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Lumiform

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Pipeline Construction Safety Audit

Rated 4.8/5 stars on Capterra

Say goodbye to paper checklists!

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  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates
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Register for free on lumiformapp.com and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 4.8/5 stars on Capterra
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Pipeline Construction Safety Audit

JSA/JHA

Performed

Appropriate for Task/Task Covered

Reviewed

Signed

Environmental/Emergency Response

Emergency Action Plan

Spill Response Kit

Certified Responders

First-Aid Kit

Hazardous Communication

MSDS Available

MSDS Reviewed

Containers Labeled Properly

Handling Procedures Followed

Language/Bilingual MSDS Available

Hygiene

Restrooms

Potable Water Available

Adequate Drinking Water for Employee Hydration

Washing Facilities

PPE

Hard Hat

Eye/Face

Hand

Hearing

Footwear

Hi-Vis Vest

Respirator

Respiratory Program in Place (MEQ, Fit Test, Training, etc...)

FRC

Monitors Available, In Use, Calibrated (4-Gas, H2S or Other)

Other:

Material Handling

Body Mechanics

Manual Lifting Devices (Come-a-Longs, Chain falls, etc…)

Safety Latch

Slings

Hooks & Shackles

Wire Rope

Lifting Chains

Load Secure, Rigged Properly

Tag Lines Used

Other:

Vehicle/Equipment/Crane

Authorized/Qualified Operator

Designated Signal Person

Seatbelt Used

Backup Alarm

Hand Signal Chart

Daily/Weekly/Annual Inspection

Inspection Completed Properly

Other:

Material Storage

Material Stored Properly

Flammable/Combustible Storage

Pipe Chocked

Other:

Fall Prevention/Protection

Access/Egress

Fall Protection

Fall Protection Inspected

Scaffolds/Ladders - Proper Type

Scaffolds/Ladders - Inspected

Scaffolds/Ladders - Use

Handrails

Hand Tools

Condition

Guards/Handles

Proper for Job/Use

Electrical

GFCI/Assured Grounding Program

Cords/Tools – Inspected

Hot Work

Permit

Permit Conditions Followed

Fire Watch

Gas Cylinder Management

Leads/Hoses/Gauges

Other:

Fire Protection & Prevention

Fire Suppression Equipment

Annual/Monthly Fire Extinguisher Inspection

Properly Rated/Size (BC versus ABC)

Combustible/Flammable Material Away from Hot Work

Excavation

Excavation Type:

Documented Inspection by Competent Person

Sloped Properly

Benched Properly

Trench Box/Shoring Proper

Trench Box Certifications

Access/Egress Points

Spoil Pile Minimum 2-Feet From Excavation

Signs, Signals & Barricades

One Call Made

Utilities Identified

Signs/Barricades

Condition

Proper Type

Marking Hazards

Housekeeping

Dunnage

Trash

Trash Receptacles

Crew Trucks/Trailers

Walking Surfaces

Holes Guarded

Pathways

Trip Hazards

Traffic Control

Designated Flagger

Signs Posted per MUTCD

Escort Required/Used

Overhead Power Lines

Power Lines Marked with Goal Post and Signs

Designated Spotter

Proper Equipment for Spotter (Air Horn, Vest, etc…)

Radiation Sources

Type:

Signs, Signals & Barricades

Film Badges for X-Ray Crew

Pressure Testing

Equipment Integrity

Whip Checks/Connections Pinned

Signs, Signals & Barricades

Abrasive Blasting

Trap and Carbon Filter Installed

CO Alarm in use

Dead-Man Switch Operable

Proper PPE

Lock-Out/Tag-Out

Potential Energy Sources Identified

Isolated

Type of Isolation:

Verified

Affected Personnel Informed

Confined Space

Permitted

Personnel Trained

Emergency Rescue Plan

Rescue/Retrieval Equipment (Anklets, Harness, Life Line, etc...…)