKEEPING PRACTICES
Injury statistics are tabulated and utilized toidentify positive / negative trends.
Mandatory regulatory injury and illness record keeping.
The injury and illness log is available / utilized / accurate.
Employees first report of injury, or approved equivalent form, is on file for each recorded injury or illness.
The injury and illness log corresponds with thecorporate MAER statistics.
Employees Occupational Injury / Illness report form utilized.
Required First Aid supplies are available / stored / dispensed in an approved manner.
Prescription medications are available / stored / dispensed with approval of medical doctor.
Person(s) administering First Aid are trained and certified.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE7 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
2
H 2.0 2.0 100.0%
I 2.0 2.0 100.0%
J All medical files are complete and organized. 1.0 1.0 100.0%
K Other
TOTAL 22.0 22.0 100.0% 0 0
SAFETY AND MEDICALRECORDKEEPING PRACTICES
(cont'd)
Employee exposure and medical records aremaintained.
Return to work forms, or similar documentationwith the attending physicians signature, are onfile.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
8 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
3 EMERGENCY PREPAREDNESS A The Emergency Plan:1 Is in writing. 2.0 2.0 100.0%2 Communicated to all project employees 2.0 2.0 100.0%3 The plan is site specific. 2.0 2.0 100.0%
4 Incorporates clients emergency procedures. n/a 0.0 #VALUE!
B There is a coordinator appointed. 2.0 2.0 100.0%
C 2.0 2.0 100.0%
D 2.0 2.0 100.0%
E 2.0 2.0 100.0%
F 2.0 2.0 100.0%
G 2.0 2.0 100.0%
H 2.0 2.0 100.0%
I 2.0 2.0 100.0%
Supervisor First Aid training has beenconducted.
Required emergency lighting and power areavailable.
Required emergency rescue equipment isavailable.
Emergency response members have beenidentified and trained.
Radios and other communication items areavailable.
Periodic emergency evacuation drills areconducted for all employees.
The plan includes a method of accounting for all employees after an emergency evacuation
occurs.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE9 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
3
J 2.0 2.0 100.0%
K 2.0 2.0 100.0%
L 2.0 2.0 100.0%
M Other 0.0 0.0
TOTAL 28.0 28.0 100.0% 0 0
EMERGENCY PREPAREDNESS(cont'd)
Employees have a working knowledge of Emergency / Evacuation Procedures, EscapeRoutes and Emergency Notification Process.
Emergency evacuation signs or exit signs are posted where required and are adequately visible.
Key personnel and contact numbers arereviewed and updated on a monthly basis.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE10 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
4 INFECTIOUS DISEASES
A 2.0 2.0 100.0%
B 2.0 2.0 100.0%
C 2.0 2.0 100.0%
D 2.0 2.0 100.0%
E 2.0 2.0 100.0%
F 3.0 3.0 100.0%
G 3.0 3.0 100.0%
H Bag valve masks are readily available. 3.0 3.0 100.0%
I 3.0 3.0 100.0%
J 3.0 3.0 100.0%
A written exposure control plan has beenestablished.
Employees who have potential to come incontact with an infectious disease have beenidentified and trained.
Hepatitis B vaccination has been offered tothose employees having potential exposure.
The medical treatment facility is maintained in aclean and sanitary condition and a cleaning schedule has been established.
Hand-washing facilities and procedures areestablished and utilized.
Employees exposed to blood or other bodily fluids utilize the P.P.E. required.
Surgical gloves, masks, eye / face and protective clothing are available.
Sharps or syringes are placed in a labeled puncture- resistant, leak-proof container for disposal as required.
Equipment and instruments are immediately disinfected after each use.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE11 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
4 INFECTIOUS DISEASES (cont'd)
K 3.0 3.0 100.0%
L 2.0 2.0 100.0%
M Other 0.0 0.0
TOTAL 30.0 30.0 100.0% 0 0
Contaminated disposable objects or materials
(bloody bandages, etc.) are placed in a leak- proof, puncture-resistant, red biohazard container for disposal as required.
Training related to infectious diseases safety and vaccinations given / refused is adequately documented.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE12 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
5
A Written Program:1 Site specific 2.0 2.0 100.0%
2 There is a designated program administrator. 2.0 2.0 100.0%
3 Identifies labels and warning methods. 2.0 2.0 100.0%
4 2.0 2.0 100.0%
5 2.0 2.0 100.0%
6 Procurement is involved. 2.0 2.0 100.0%
B Record keeping:1 The inventory list is in place / current / complete. 2.0 2.0 100.0%
2 The MSDS file is in place / current / complete. 2.0 2.0 100.0%
3 Records of all Hazcom training on file. 2.0 2.0 100.0%4 The written Hazcom plan is on file. 2.0 2.0 100.0%
5 2.0 0.0 0.0%
C Training includes:
1 OSHA requirements /standards on Hazcom. n/a 0.0 #VALUE!
HAZARD COMMUNICATIONPROGRAM
Identifies methods of informing employees of non-routine tasks.
For multi-employer sites, communicationbetween contractors (Re: Hazcom)
Test results on file from Hazcom training sessions.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE13 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
5
2 Fluor Daniel Hazcom program requirements. 2.0 2.0 100.0%3 Labeling system. 2.0 2.0 100.0%4 Location of MSDS's 2.0 2.0 100.0%5 Use of MSDS 2.0 2.0 100.0%6 Personal Protection Equipment 2.0 2.0 100.0%7 Non-routine tasks 2.0 2.0 100.0%8 Refresher / annual up date training 2.0 0.0 0.0%
D 2.0 2.0 100.0%
E n/o 0.0 #VALUE!
F 2.0 2.0 100.0%
G 2.0 2.0 100.0%
H Other 0.0 0.0
TOTAL 42.0 38.0 90.5% 0 0
HAZARD COMMUNICATIONPROGRAM (cont'd)
Copies of on site contractor Hazcom programsare available.
Employees are knowledgeable of the Hazcom program based on responses to questions.
Vessels and material containers are labeled asrequired.
Hazard information posters / signs are displayed to inform employees.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE14 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
6
A 2.0 2.0 100.0%
B 2.0 2.0 100.0%
C 2.0 2.0 100.0%
D 1.0 1.0 100.0%
E 3.0 3.0 100.0%
F 3.0 3.0 100.0%
G 3.0 3.0 100.0%
H 3.0 3.0 100.0%
MOBILE EQUIPMENT OPERATIONS
There is a maintenance schedule for all mobileequipment and the schedule is followed.
Daily pre-operational inspections are performed on all equipment.
Annual inspections are performed on all equipment (cranes certified).
Mobile equipment accidents are investigated and reported.
Suspended work baskets are certified as safeand utilized for personnel as required.
Suspended work baskets are built according toapproved designs.
Suspended work baskets are labeled asrequired to show maximum weight capacity,maximum number of persons allowed and total basket weight (actual empty weight).
Permits are utilized and retained for suspended work basket usage.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE15 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
6
I 3.0 3.0 100.0%
J 3.0 3.0 100.0%
K 3.0 3.0 100.0%
L Other 0.0 0.0
TOTAL 28.0 28.0 100.0% 0 0
MOBILE EQUIPMENT OPERATIONS (cont'd)
Critical lift permits are utilized in accordance withcorporate policy.
A load test has been performed that established a safety factor of 2 times for the suspended work basket.
Operator certification program is utilized for aerial lifts, heavy equipment and vehicles.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE16 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
7 INSPECTION PROCEDURES
A 2.0 2.0 100.0%
B
1 Power tools 2.0 2.0 100.0%
2 Assured grounding and electrical cords / leads 2.0 2.0 100.0%
3 Fire extinguishers 2.0 2.0 100.0%4 Ladders 2.0 2.0 100.0%5 Scaffolds 2.0 2.0 100.0%6 Rigging /Hoisting equipment and devices 2.0 2.0 100.0%7 Fall protection equipment and devices 2.0 2.0 100.0%8 Emergency and rescue equipment n/o 0.0 #VALUE! 9 Excavations 2.0 2.0 100.0%
10 Temporary electrical distribution installations 2.0 2.0 100.0%
11 Electrical (ARC) welding equipment 2.0 2.0 100.0%
C 2.0 2.0 100.0%
D Other 0.0 0.0
TOTAL 24.0 24.0 100.0% 0 0
Regular safety inspections of the site / operationare conducted and documented.
Inspection program has been implemented for the following:
There is a follow-up procedure established for the correction of deficiencies noted during inspections.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE17 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
8 RESPIRATORY PROTECTION
A 2.0 2.0 100.0%
B 2.0 2.0 100.0%
C n/a 0.0 #VALUE!
D 2.0 2.0 100.0%
E 2.0 2.0 100.0%
F 2.0 2.0 100.0%
G n/o 0.0 #VALUE!
H n/o 0.0 #VALUE!
There is a written respiratory protection programwhich addresses the respiratory protection
exposure / need as required, or a writtenrespirator use assessment.
Fit testing is provided for all employees required to wear respirators (both APR's and SAR's).
Employees are offered at least 2 different makes, models and sizes of respirators.
Documentation of respirator selection criteria isavailable (i.e. air sample results, calculations,etc.)
Respiratory protection training is conducted,documented, and validated by testing.
Records of training, medical assessment and fit testing are available, and meet confidentiality requirement.
Seal checks are performed and documented each time respirators are used.
Breathing air for supplied air respirators meets
breathing air requirements. Sample results areavailable.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE18 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
8
I n/o 0.0 #VALUE!
J n/o 0.0 #VALUE!
K Breathing air cylinders are labeled as required. n/a 0.0 #VALUE!
L n/a 0.0 #VALUE!
M 2.0 1.0 50.0%
TOTAL 12.0 11.0 91.7% 0 0
RESPIRATORY PROTECTION(cont'd)
If a breathing air compressor is used, it isequipped with a proper filtration system, Co
Alarm, reserve air tank and compressor failurealarm.
Hose couplings used with supplied air respirators are incompatible with other couplings.
Respiratory protection equipment is properly
cleaned, sanitized, and stored after being used.Periodic inspections are performed and documented to ensure that all elements of thewritten program are effective.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE19 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
9
A 2.0 2.0 100.0%
B 2.0 2.0 100.0%
C 2.0 2.0 100.0%
D 2.0 2.0 100.0%
E 2.0 2.0 100.0%
F Other 0.0 0.0
TOTAL 10.0 10.0 100.0% 0 0
ENFORCEMENT ANDDISCIPLINE
Employee Health & Safety responsibilities havebeen communicated to all employees.
Supervisor Health & Safety responsibilities havebeen communicated to all supervisors.
Records of employee safety related disciplineare maintained. (i.e. verbal / written warning,retraining, termination, etc. )
Disciplinary action is initiated by supervisionwhen unsafe acts and conditions occur.
The record of disciplinary action is consistent with the record of incidents and accidents wheredisciplinary action was warranted.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE20 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
10 EDUCATION AND TRAINING
A 2.0 2.0 100.0%
B 2.0 2.0 100.0%
C Task specific training is conducted. 2.0 2.0 100.0%
D 2.0 2.0 100.0%
E 2.0 2.0 100.0%
F Visitor safety induction program is in place. 2.0 2.0 100.0%
G 2.0 2.0 100.0%
H 2.0 2.0 100.0%
I 2.0 2.0 100.0%
J Other 0.0 0.0
TOTAL 18.0 18.0 100.0% 0 0
New employee orientation is provided for employees.
Safety training programs are conducted for management and supervisors .
Safety meetings are conducted for all employees, supervisors and management.
Emergency preparedness and evacuationtraining is in place.
Training records are maintained in good order for all employee safety training.
Testing performed to assure employeeunderstanding of safety training programs.
All site supervisors have attended Safety Leadership Training (SLT).
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE21 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
11 PERFORMANCE INDICATORS
A 10.0 10.0 100.0%
B 3.0 3.0 100.0%
C 3.0 3.0 100.0%
D 1.0 1.0 100.0%
E Other 0.0 0.0
TOTAL 17.0 17.0 100.0% 0 0
There has not been a fatal injury in theworkplace during the past six months.
The year-to-date lost time injury frequency rateis zero.
The year-to-date recordable incidence rate is at or below the current corporate goal.
Actual, ytd _________ Current Goal __________
Contractor / Subcontractor Experience isreported and measured.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE22 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
12
A There is a written accident / incident policy. 1.0 1.0 100.0%
B 2.0 2.0 100.0%
C A standard investigation format is used. 1.0 1.0 100.0%
D 1.0 1.0 100.0%
E 1.0 1.0 100.0%
F 2.0 2.0 100.0%
G 1.0 1.0 100.0%
H Other 0.0 0.0
TOTAL 9.0 9.0 100.0% 0 0
ACCIDENT / INCIDENT INVESTIGATION
Accident / incident policy complies with local regulatory reporting requirements.
Serious injury and fatal injury accidents arecommunicated to management personnel,expeditiously as required.
All lost time injury reports are reviewed by sitemanagement.
There is a remedial follow-up and action plan to
prevent recurrent of accidents / incidents. Accident / incidents information is shared withother operations / projects.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE23 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
13 CONTRACTORS
A 2.0 2.0 100.0%
B 2.0 2.0 100.0%
C 1.0 1.0 100.0%
D 2.0 2.0 100.0%
E 2.0 2.0 100.0%
F 2.0 2.0 100.0%
G 2.0 2.0 100.0%
H 2.0 2.0 100.0%
I Safety violations are properly documented. 2.0 2.0 100.0%
Written qualifications are established for theselection of contractors.
Past Health & Safety performance is factored into contractor selection.
Contractors are required to provide a copy of their safety program.
Prior to starting work on-site, contractors are provided site orientation.
Prior to starting work on-site, contractors are provided the operations health and safety rules,and emergency procedures.
Prior to starting work on-site, contractors aremade aware of any chemicals they may encounter on-site.
Prior to bringing any chemicals on-site,contractors are required to inform safety of thechemicals and provide a material safety datasheet (MSDS).
Contractors are required to follow the samehealth and safety rules as Fluor Daniel employees.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE24 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
13 CONTRACTORS (cont'd)
J 2.0 2.0 100.0%
K 3.0 3.0 100.0%
L Other 0.0 0.0
TOTAL 22.0 22.0 100.0% 0 0
Corrective action taken by subcontractors tocorrect violation and is properly documented
Contractors are required to utilize the FD STA process (or equivalent program).
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE25 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
14
A Employees are given STA by their supervisors 3.0 3.0 100.0%
B 3.0 3.0 100.0%
C n/o 0.0 #VALUE!
D 3.0 3.0 100.0%
E Other 0.0 0.0
TOTAL 9.0 9.0 100.0% 0 0
SAFETY TASK ASSIGNMENT (STA)
The Safety Task Assignment form or equivalent is being used.
Employees questioned about the STA processwhere knowledgeable of the requirement.
Evidence of STA planning / instruction is vis iblein the field.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE26 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
15
A 1.0 1.0 100.0%
B
1 Opening Conference 1.0 1.0 100.0%2 Walk around /inspection phase 1.0 1.0 100.0%3 Records /note taking 1.0 1.0 100.0%4 Tests n/a 0.0 #VALUE! 5 Photographs n/a 0.0 #VALUE! 6 Employee interview procedures 1.0 1.0 100.0%7 Closing conference 1.0 1.0 100.0%8 Post inspection report 1.0 1.0 100.0%9 Corporate notification 1.0 1.0 100.0%C Other 0.0 0.0
TOTAL 8.0 8.0 100.0% 0 0
REGULATORY AGENCY INSPECTION / CONTACT
Two members of management have beenidentified as project representatives to
participate in regulatory agency visits / inspections.
The management members selected torepresent the project during regulatory agency visits have been trained in the following topics.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE27 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
16 CLAIMS MANAGEMENT
A Project has established Company physicians. 1.0 1.0 100.0%
B n/a 0.0 #VALUE!
C n/a 0.0 #VALUE!
D 1.0 1.0 100.0%
E 1.0 1.0 100.0%
F Other 0.0 0.0
TOTAL 3.0 3.0 100.0% 0 0
Employees' First Report of Injury filed withinsurance carrier within 24 hours.
Employees have been notified in writing of their responsibility to report a Workers' Compensationclaim.
Modified Work / Restricted Work programestablished and implemented at Project.
Project Management is pro-Active in Post Injury follow up and to express their concern for theinjured employee.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE28 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
17
A n/a 0.0 #VALUE!
B n/a 0.0 #VALUE!
C n/a 0.0 #VALUE!
D n/a 0.0 #VALUE!
E Other 0.0 0.0
TOTAL 0.0 0.0 #DIV/0! 0 0
PROCESS SAFETY MANAGEMENT (PSM)
Known fire, explosion, and toxic release hazardshave been communicated to employees who areworking on or around covered equipment or
processes.
Applicable provisions of the plant emergency action and evacuation plan has beencommunicated to all affected employees.
Site safe work practices have beencommunicated to all affected employees.
Affected employees have been trained in all of the above listed procedures and practices.Testing procedures to ensure employeecompetency and understanding have beenestablished.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE29 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
18 SUBSTANCE ABUSE PROGRAM
A n/a 0.0 #VALUE!
B n/a 0.0 #VALUE!
C The project conducts random screening. n/a 0.0 #VALUE!
D n/a 0.0 #VALUE!
E n/a 0.0 #VALUE!
F The project includes testing for alcohol. n/a 0.0 #VALUE! G Other 0.0 0.0
TOTAL 0.0 0.0 #DIV/0! 0 0
The project has an approved Substance AbusePrevention Policy and Project Specific Procedures.
The project conducts post-offer / pre-placement testing for all new / rehire employees.
The project conducts post accident and for cause testing.
All contractors / subcontractors are required toadhere to the Corporate substance abuse
prevention program.
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* REPEATED DEFICIENCIES = -10 MAX POSSIBLE
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE30 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
19 STRATEGIC INITIATIVES
A The strategies 2000 manual is available on site. n/a 0.0 #VALUE!
B n/a 0.0 #VALUE!
C n/a 0.0 #VALUE!
D n/a 0.0 #VALUE!
E n/a 0.0 #VALUE!
F n/a 0.0 #VALUE!
G n/a 0.0 #VALUE!
H n/a 0.0 #VALUE!
Section 1 - Contractor prequalification evaluation process has been implemented as required.
Section 2. - Accountability programs have beenimplemented as required.
Section 3 - Pre-bid, pre-mobilization alignmentsfor subcontractors has been implemented and required.
Section 4 - Safety resources for subcontractorshas been implemented as required.
Section 5 - Safety orientation guidelines for subcontractors has been implemented asrequired.
Section 6 - Safety Task Assignment (STA) for subcontractors has been implemented asrequired.
Section 7 - Scaffold guidelines for subcontractor has been implemented as required.
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE31 04/18/201032564844.xls
SAFETY AUDITADMINISTRATION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENT
DANGER(X)
19
I n/a 0.0 #VALUE!
J n/a 0.0 #VALUE!
K n/a 0.0 #VALUE!
L n/a 0.0 #VALUE!
M n/a 0.0 #VALUE!
TOTAL 0.0 0.0 #DIV/0! 0 0
STRATEGIC INITIATIVES(cont'd)
Section 8 - Fall hazard management for subcontractors has been implemented asrequired.
Section 9 - Remote travel and driver safety guidelines for subcontractors has beenimplemented as required.
Section 10 - heavy haulage vehicle safety for subcontractors has been implemented asrequired.
Section 11 - Safety training has beenimplemented as required.
Section 12 - Corporate management ownership
for subcontractors has been implemented asrequired.
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SAFETY AUDIT
DETAILED ASSESSMENT SCORE SUMMARYFIELD EXECUTION
SCORE SET STANDARD REDUCTION
SECTION SECTION NAME
1 Housekeeping 15.0 7.0 12 NOT MET 0 02 Health & Hygiene 26.0 21.0 20.8 MET 0 03 Work Area Lighting 9.0 9.0 7.2 MET 0 0
4 Personal Protective Equipment (P.P.E.) 61.0 55.0 48.8MET
0 05 Hand Tools 13.0 13.0 10.4 MET 0 0
6 14.0 14.0 11.2 MET 0 07 Power Tools and Power Equipment 13.0 12.5 10.4 MET 0 08 Hot Work (Welding, Heating, Burning) 63.0 62.0 50.4 MET 0 09 Electrical 51.0 46.3 40.8 MET 0 0
10 Equipment Operations 123.0 95.0 98.4 NOT MET 0 011 Excavation and Trenching 30.0 30.0 24 MET 0 0
12 Steel Erection and Floor and Wall Opening 7.0 7.0 5.6 MET 0 0
13 Material Handling Storage 19.0 18.0 15.2 MET 0 014 Signs, Signals, Barricades 22.0 20.0 17.6 MET 0 015 Fire Prevention and Protection 30.0 30.0 24 MET 0 0
16 94.0 93.3 75.2 MET 0 0
17 20.0 20.0 16 MET 0 0
18 Demolition 15.0 0.0 12 NOT MET 0 019 Blasting - Use of Explosives 0.0 0.0 0 MET 0 020 High-Pressure Water Cleaning 0.0 0.0 0 MET 0 021 Confined Spaces 22.0 22.0 17.6 MET 0 0
TOTALS 647.0 575.1 517.6 MET 0 0
MAXIMUMPOSSIBLE
ASSESSEDTOTAL
MINIMUMSTANDARD
MET /NOT MET
REPEATDEFICIENCY
IMMINENTDANGER
Ladders, Scaffolds, and Elevated WorkPlatformsConcrete, Concrete Forms, Shoring,Masonry
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
1 HOUSEKEEPING
A 3.0 1.0 33.3%
B 1.0 1.0 100.0%
C 1.0 1.0 100.0%
D 2.0 1.0 50.0%
E 2.0 1.0 50.0%
F 3.0 1.0 33.3%
G n/o 0.0 #VALUE!
H 3.0 1.0 33.3%
I n/o 0.0 #VALUE!
J Other 0.0 0.0
TOTAL 15.0 7.0 46.7% 0 0
Work areas are clean and free of excess trash / debris.
Provisions have been made for routing trashcollection and disposal.
Trash receptacles are provided in all work areas,and one is present at each water keg.
Scrap lumber is free of protruding nails or other puncture hazards.
Glass containers are prohibited, none wereobserved.
Electrical cords, hoses, welding leads, etc., areelevated to prevent tripping hazards.
Butt cans, where used, are maintained free of combustible material and emptied routinely.
Elevated areas are maintained clear of debris,material, tools, etc., where such items could fall to areas below.
Drip pans are utilized for oil dispensing locationsand under threading machines and saws wherelubricant could drip
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
2 HEALTH & HYGIENE
A 2.0 2.0 100.0%
B 2.0 2.0 100.0%
C 2.0 2.0 100.0%
D 2.0 2.0 100.0%
E 2.0 2.0 100.0%
F 2.0 1.0 50.0%
G 2.0 1.0 50.0%
H 2.0 1.0 50.0%
I 2.0 1.0 50.0%
J 2.0 1.0 50.0%
The required number of toilets are provided (1toilet for every 29 workers).
Provisions for servicing / cleaning toilets hasbeen made.
Toilets are kept clean and sanitary. Toilet paper is in place.
Washing facilities are available for worker use prior to lunch / breaks when required.
Vermin (rodents, insects, etc.) control is provided.
Ventilation in work areas is provided for the typeof work being performed.
Local exhaust ventilation is used wherenecessary.
There are designated areas where employeescan eat lunch / dinner in a sanitary environment separate from any toilet facility and not exposed to toxic materials.
Lunch / dinner areas / facilities are clean and kept clean on a regular basis.
A common drinking cup is not allowed, individual cups are provided.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
2 HEALTH & HYGIENE (cont'd)
K 2.0 2.0 100.0%
L 2.0 2.0 100.0%
M 2.0 2.0 100.0%
N Other 0.0 0.0
TOTAL 26.0 21.0 80.8% 0 0
The required supply of drinking water is provided and conveniently located.
Where water kegs are used they are clean,labeled, as required and used only for drinking.
Water kegs are sealed to prevent / indicatetamerping
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
3 WORK AREA LIGHTING
A 3.0 3.0 100.0%
B 1.0 1.0 100.0%
C 1.0 1.0 100.0%
D 1.0 1.0 100.0%
E 3.0 3.0 100.0%
F Other 0.0 0.0
TOTAL 9.0 9.0 100.0% 0 0
Required lighting is provided for the work being performed.
Portable light plants are maintained and kept operational.
Portable light plants are positioned to providemaximum lighting where required.
Portable light plants are easily moved and positioned.
Portable light plant masts are easily raised and lowered.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
4
A Head Protection1 Worn where required. 3.0 3.0 100.0%
2 Bills worn to the front. 2.0 2.0 100.0%3 2.0 2.0 100.0%
4 2.0 2.0 100.0%
B Eye Protection1 Worn where required. 2.0 2.0 100.0%2 Side shields required and used. 2.0 2.0 100.0%
3 n/a 0.0 #VALUE!
4 Face shields are worn when required. 2.0 2.0 100.0%
5 n/a 0.0 #VALUE!
6 2.0 2.0 100.0%
C Fall Protection
1 4.0 4.0 100.0%
2Lanyard are equipped with shock absorbers.
3.0 3.0 100.0%
PERSONAL PROTECTIVEEQUIPMENT (P.P.E.)
Hard Hat suspension systems maintained in asafe manner.
Hard hats are free from cracks, holes or any damage
Lens cleaning stations and material are provided.
Signs are posted at bench grinders "Faceshields required."
Safety glasses or goggles are worn under faceshields or welding shields.
Safety harness is required and used where fall exposure > 2 meters is present. (6ft)
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
4
3 4.0 4.0 100.0%
4 4.0 4.0 100.0%
5 3.0 3.0 100.0%
6 4.0 4.0 100.0%
7 1.0 1.0 100.0%
D Hearing Protection
1 n/o 0.0 #VALUE!
2 2.0 2.0 100.0%
3 2.0 2.0 100.0%
E Foot and Toe Protection
1 Appropriate foot wear is worn by all employees 2.0 2.0 100.0%
2 Steel toe protection is used where required 3.0 3.0 100.0%
PERSONAL PROTECTIVEEQUIPMENT (P.P.E.) (cont'd)
Lanyards hooks are provided with locking safety latch to prevent "Roll Out".
Lanyards are secured to a substantial object -fall distance is maintained to a minimum.
Fall protection equipment is only used for fall protection
Static / catenary lines are installed to facilitatetie-off and will support a force of 2,450 kgs.(5400 lbs.)
Fall protection equipment is inspected on aregular basis and tagged accordingly.
Noise areas are posted as areas where hearing protection is required.
Noise surveys are performed periodically and documented.
Hearing protection is properly worn where and when required.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
4
F 2.0 2.0 100.0%
G 3.0 3.0 100.0%
H 3.0 0.0 0.0%
I 3.0 0.0 0.0%
J 1.0 1.0 100.0%
K n/a 0.0 #VALUE!
L Other 0.0 0.0
TOTAL 61.0 55.0 90.2% 0 0
PERSONAL PROTECTIVEEQUIPMENT (P.P.E.) (cont'd)
Hand protection is provided by gloves that areselected according to specific hazards,anticipated or present.
Employees working near heavy equipment operations wear high visibility and reflectivesafety vests.
Employees working non-daylight hours are provided with reflective striped clothing, vests or other high visibility material.
Employees working non-daylight hours havereflective tape on their hard hats.
All employees receive information and/or training
on the proper use and care of PPE.Emergency eye wash and shower stations areclearly marked and not obstructed.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
5 HAND TOOLS
A 3.0 3.0 100.0%
B Tools are used in an approved manner. 3.0 3.0 100.0%C Tools are carried and stored properly. 1.0 1.0 100.0%
D 3.0 3.0 100.0%
E 3.0 3.0 100.0%
F Other 0.0 0.0
TOTAL 13.0 13.0 100.0% 0 0
Correct tools are used for the work being performed.
Chisels, hammer wrenches and other "striking tools" are dressed at the striking end to prevent "mushrooming".
Job made / home made tools are prohibited and none were observed.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
6 POWDER ACTUATED TOOLS
A 3.0 3.0 100.0%
BCorrect load strengths are known and used.
3.0 3.0 100.0%
C 3.0 3.0 100.0%
D n/o 0.0 #VALUE!
E 1.0 1.0 100.0%
F 3.0 3.0 100.0%
G 1.0 1.0 100.0%
H Other 0.0 0.0
TOTAL 14.0 14.0 100.0% 0 0
Employees using powder actuated tools havebeen trained and certified.
Loads are removed while the tool is stored or left unattended.
Proper P.P.E. is worn by the tool operator whileusing the tool. Proper P.P.E. includes hard hat,face shield, safety glasses and hearing
protection.
The tool and all loads are stored in a locked cabinet.
The tool and all loads are issued only to trained and certified employees.
The tool is inspected on a regular basis and tagged to show that it has been inspected.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
7
A 1.0 1.0 100.0%
B 3.0 3.0 100.0%
C n/o 0.0 #VALUE!
D n/o 0.0 #VALUE!
E 3.0 3.0 100.0%
F 3.0 2.5 83.3%
G 3.0 3.0 100.0%
H Other 0.0 0.0
TOTAL 13.0 12.5 96.2% 0 0
POWER TOOLS AND POWEREQUIPMENT
All power tools are inspected on a regular basisand tagged to show that they have beeninspected.
Required safety guards are in place and functional.Work rests on bench grinders are adjusted within 3mm of the wheel.
Wheels on bench and stand grinders aredressed as required.Discs on portable grinders are compatible withthe equipment's maximum RPM's.
Electrical cords are elevated, protected, or otherwise arranged so as to prevent damage tothe cord or create a tripping hazard.
Employees are trained and certified (Whenrequired) in safe operation of power tools.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
8
A 4.0 4.0 100.0%
B 3.0 3.0 100.0%
C 2.0 2.0 100.0%
D 3.0 3.0 100.0%
E 3.0 3.0 100.0%
F 2.0 2.0 100.0%
G 2.0 2.0 100.0%
H 3.0 2.5 83.3%
I 3.0 3.0 100.0%
J 3.0 2.5 83.3%
HOT WORK (Welding, Heating,Burning)
Hot work on or near areas or processes that
involve flammable, combustible or explosivematerials or chemicals is performed under a safework or hot work permit.
A fire extinguisher is immediately available and operable at all Hot Work locations.
Welding screens are used around all ground or floor level arc welding operations.
Arc welding is performed with a required electrical ground.
Welding cables and ground cables are free of damage and non-insulated connections.
Welding cables and ground cables are inspected on a regular basis.
Where cables are suspended or secured, they are done so by using non-conductive materials.
Cables, cords, and hoses are elevated or protected to prevent tripping hazards.
Compressed gas cylinders are labeled asrequired.
Compressed gas cylinders are stored and capped as required.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
8
K 3.0 3.0 100.0%
L 3.0 3.0 100.0%
M 3.0 3.0 100.0%
N Strikers are used to light torches. 3.0 3.0 100.0%
O 2.0 2.0 100.0%
P 3.0 3.0 100.0%
Q 3.0 3.0 100.0%
R 3.0 3.0 100.0%
S 3.0 3.0 100.0%
HOT WORK (Welding, Heating,Burning) (cont'd)
Reverse flow or flash back arrestors are used onall oxygen/acetylene rigs.
Regulator gauges are attached as required and in good condition.
Compressed gas cylinder valves are turned off when not in use.
Welding rods are stored as required and rod stubs are placed in a container to prevent atripping hazard.
Welding rods are not left in theelectrode/rodholder while not in use.
Compressed gas cylinders are located outside of closed areas and are not exposed to slag or sparks.
Gas cylinders are moved and transported in therequired manner.
Hot slag and sparks are maintained and controlled as required to prevent fires and contact with employees.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
8
T 3.0 3.0 100.0%
U 2.0 2.0 100.0%
V 2.0 2.0 100.0%
W 2.0 2.0 100.0%
X Other 0.0 0.0
TOTAL 63.0 62.0 98.4% 0 0
HOT WORK (Welding, Heating,Burning) (cont'd)
Required P.P.E. is worn for the hot work activity being performed or immediately exposed to,including eye protection, clothing, gloves, and respirator if needed.
Oxygen / acetylene hoses are maintained free of oil and grease.
Compressed gas hoses are inspected and arefree of damage.
Compressed gas cylinders are properly secured to prevent displacement.
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SCORE PENALTY
ASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE%
0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
9 ELECTRICAL
A 3.0 3.0 100.0%
B 4.0 4.0 100.0%
C n/a 0.0 #VALUE!
D n/a 0.0 #VALUE!
E 4.0 2.0 50.0%
F 4.0 2.0 50.0%
G 2.0 2.0 100.0%
H 3.0 3.0 100.0%
I 3.0 3.0 100.0%
J 2.0 2.0 100.0%
K 3.0 2.5 83.3%
Electrical equipment is marked as to the amount of voltage and the control source.
The required "lock out - tag out " procedure isimplemented where circuits are de-energized due to maintenance, repair or other activity.
Employees performing low, medium, or highvoltage work are trained and certified.
Protective gear (rubber gloves, blankets, hot sticks, etc.) are inspected by an independent testing firm.
Tests are performed to determine if current carrying parts are "Hot" or De-energized
All line parts are guarded or protected against contact.GFCI controlled outlets and panels are labeled and tested
Electrical cords are inspected and approved for the type of usage and are free of breaks in theinsulation.
Outlets, receptacles, junction boxes, etc., areapproved and maintained as required.
Where electrical cords are suspended or secured, they are done so by using non-conducting materials.
Electrical cords are elevated over passageways, or are protected from damage whencrossing roads or passage ways.
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%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
9 ELECTRICAL (cont'd)
L 3.0 3.0 100.0%
M 2.0 2.0 100.0%
N 3.0 3.0 100.0%
O 3.0 3.0 100.0%
P 3.0 3.0 100.0%
R 3.0 3.0 100.0%
S 3.0 2.8 93.3%
T 3.0 3.0 100.0%
U Other 0.0 0.0
TOTAL 51.0 46.3 90.8% 0 0
Temporary lighting is installed as required using approved materials.
Light bulbs and fluorescent tubes are guarded as required.
Buried temporary electrical cables are marked on the surface to avoid accidental contact fromdrilling / excavating.
Electrical plugs are maintained in good conditionand are the proper type for voltage / amperage / grounding requirements
All temporary electrical outlets, receptacles, junction boxes and panels are electrically grounded
All electrical tools are quipped with a ground conductor or are double insulated.
Strain relief is provided for all cords or cablesthat prevents pull from being directly transmitted to joints or terminal screws.
Cord repairs meet or exceed the original insulation and are performed by a qualified
person.
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%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
10 EQUIPMENT OPERATIONSA Crane Operations
1 3.0 3.0 100.0%
2 3.0 3.0 100.0%
3 3.0 3.0 100.0%
4 3.0 3.0 100.0%
5 3.0 3.0 100.0%
6 n/a 0.0 #VALUE!
7 3.0 3.0 100.0%
8 3.0 3.0 100.0%
9 4.0 4.0 100.0%
10 3.0 3.0 100.0%
11 3.0 0.0 0.0%
Load charts are posted and utilized and operators manuals are available.
The swing radius of the counter weight isbarricaded.
The crane is operated level with all outriggersfully extended on adequate outrigger pads.
Moving and travel practices are utilized toinclude the use of a flagger.
The operator is trained and certified for thespecific crane being operated.
Specific attention to power line clearance isgiven.
Flagman is used to signal crane operators whenraising, lowering and swinging the hook, loaded or unloaded.
An anti-two-block limit switch is in place and functional on all cranes.
Crane, hook and hoist equipment is free fromdefects.
Operator determines weight of load prior to performing lift.
Operator determines weight of load prior to performing lift.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
10
B General Equipment
1 3.0 0.0 0.0%
2 2.0 1.0 50.0%
3 All lights are operational 2.0 2.0 100.0%4 Horns are operational 3.0 3.0 100.0%5 Back-up alarms are operational. 3.0 3.0 100.0%
6Equipment is operated at a safe travel speed.
3.0 3.0 100.0%
7 3.0 3.0 100.0%
8 3.0 3.0 100%
C Haulage Operations
1 3.0 0.0 0.0%
2 Traffic flow is regulated and enforced. 3.0 0.0 0.0%
3 Speed limits are posted and observed. 3.0 0.0 0.0%
4 2.0 0.0 0.0%
5 2.0 0.0 0.0%
EQUIPMENT OPERATIONS(cont'd)
Operator is Certified as competent for equipment operation
Seat belts are provided and used with ROP structures.
Flagmen are used to signal equipment operatorsworking in confined or congested areas.
Seat belts are worn by driver and all passengersin equipment provided with seat belts.
Elevated fill areas/roads are identified or protected by cones, berms and/or guard rails.
All Vehicles are clearly identified as Project vehicles and have Project ID Numbersdisplayed.
Refueling maintenance activities are performed away from haulage road traffic areas.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
10
6 2.0 0.0 0.0%
7 2.0 0.0 0.0%
8 3.0 3.0 100.0%
D Rigging Equipment 1 Approved rigging practices are used. 3.0 3.0 100.0%
2 3.0 3.0 100.0%
3 3.0 3.0 100.0%
4 1.0 1.0 100.0%
5 2.0 2.0 100.0%
6 Cable clamps are installed properly 2.0 2.0 100.0%
EQUIPMENT OPERATIONS(cont'd)
Haulage roads are maintained in good condition.
Dust is controlled to minimize haulage road
hazards.Dust control is implemented effectively whenand where required.
Rigging equipment is maintained and free of damage, excess wear or defect.
All crane and sling hooks are equipped with afunctional safety latch.
Regular inspections of rigging equipment are performed and the equipment is tagged accordingly.
The throat of load hooks are measured periodically to detect change in hook gap.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
10
E Warning Methods
1 2.0 0.0 0.0%
2 n/a 0.0 #VALUE!
3 2.0 0.0 0.0%
F Helicopter Operations
1 n/a 0.0 #VALUE!
2Loose debris is kept clear of the landing area.
n/a 0.0 #VALUE!
3 n/a 0.0 #VALUE!
4 n/a 0.0 #VALUE!
5 n/a 0.0 #VALUE!
6 n/a 0.0 #VALUE!
7 n/a 0.0 #VALUE!
EQUIPMENT OPERATIONS(cont'd)
Reflective triangles are provided for all equipment and vehicles, that operate on roads
either on site or off-site.Reflective triangles are employed to warn of equipment breakdown / accident or road hazards as required.
Flashing lights and/or strobes are used on all slow moving vehicles that operate in the vicinity of large excavation and haulage equipment.
Helicopter landing areas provide required clearance for rotors away from trees, buildings,roadways, utilities, poles and overhead wires.
Required landing pad lighting is provided and operable for night operations.
A wind sock or wind direction indicator is in place and in view of the landing area.
Helicopter safety procedures are posted and communicated to all passengers.
Aviation life-jackets are provided and worn by all passengers when operating over water.
Helicopter inspections are performed regularly by the owner / operator and adequately documented.
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%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
10
G Machine and Equipment Guarding
1 3.0 3.0 100.0%
2 3.0 3.0 100.0%
3 3.0 3.0 100.0%
4 n/o 0.0 #VALUE!
5 3.0 3.0 100.0%
EQUIPMENT OPERATIONS(cont'd)
Guards around pinch points, rotating equipment,shafts, pulleys, belt drives and chain drives areguarded to prevent accidental contact.
Equipment guards are firmly attached and are of a material or design that will prevent contact by hands, clothing, tools or material or any other accidental worker contact.
Where rotating equipment maintenance work is performed, the maintenance is performed withall guards in place. If the guards(s) must beremoved, the equipment is locked out and tagged.
Emergency stop cords are installed on all conveyor belt lines. The emergency stop cordsare functional and tested on a periodic basis.
Employees servicing or working near pinch points or rotating equipment are not wearing loose clothing or any other loose articles.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
10
H Bridge Cranes
1 n/a 0.0 #VALUE!
2 2.0 2.0 100.0%
I Mobile Personnel Lifts
1 Operators are properly trained and certified. 3.0 3.0 100.0%
2 3.0 3.0 100.0%
3 The equipment is operated on level ground. 3.0 3.0 100.0%
4 3.0 3.0 100.0%
5 3.0 3.0 100.0%
6 3.0 3.0 100.0%
J Other 0.0 0.0
TOTAL 123.0 95.0 77.2% 0 0
EQUIPMENT OPERATIONS(cont'd)
Bridge crane operators are properly trained / certified.
Bridge crane controls are locked out when not inuse.
Traveling with the boom extended and/or elevated is prohibited.
All employees working in the lift basket are properly "tied off".
The capacity of the equipment is known by theoperator and are not exceeded.
The equipment is not used to hoist or support equipment or material.
SAFETY AUDIT
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
11 EXCAVATION AND TRENCHING
A 3.0 3.0 100.0%
B Required Excavation permits are utilized. 3.0 3.0 100.0%
C 3.0 3.0 100.0%
DSpoil dirt is at least 6cm (2 FT) from the edge.
3.0 3.0 100.0%
E 3.0 3.0 100.0%
F Proper access and egress provided. 3.0 3.0 100.0%
G 3.0 3.0 100.0%
H 3.0 3.0 100.0%
I. 3.0 3.0 100.0%
J. 3.0 3.0 100.0%
K Other 0.0 0.0
TOTAL 30.0 30.0 100.0% 0 0
A supervisor and a competent person is incharge of excavation and trenching.
Documented daily inspections performed including adverse weather changes.
Correct slope angle is maintained or shoring used where required and approved installationand removal procedures are followed..
Approved barricades are erected at the edge of
all open trenches and excavations as required.Prior to beginning any excavation or trenching,all underground utilities in the work area arelocated.
Fall protection is implemented as required for excavations > 2 meters(6 FT) in depth.
Confined space entry procedure followed whenworking in any excavation in an operating facility or where there could be a presence of toxic / hazardous substances.
SAFETY AUDIT
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
12
A Required access and egress provided. n/a 0.0 #VALUE!
B n/a 0.0 #VALUE!
C 4.0 4.0 100.0%
D n/a 0.0 #VALUE!
E n/a 0.0 #VALUE!
F Bolt-up requirements are met. n/a 0.0 #VALUE!
G Bolt buckets are used to contain bolts. n/a 0.0 #VALUE! H Decking requirements are met. n/a 0.0 #VALUE! I Approved rigging techniques are used. n/a 0.0 #VALUE!
J n/a 0.0 #VALUE!
K n/a 0.0 #VALUE!
L n/a 0.0 #VALUE!
STEEL ERECTION AND FLOOR AND WALL OPENING
Required perimeter cables are used and
approved installation procedures are followed.Floor openings are properly guarded or arecovered with a secured cover and properly labeled as such.
Elevated areas are free of loose excessmaterials and debris that could fall to levelsbelow.
Static lines, catenary lines, etc., installed tofacilitate employee tie-off.
Barricades and signs are posted in the area towarn employees as required.
Employees providing hand signals havereceived hand signal training.
Signals or warnings are provided when loads areraised.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
12
M n/a 0.0 #VALUE!
N n/a 0.0 #VALUE!
O 3.0 3.0 100.0%
P n/a 0.0 #VALUE!
Q Other 0.0 0.0
TOTAL 7.0 7.0 100.0% 0 0
STEEL ERECTION AND FLOOR AND WALL OPENING (cont'd)
All employees are wearing and using required PPE (safety harnesses and lanyards.).
Taglines are used to control movement of all suspended loads.
Floor grating sections are adequately secured against displacement.
A steel erection safety plan has been developed and implemented.
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SAFETY AUDITFIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
13 MATERIAL HANDLING STORAGE
A 2.0 2.0 100.0%
B 2.0 2.0 100.0%
C 2.0 2.0 100.0%
D 3.0 3.0 100.0%
E 3.0 2.0 66.7%
F 2.0 2.0 100.0%
G n/o 0.0 #VALUE!
H 3.0 3.0 100.0%
I 2.0 2.0 100.0%
J Other 0.0 0.0
TOTAL 19.0 18.0 94.7% 0 0
All materials are stacked and stored in anapproved manner.
Aisles, passageways are maintained clean and unobstructed.
Employees have been trained in safe material handling techniques and use safe handling techniques.
Materials are stacked to prevent displacement and falling.
Employees have been trained in the Back Safety Course.
Material handling equipment is used to handle / move material when possible.
Materials handling equipment (mono-rails, A-frames, etc.) is labeled to identify load capacity.
Softeners are used to protect wire and nylonchokers where needed.
Employees use gloves to protect hands whenhandling materials.
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SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
14 SIGNS, SIGNALS, BARRICADES
A 3.0 3.0 100.0%
B Flagmen used where required. 3.0 3.0 100.0%
C 3.0 2.0 66.7%
D 3.0 2.0 66.7%
E A barricade procedure has been established.
1.0 1.0 100.0%
F 3.0 3.0 100.0%
G 3.0 3.0 100.0%
H 3.0 3.0 100.0%
I Other 0.0 0.0
TOTAL 22.0 20.0 90.9% 0 0
Accident prevention signs, symbols, tags areused as required to warn employees where
potential hazards exist.
Barricade methods used to prevent all unauthorized entry.Barricades are used to warn of potential hazards.
Flashing lights or other such method are used towarn equipment and vehicle operators of hazards on or near the roadway.
Signs are clearly posted to advise operators and drivers of speed limits, pedestrians, and hazardous conditions.
Regular surveys are conducted to assureadequate and proper signage is present in all work areas.
SAFETY AUDIT
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FIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
15
A Fire extinguishers are provided as required.
1 2.0 2.0 100.0%
2 3.0 3.0 100.0%
3 3.0 3.0 100.0%
B 3.0 3.0 100.0%
C Extinguishers are identified as required. 2.0 2.0 100.0%
D 3.0 3.0 100.0%
E n/o 0.0 #VALUE!
F 3.0 3.0 100.0%
G n/o 0.0 #VALUE!
FIRE PREVENTION ANDPROTECTION
Located adjacent to each stairway on each floor level.
Where more than 18 liters of flammable or combustible liquids are used. (5.0 gal.)
At least one 9 kg. extinguisher at fuel dispensing areas. (20 lbs.)
Required access to fire extinguishers ismaintained.
Inside storage of flammable liquids does not
exceed 90 liters outside of an approved cabinet.
Inside storage cabinets are labeled as required,and maximum limits (225 liters / cabinet and 3cabinets / area) are not exceeded. (60 gal.)
Materials that react to water are not stored withflammables.
Containers are electrically interconnected (bonded) when flammable liquids are transferred from one container to another.
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FIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
15
H 3.0 3.0 100.0%
I 3.0 3.0 100.0%
JLPG containers are not stored inside buildings.
3.0 3.0 100.0%
K n/a 0.0 #VALUE!
L n/o 0.0 #VALUE!
M 2.0 2.0 100.0%
N Other 0.0 0.0
TOTAL 30.0 30.0 100.0% 0 0
FIRE PREVENTION ANDPROTECTION (cont'd)
Portable storage tanks containing liquid flammables are located at least 6 meters away from buildings. (20 FT.)
NO SMOKING - NO OPEN FLAMES signs are posted where flammable liquids are used or dispensed or stored..
Smoke detectors are provided in sleeping quarters and are tested on a regular basis.
Fire suppression systems are inspected on aregular basis to assure functional availability.
Employees have been trained on how to operatea fire extinguisher.
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%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
16
A Ladders1 Are in good condition. 3.0 2.8 93.3%2 Built and used in an approved manner. n/a 0.0 #VALUE!
3 3.0 3.0 100.0%
4 3.0 3.0 100.0%
5 3.0 3.0 100.0%
6 4.0 4.0 100.0%
7 Fixed ladder landing areas are kept clear. 3.0 3.0 100.0%
8 3.0 3.0 100.0%
B SCAFFOLDS 1 Provided with required access and egress. 3.0 3.0 100.0%
2 3.0 3.0 100.0%
3 1.0 1.0 100.0%
LADDERS, SCAFFOLDS, ANDELEVATED WORK PLATFORMS
Secured in an approved manner and placed at the correct angle.
Exceed the landing area by 1 meter or have agrab rail. (3 FT.)
Are not used where they can be displaced by doors, equipment, etc., unless protected by guards or barricades.
Metal ladders are not used where contact withelectrical energy is possible.
Sections of cable tray or other materials are not used as ladders.
Has a standard guard rail (106 cm top rail, 53cm midrail, and 10cm toe board) whenever
possible.
Scaffold tags are used to identify incompletescaffolds and requirements for safe use.
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FIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
16
4 3.0 3.0 100.0%
5 3.0 3.0 100.0%
6 3.0 3.0 100.0%
7 3.0 3.0 100.0%
8 3.0 3.0 100.0%
9 3.0 3.0 100.0%
10 An approved base is provided. 3.0 2.5 83.3%11 Scaffold boards are secured. 3.0 3.0 100.0%
12 n/o 0.0 #VALUE!
13 3.0 3.0 100.0%
LADDERS, SCAFFOLDS, ANDELEVATED WORK PLATFORMS
(cont'd)Complete decking is provided whenever
possible and is of scaffold grade material.
Employees who erect and dismantle scaffoldsare qualified and competent.
Scaffolds are free of defects and built per specifications.
Overhead protection is provided where there isexposure.
Casters are locked and pinned on mobilescaffolds when in use and no riding allowed.
Outriggers are provided and used or the scaffold is secured to the structure when the height exceeds 4 times the minimum base dimension.
Two-point suspension scaffolds are erected inan approved manner.
Scaffold components are not interchanged between manufacturers / type.
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%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
16
14 3.0 3.0 100.0%
15 3.0 3.0 100.0%
a Approved design. n/o 0.0 #VALUE! b Approved life lines are provided. n/o 0.0 #VALUE! c Approved rope grab lanyards provided. n/o 0.0 #VALUE! d Tie-off fall protection used. 3.0 3.0 100.0%
C
1 3.0 3.0 100.0%
2 A means of tie-off is provided and used. 4.0 4.0 100.0%3 Required access and egress is provided 3.0 3.0 100.0%
4 3.0 3.0 100.0%
a Outriggers provided and used as required. 3.0 3.0 100.0%
LADDERS, SCAFFOLDS, ANDELEVATED WORK PLATFORMS
(cont'd)Rope and / or cable are not used for guardrail
protection.
A competent person inspects all scaffolding on adaily basis and maintains a current and complete record of those inspections.
Elevated work platforms (high-jackers, scissorslifts, JLG's, etc.)
Elevated scaffold platforms are of substantial construction and secured properly.
Elevated work platforms are used in accordancewith manufacturers recommendations.
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*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
16
b Ground controls operational. 3.0 3.0 100.0%c Operators trained and certified. 3.0 3.0 100.0%
d Fall protection provided and used. 4.0 4.0 100.0%
e 3.0 3.0 100.0%
D Other 0.0 0.0
TOTAL 94.0 93.3 99.3% 0 0
LADDERS, SCAFFOLDS, ANDELEVATED WORK PLATFORMS
(cont'd)
Employees maintain both feet on the platform,and do not use equipment as a means of access
/egress, and do not work from guard rails.
SAFETY AUDITFIELD EXECUTION
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* REPEATED DEFICIENCY = -10 MAX POSSIBLE
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FIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
17
A Required access and egress provided. 3.0 3.0 100.0%
B 3.0 3.0 100.0%
C 3.0 3.0 100.0%
D 3.0 3.0 100.0%
E 3.0 3.0 100.0%
F 2.0 2.0 100.0%
G 3.0 3.0 100.0%
H Other N/A 0.0
TOTAL 20.0 20.0 100.0% 0 0
CONCRETE, CONCRETE FORMS,SHORING, MASONRY
All exposed rebar ends protected from exposure,both vertical and horizontal.
Masonry saws are guarded with a semicircular enclosure cover.
All shoring erected to contain and / or support concrete is the required type and approved installation procedures are followed.
Precast and lift slab operations are performed inaccordance with respective standards.
PPE required for these operations is provided and used which would include safety glasses,gloves, proper clothing and foot wear.
All connections on air hoses and pipes aresecured to prevent displacement.
SAFETY AUDITFIELD EXECUTION
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* REPEATED DEFICIENCY = -10 MAX POSSIBLE
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FIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
18 DEMOLITIONA All operations are planned ahead. 3.0 0.0 0.0%B Required access and egress provided. 3.0 0.0 0.0%
C 3.0 0.0 0.0%
D 3.0 0.0 0.0%
E 3.0 0.0 0.0%
F Other 0.0 0.0
TOTAL 15.0 0.0 0.0% 0 0
Material removal (floor holes, skip-pan, chutes,etc.) is conducted in an approved manner.
Any and all asbestos containing material wasremoved prior to demolition.
Structural member removal is conducted in anapproved manner.
SAFETY AUDITFIELD EXECUTION
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* REPEATED DEFICIENCY = -10 MAX POSSIBLE
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FIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
19
A n/a 0.0 #VALUE!
B The blasting procedure is adhered to. n/a 0.0 #VALUE!
C n/a 0.0 #VALUE!
D n/a 0.0 #VALUE!
E n/a 0.0 #VALUE!
F Other 0.0 0.0
TOTAL 0.0 0.0 #DIV/0! 0 0
BLASTING - USE OFEXPLOSIVES
A blasting procedure has been developed and addresses all current blasting activities.
Storage and transport of explosives are done inaccordance with regulatory requirements,manufacturers instruction and the blasting policy and procedures.
An approved method for identifying and safely removing / eliminating "Boot Legs" or unsuccessfully detonated charges has beendeveloped.
Employees handling and using explosives havebeen trained and are certified.
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* REPEATED DEFICIENCY = -10 MAX POSSIBLE
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FIELD EXECUTION
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
20
A n/a 0.0 #VALUE!
B n/a 0.0 #VALUE!
C n/a 0.0 #VALUE!
D n/a 0.0 #VALUE!
EOperators are trained annually at a minimum.
n/a 0.0 #VALUE!
F n/a 0.0 #VALUE!
G n/a 0.0 #VALUE!
H n/a 0.0 #VALUE!
I n/a 0.0 #VALUE!
HIGH-PRESSURE WATERCLEANING
Operators are wearing rain suits, gloves, faceshields, hard hats, safety glasses with sideshields, rubber steel toe boots or metatarsal guards.
Standby Operator(s) is wearing hard-hat and safety glasses with side shields.
Operators are not allowing any part of their body to be placed in front of the water jet.
Operators are not handling hose within one foot of hose-to-hose connections.
Hose data such as manufacturer's symbol, serial
number, working and test pressure, and certified rating which will provided a safety factor of 3 to 1against burst is recorded and retained at the
project.
Work area is barricaded at a minimum of 4.5 meters and signs stating, "DANGER - HIGH PRESSURE WATER CLEANING." (15 FT.)
Equipment to be cleaned is dismantled / isolated, locked and tagged as required.
All fittings and components meet manufacturer'sguidelines.
SAFETY AUDITFIELD EXECUTION
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* REPEATED DEFICIENCY = -10 MAX POSSIBLE
69 04/18/201032564844.xls
SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
20
J n/a 0.0 #VALUE!
K n/a 0.0 #VALUE!
L n/a 0.0 #VALUE!
M n/a 0.0 #VALUE!
N Other 0.0 0.0
TOTAL 0.0 0.0 #DIV/0! 0 0
HIGH-PRESSURE WATERCLEANING (cont'd)
Records of high-pressure water cleaning equipment inspection are on file.
Lance or mole marker 60 cm (24 in.) fromnozzle end.
Shotguns have a 2 meter (6 FT.) shroud and area minimum of 165 cm (66 in.) in length.
Safety equipment has not been altered or by- passed.
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* REPEATED DEFICIENCY = -10 MAX POSSIBLE
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SCORE PENALTYASSESSED ASSESSORS COMMENTSMAXIMUMPOSSIBLE
%0 - 100
*REPEATED
DEFICIENCIES(X)
**IMMINENTDANGER
(X)
21 CONFINED SPACES
A 2.0 2.0 100.0%
B 3.0 3.0 100.0%
C 3.0 3.0 100.0%
D 3.0 3.0 100.0%
E 3.0 3.0 100.0%
F 3.0 3.0 100.0%
G 2.0 2.0 100.0%
H 3.0 3.0 100.0%
I Other 0.0 0.0
TOTAL 22.0 22.0 100.0% 0 0
A confined space entry procedure, which meetsrequirements, is in place .
Lighting and electrical tools used inside confined spaces are 12 volt or GFCI protected.
Required emergency equipment is available (i.e.body harness, S.C.B.A., fire extinguisher, etc.)
Stand-by ("Hole Watch") person(s) are utilized and are trained in confined space proceduresand their responsibilities.
Air sampling performed, checking % 02 and %L.E.L, at a minimum.
Energy isolation / lock-out is implemented relative to confined space work.
Entry permits, which meets requirements areused, and sign-off for responsible parties is
provided and adhered to.
Winch / Hoisting equipment is immediately available to hoist personnel out of confined spaces if emergency situation requires.
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