Field Safety Audit Form – Nitrogen Services Compliance Management System

Nitrogen Services Field Safety Audit

General Information

Date *

Time *

Division *

Sub-Contractor

Safety Auditor

Superintendent *

Project Number *

Area Reviewed *

Weather *

Conditions *

Toolbox Conducted *

Yes

Toolbox Topic *

Safety Auditor (E-mail) *

Superintendent (E-mial) *

Safety Lead

Safety Lead (E-mail)

Personal Protective Equipment

001 Hard Hats *

002 Eye Face *

003 Respirators *

004 Hearing *

005 Hand *

006 Foot *

007 FRC *

008 H V Vests *

Material Handling - Manual

009 Technique *

010 Tools *

Material Handling - Equipment

011 Inspections *

012 Equipment *

Material Handling - Use

013 SDS *

014 PPE *

Material Handling - Storage

015 Flammables *

016 Combustibles *

Job Safety Analyses

017 Completed *

018 Signed *

Hand/Power Tools

019 Condition *

020 Guarded *

Electrical

021 Grounding *

022 Aux Generator *

Scaffolds - Ladders

023 Inspections *

024 Use *

Working at Heights

025 FA Systems *

026 FA Inspection *

Hot Work

027 Permit *

028 Fire Watch *

Pressure Testing

029 Whip Check *

030 Barricades *

Signs and Barricades

031 Installed *

032 Condition *

Walking Surfaces

033 Holes Guarded *

034 Surfaces *

Hygiene

035 Rest Rooms *

036 Pot Water *

Traffic Control

037 Flaggers *

038 Signage *

Confined Spaces

039 Permitted *

040 Rescue Plan *

Excavations

041 Insp Report *

042 Access Egress *

Lockout Tag out

043 Program *

044 Knowledge *

Haz. Communication

045 SDS *

046 Knowledge *

Fire Protection

047 Smoking *

048 Housekeeping *

Welding Operations

049 PPE *

050 Cylinders *

051 Leads *

052 Fire Protection *

Drilling/Boring

053 JSA *

054 PPE *

Radiation

055 JSA *

056 PPE *

Attachments

Maximum file size: 516MB

Documents, pictures, drawings, etc.

Non-Compliance and Actions Taken *

0 of 150 max words

Include Line Number and Brief Description of Observation

Overview of Incidents During The Day *

0 of 150 max words

Simply Add N/A for No Incidents

Signature

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