Facility HSE Assessment
ASE Safety Management System
Date
-
Month
-
Day
Year
Date
Assessor
First Name
Last Name
Email
example@example.com
Facility Name/s
Supervisor on Duty
Name
Supervisor Email
Email Address
Type of Assessment
Scheduled Safety Assessment
Walk Through
Progress
Draft Assessment
Closed Assessment
Section 1
1. Road surface damage excessive or could cause damage to vehicles
2. Visitor tracking system not in proper order
3. Litter present along lease road or entrance to location
4. Signage not adequate at entrance to location
5. Emergency Action Plan in place as per 29 CFR 1910.38
6. Site Specific Safety Plan/Emergency Evacuation plan not posted as required
7. Emergency phone numbers not listed
8. Map/station bill not posted
9. Right to know center (Safety Data Sheets) not in proper order
10. First aid supplies not available or not adequate
11. AED not present or not adequate
12. Alarm system not adequate
13. OSHA posters not posted
14. Visitor tracking system not in proper order
15. Traffic control not in proper order
16. Parking not adequate
17. Access to offices or trailers not in proper order
18. Designated smoking area not present or not adequate
19. Muster area not in proper order
20. Wind indicator in disrepair or not present
21. PPE not in proper order
22. PPE not used as required
23. Long hair or loose clothing is not contained
24. Safety equipment/devices not adequate
25. Fire Extinguishers and detectors not in proper order
26. Eye wash station not adequate
27. Restroom facilities not sanitary or adequate
28. Workers observed at height without proper fall protection
29. Crew members have not attended Arrow S Energy Operating Safety Orientation
30. Drills are not conducted as required
31. Various safety meetings are not conducted as required
32. SIMOPS Management Plan not posted as require
33. Job Safety Analysis (JSA’s) not conducted
34. Hot work being conducted in unsafe manner
35. Flammable liquid storage not in proper order
36. Fire fighting equipment not adequate
37. Drinking water not readily available
38. Gate in poor condition if applicable
39. Cattle guard in poor condition
40. Poor housekeeping
41. Presence of or condition of rental/ third-party equipment on location
42. Fencing not adequate or in poor condition
43. Wildlife hazard present on location
44. Hazard/Caution signs/placards not present or in poor condition
45. Open pit(s) on location
46. Pit(s) not adequately backfilled and/or reclaimed
47. Barrier not present around open pit
48. Cellar not filled in or barricaded
49. Leaks on location
50. Liquid/chemicals not labeled
51. Facility Piping not adequate
52. Electrical or grounding components not adequate
53. Spills present on location
54. Spill kits/containment not adequate
55. Hydraulic line placement
56. High pressure areas flagged or taped
57. Facility lighting not adequate
58. Stairways, walkways, toe-boards, guardrails and ladders not in proper order
59. Walking and working surface not in proper order
60. Fuel storage not in proper order
61. Fuel storage containment not in proper order
62. Fuel storage electrical or grounding not in proper order
63. Fuel dispense equipment not in proper order
64. General housekeeping poor at fuel storage area
65. Compressed gas storage not in proper order
66. Oil storage not in proper order
67. Oil containment not in proper order
68. Chemical storage are not in proper order
69. Bulk liquid or other tanks is not in proper order
70. Bulk liquid or other tanks not properly grounded
71. Fluid leak/s or spill present at bulk storage or chemical storage area
72. Stairways, guardrails, handrails and ladders on bulk storage not in proper order
73. High pressure systems not in proper order
74. Electrical or grounding not in proper order at storage areas
75. Lighting in bulk storage areas not in proper order
76. Labeling or signage at storage areas not in proper order
77. Walking or working surface at bulk storage area not in proper order
78. General housekeeping not in proper order at bulk or chemical storage areas
79. Powered vehicle/s not in proper order
80. Powered vehicle/s left unattended while running
81. Powered vehicle operator/s training not adequate
82. Powered vehicle/s fire extinguisher not adequate
83. Powered vehicle/s electrical not in proper order
84. Powered vehicle/s signage and/or labeling not adequate
85. General housekeeping not adequate at powered vehicles
86. Tank/equipment signage not adequate
87. Facility office not adequate
88. Vegetation overgrowth
89. Corrosion on facility
Other
Section 1. Number of Deficiencies Noted
Section 1. Notes/Deficiencies
Section 1. Photo
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