Facility/Wellsite Inspection
Use for HSE only
Your Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Time of Observation
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
What Inspection are you doing?
*
Facility Inspection
Wellsite Inspection
Surface Location
*
Downhole Location (if applicable)
Division
*
HSE
Chauvin
HSE Area
*
AB - HSE
SK - HSE
Chauvin Area
*
Chauvin - Maintenance
Chauvin - Midstream
Chauvin - Operations
Core North Chauvin Run #00
Core North Chauvin Run #01
Core North Chauvin Run #02
Core South Chauvin Run #10
Core South Chauvin Run #11
Core South Chauvin Run #12
Core South Chauvin Run #13
Czar Operations
Edgerton Operations
Lead Operator
*
First Name
Last Name
Optional Comments
Optional Pictures
Browse Files
Cancel
of
Wellsite
Lease/Site Condition
Lease Road - surface/ditch in good condition; guards/gates in good condition; no standing water?
*
Satisfactory
Unsatisfactory
N/A
Lease Road Comments
Lease Road Picture
Browse Files
Cancel
of
Signage/Warning Signage - in place/legible, not faded; contains correct information (emergency phone #, location, correct UN #) (lease sign, start/stop sign)?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Vegetation - weeds sprayed/mowed; no sign of noxious weeds present; flare stack area clear?
*
Satisfactory
Unsatisfactory
N/A
Vegetation Comments
Vegetation Picture
Browse Files
Cancel
of
Soil Staining - lease clear of staining (chemical or production fluids); no offsite staining; no evidence of previous spills?
*
Satisfactory
Unsatisfactory
N/A
Soil Staining Comments
Soil Staining Picture
Browse Files
Cancel
of
Housekeeping - excessive number of drums (or 3 full drums stored without containment), scrap not present; equipment properly stored?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Wind Indication - flag/sock in good condition; moves with wind direction change and not obstructed by buildings or tanks (only required for sour wells)?
*
Satisfactory
Unsatisfactory
N/A
Wind Indication Comments
Wind Indication Picture
Browse Files
Cancel
of
Inspection Comments
Inspection Picture
Browse Files
Cancel
of
Facility
Office
Roadblock Kit - are all contents accounted for?
*
Satisfactory
Unsatisfactory
N/A
Roadblock Kit Comments
Facility Roadblock Kit Picture
Browse Files
Cancel
of
Respiratory Protection - inspected and ready for use?
*
Satisfactory
Unsatisfactory
N/A
Respiratory Protection Comments
Respiratory Protection Picture
Browse Files
Cancel
of
First Aid Kit - In place, functional, accessible and not expired?
*
Satisfactory
Unsatisfactory
N/A
First Aid Kit Comments
First Aid Kit Picture
Browse Files
Cancel
of
AED - In place, functional, accessible and not expired?
*
Satisfactory
Unsatisfactory
N/A
AED Kit Comments
AED Kit Picture
Browse Files
Cancel
of
Smoke/CO Detector - In place, functional, when were the batteries changed last?
*
Satisfactory
Unsatisfactory
N/A
Smoke/CO Detector Comments
Smoke/CO Detector Picture
Browse Files
Cancel
of
Eyewash - In place, functional, accessible and not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Comments
Eyewash Picture
Browse Files
Cancel
of
Door Condition - is door in good condition and can be locked to prevent theft?
*
Satisfactory
Unsatisfactory
N/A
Door Condition Comments
Door Condition Picture
Browse Files
Cancel
of
General Facility
Facility Lease Road - surface/ditch in good condition; guards/gates in good condition, no standing water?
*
Satisfactory
Unsatisfactory
N/A
Lease Road Comments
Lease Road Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and has correct information (emergency number, location, correct UN #)?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Vegetation - weeds sprayed/mowed; flare stack area clear of vegetation?
*
Satisfactory
Unsatisfactory
N/A
Vegetation Comments
Vegetation Picture
Browse Files
Cancel
of
Staining - lease clear of staining?
*
Satisfactory
Unsatisfactory
N/A
Staining Comments
Staining Picture
Browse Files
Cancel
of
Offsite Contamination/Odors - no sign of strained or stressed vegetation?
*
Satisfactory
Unsatisfactory
N/A
Offsite Contamination Comments
Offsite Contamination Picture
Browse Files
Cancel
of
Powerlines - marked for caution?
*
Satisfactory
Unsatisfactory
N/A
Powerlines Comments
Powerline Picture
Browse Files
Cancel
of
Barriers/Flagging - barriers installed where necessary; guy wires/rig anchors are flagged?
*
Satisfactory
Unsatisfactory
N/A
Barriers/Flagging Comments
Barriers/Flagging Picture
Browse Files
Cancel
of
Wind Indicators - windsock in good condition; moves with the wind direction, not obstructed?
*
Satisfactory
Unsatisfactory
N/A
Wind Indicator Comments
Wind Indicator Picture
Browse Files
Cancel
of
GHS - lines, tanks and vessels labelled for direction and contents?
*
Satisfactory
Unsatisfactory
N/A
GHS Comments
GHS Picture
Browse Files
Cancel
of
Portable Ladders - in good condition and stored properly?
*
Satisfactory
Unsatisfactory
N/A
Portable Ladders Comments
Portable Ladders Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
MCC
Housekeeping?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Combustibles - no combustibles stored in MCC?
*
Satisfactory
Unsatisfactory
N/A
Combustibles Comments
Combustibles Picture
Browse Files
Cancel
of
Breakers - are there breakers that are not in service and have not been locked and tagged out?
*
Satisfactory
Unsatisfactory
N/A
Breakers Comments
Breakers Picture
Browse Files
Cancel
of
Flare/Incinerator
Flare/Incinerator - in good condition; flame arrestor in good shape and in place?
*
Satisfactory
Unsatisfactory
N/A
Flare/Incinerator Comments
Flare/Incinerator Picture
Browse Files
Cancel
of
Knockout - flare knockout maintained empty?
*
Satisfactory
Unsatisfactory
N/A
Knockout Comments
Knockout Picture
Browse Files
Cancel
of
Ignitor - auto ignitor operational?
*
Satisfactory
Unsatisfactory
N/A
Ignitor - is the flare lit and functioning?
*
Satisfactory
Unsatisfactory
N/A
Ignitor Comments
Ignitor Picture
Browse Files
Cancel
of
Tank Farm
Tanks - in good condition; not in service tanks marked "Out of Service"?
*
Satisfactory
Unsatisfactory
N/A
Tanks Comments
Tanks Picture
Browse Files
Cancel
of
Gauge Boards - operational and legible?
*
Satisfactory
Unsatisfactory
N/A
Gauge Boards Comments
Gauge Boards Picture
Browse Files
Cancel
of
Burners - all bolts in place; flame arrestor in place and in good condition?
*
Satisfactory
Unsatisfactory
N/A
Burners Comments
Burners Picture
Browse Files
Cancel
of
Thief Hatches - in proper position (open or removed) closed if VU system is functional?
*
Satisfactory
Unsatisfactory
N/A
Thief Hatches Comments
Thief Hatches Picture
Browse Files
Cancel
of
Load Lines - transfer points have load box drip trays; camlock caps installed; ground cable?
*
Satisfactory
Unsatisfactory
N/A
Load Lines Comments
Load Lines Picture
Browse Files
Cancel
of
Signage - in place, legible and not faded (correct information and warning signs)?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Barrel Dock
Barrels - all marked for content?
*
Satisfactory
Unsatisfactory
N/A
Barrels - are there a collection of containers with an aggregate volume greater than 1m3 (e.g. approximately five 45 gallon drums) on site that require secondary containment and weather protection?
*
Satisfactory
Unsatisfactory
N/A
Barrels Comments
Barrels Picture
Browse Files
Cancel
of
Fluids - empty of free fluids?
*
Satisfactory
Unsatisfactory
N/A
Fluids Comments
Fluids Picture
Browse Files
Cancel
of
Building Inspection
Buildings
*
Injection Building
Compressor Building
Treater Building
FWKO Building
Inlet Building
Cut Shack
Sales Oil Pump Building
Other
Injection Building Button
Injection Building
Doors - open freely; panic hardware in place and functional?
*
Satisfactory
Unsatisfactory
N/A
Doors Comments
Doors Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and contains the correct information?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Housekeeping - are plugs and caps installed?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Grounding/Bonding - pails/tanks grounded?
*
Satisfactory
Unsatisfactory
N/A
Grounding/Bonding Comments
Grounding/Bonding Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks - are product identifier labels on discharge lines from the chemical pump?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks - is the top inspection in place on the chemical pump?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
Shutdowns - have annual function test been completed (fire, gas, high level, low level)?
*
Satisfactory
Unsatisfactory
N/A
Shutdowns Comments
Shutdowns Picture
Browse Files
Cancel
of
Lighting - is the lighting adequate; intrinsically safe?
*
Satisfactory
Unsatisfactory
N/A
Lighting Comments
Lighting Picture
Browse Files
Cancel
of
Catadyne Heaters - guards in place; liquids not present; shutoff regulator functional (not tied down)?
*
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters Comments
Catadyne Heaters Picture
Browse Files
Cancel
of
Fire Fighting Equipment - hung up/stored properly; protected from the elements; inspected monthly/serviced annually?
*
Satisfactory
Unsatisfactory
N/A
Fire Fighting Equipment Comments
Fire Fighting Equipment Picture
Browse Files
Cancel
of
Hearing Protection - signage in place and in good condition?
*
Satisfactory
Unsatisfactory
N/A
Hearing Protection Comments
Hearing Protection Picture
Browse Files
Cancel
of
Eyewash Bottle - in place and functional; contents not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Bottle Comments
Eyewash Bottle Picture
Browse Files
Cancel
of
ESD - accessible, protected from accidental engagement?
*
Satisfactory
Unsatisfactory
N/A
ESD Comments
ESD Picture
Browse Files
Cancel
of
Compressor Building Button
Compressor Building
Doors - open freely; panic hardware in place and functional?
*
Satisfactory
Unsatisfactory
N/A
Doors Comments
Doors Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and contains the correct information?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Housekeeping - are plugs and caps installed?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Grounding/Bonding - pails/tanks grounded?
*
Satisfactory
Unsatisfactory
N/A
Grounding/Bonding Comments
Grounding/Bonding Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
Shutdowns - annual function test (fire, gas, high level, low level)?
*
Satisfactory
Unsatisfactory
N/A
Shutdowns Comments
Shutdowns Picture
Browse Files
Cancel
of
Lighting - is the lighting adequate; intrinsically safe?
*
Satisfactory
Unsatisfactory
N/A
Lighting Comments
Lighting Picture
Browse Files
Cancel
of
Catadyne Heaters - guards in place; liquids not present; shutoff regulator functional (not tied down)?
*
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters Comments
Catadyne Heaters Picture
Browse Files
Cancel
of
Fire Fighting Equipment - hung up/stored properly; protected from the elements; inspected monthly/serviced annually?
*
Satisfactory
Unsatisfactory
N/A
Fire Fighting Equipment Comments
Fire Fighting Equipment Picture
Browse Files
Cancel
of
Hearing Protection - signage in place?
*
Satisfactory
Unsatisfactory
N/A
Hearing Protection Comments
Hearing Protection Picture
Browse Files
Cancel
of
Eyewash Bottle - in place and functional; contents not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Bottle Comments
Eyewash Bottle Picture
Browse Files
Cancel
of
ESD - accessible, protected from accidental engagement?
*
Satisfactory
Unsatisfactory
N/A
ESD Comments
ESD Picture
Browse Files
Cancel
of
Crane - inspected annually?
*
Satisfactory
Unsatisfactory
N/A
Crane Comments
Crane Picture
Browse Files
Cancel
of
Treater Building Button
Treater Building
Doors - open freely; panic hardware in place and functional?
*
Satisfactory
Unsatisfactory
N/A
Doors Comments
Doors Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and contains the correct information?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Housekeeping - are plugs and caps installed?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Grounding/Bonding - pails/tanks grounded?
*
Satisfactory
Unsatisfactory
N/A
Grounding/Bonding Comments
Grounding/Bonding Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
Shutdowns - annual function test (fire, gas, high level, low level)?
*
Satisfactory
Unsatisfactory
N/A
Shutdowns Comments
Shutdowns Picture
Browse Files
Cancel
of
Lighting - is the lighting adequate; intrinsically safe?
*
Satisfactory
Unsatisfactory
N/A
Lighting Comments
Lighting Picture
Browse Files
Cancel
of
Catadyne Heaters - guards in place; liquids not present; shutoff regulator functional (not tied down)?
*
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters Comments
Catadyne Heaters Picture
Browse Files
Cancel
of
Fire Fighting Equipment - hung up/stored properly; protected from the elements; inspected monthly/serviced annually?
*
Satisfactory
Unsatisfactory
N/A
Fire Fighting Equipment Comments
Fire Fighting Equipment Picture
Browse Files
Cancel
of
Hearing Protection - signage in place?
*
Satisfactory
Unsatisfactory
N/A
Hearing Protection Comments
Hearing Protection Picture
Browse Files
Cancel
of
Eyewash Bottle - in place and functional; contents not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Bottle Comments
Eyewash Bottle Picture
Browse Files
Cancel
of
ESD - accessible, protected from accidental engagement?
*
Satisfactory
Unsatisfactory
N/A
ESD Comments
ESD Picture
Browse Files
Cancel
of
Treaters/Line Heaters/FWKO - all bolts in place; flame arrestor in place and in good condition?
*
Satisfactory
Unsatisfactory
N/A
Treaters/Line Heaters/FWKO Comments
Treaters/Line Heaters/FWKO Picture
Browse Files
Cancel
of
FWKO Building Button
FWKO Building
Doors - open freely; panic hardware in place and functional?
*
Satisfactory
Unsatisfactory
N/A
Doors Comments
Doors Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and contains the correct information?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Housekeeping - are plugs and caps installed?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Grounding/Bonding - pails/tanks grounded?
*
Satisfactory
Unsatisfactory
N/A
Grounding/Bonding Comments
Grounding/Bonding Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
Shutdowns - annual function test (fire, gas, high level, low level)?
*
Satisfactory
Unsatisfactory
N/A
Shutdowns Comments
Shutdowns Picture
Browse Files
Cancel
of
Lighting - is the lighting adequate; intrinsically safe?
*
Satisfactory
Unsatisfactory
N/A
Lighting Comments
Lighting Picture
Browse Files
Cancel
of
Catadyne Heaters - guards in place; liquids not present; shutoff regulator functional (not tied down)?
*
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters Comments
Catadyne Heaters Picture
Browse Files
Cancel
of
Fire Fighting Equipment - hung up/stored properly; protected from the elements; inspected monthly/serviced annually?
*
Satisfactory
Unsatisfactory
N/A
Fire Fighting Equipment Comments
Fire Fighting Equipment Picture
Browse Files
Cancel
of
Hearing Protection - signage in place?
*
Satisfactory
Unsatisfactory
N/A
Hearing Protection Comments
Hearing Protection Picture
Browse Files
Cancel
of
Eyewash Bottle - in place and functional; contents not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Bottle Comments
Eyewash Bottle Picture
Browse Files
Cancel
of
ESD - accessible, protected from accidental engagement?
*
Satisfactory
Unsatisfactory
N/A
ESD Comments
ESD Picture
Browse Files
Cancel
of
Treaters/Line Heaters/FWKO - all bolts in place; flame arrestor in place and in good condition?
*
Satisfactory
Unsatisfactory
N/A
Treaters/Line Heaters/FWKO Comments
Treaters/Line Heaters/FWKO Picture
Browse Files
Cancel
of
Inlet Building Button
Inlet Building
Doors - open freely; panic hardware in place and functional?
*
Satisfactory
Unsatisfactory
N/A
Doors Comments
Doors Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and contains the correct information?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Housekeeping - are plugs and caps installed?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Grounding/Bonding - pails/tanks grounded?
*
Satisfactory
Unsatisfactory
N/A
Grounding/Bonding Comments
Grounding/Bonding Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
Shutdowns - annual function test (fire, gas, high level, low level)?
*
Satisfactory
Unsatisfactory
N/A
Shutdowns Comments
Shutdowns Picture
Browse Files
Cancel
of
Lighting - is the lighting adequate; intrinsically safe?
*
Satisfactory
Unsatisfactory
N/A
Lighting Comments
Lighting Picture
Browse Files
Cancel
of
Catadyne Heaters - guards in place; liquids not present; shutoff regulator functional (not tied down)?
*
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters Comments
Catadyne Heaters Picture
Browse Files
Cancel
of
Fire Fighting Equipment - hung up/stored properly; protected from the elements; inspected monthly/serviced annually?
*
Satisfactory
Unsatisfactory
N/A
Fire Fighting Equipment Comments
Fire Fighting Equipment Picture
Browse Files
Cancel
of
Hearing Protection - signage in place?
*
Satisfactory
Unsatisfactory
N/A
Hearing Protection Comments
Hearing Protection Picture
Browse Files
Cancel
of
Eyewash Bottle - in place and functional; contents not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Bottle Comments
Eyewash Bottle Picture
Browse Files
Cancel
of
ESD - accessible, protected from accidental engagement?
*
Satisfactory
Unsatisfactory
N/A
ESD Comments
ESD Picture
Browse Files
Cancel
of
Sales Oil Pump Building Button
Sales Oil Pump Building
Doors - open freely; panic hardware in place and functional?
*
Satisfactory
Unsatisfactory
N/A
Doors Comments
Doors Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and contains the correct information?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Housekeeping - are plugs and caps installed?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Grounding/Bonding - pails/tanks grounded?
*
Satisfactory
Unsatisfactory
N/A
Grounding/Bonding Comments
Grounding/Bonding Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
Shutdowns - annual function test (fire, gas, high level, low level)?
*
Satisfactory
Unsatisfactory
N/A
Shutdowns Comments
Shutdowns Picture
Browse Files
Cancel
of
Lighting - is the lighting adequate; intrinsically safe?
*
Satisfactory
Unsatisfactory
N/A
Lighting Comments
Lighting Picture
Browse Files
Cancel
of
Catadyne Heaters - guards in place; liquids not present; shutoff regulator functional (not tied down)?
*
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters Comments
Catadyne Heaters Picture
Browse Files
Cancel
of
Fire Fighting Equipment - hung up/stored properly; protected from the elements; inspected monthly/serviced annually?
*
Satisfactory
Unsatisfactory
N/A
Fire Fighting Equipment Comments
Fire Fighting Equipment Picture
Browse Files
Cancel
of
Hearing Protection - signage in place?
*
Satisfactory
Unsatisfactory
N/A
Hearing Protection Comments
Hearing Protection Picture
Browse Files
Cancel
of
Eyewash Bottle - in place and functional; contents not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Bottle Comments
Eyewash Bottle Picture
Browse Files
Cancel
of
ESD - accessible, protected from accidental engagement?
*
Satisfactory
Unsatisfactory
N/A
ESD Comments
ESD Picture
Browse Files
Cancel
of
Cut Shack Button
Cut Shack
Doors - open freely; panic hardware in place and functional?
*
Satisfactory
Unsatisfactory
N/A
Doors Comments
Doors Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and contains the correct information?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Housekeeping - are plugs and caps installed?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Grounding/Bonding - pails/tanks grounded?
*
Satisfactory
Unsatisfactory
N/A
Grounding/Bonding Comments
Grounding/Bonding Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
Shutdowns - annual function test (fire, gas, high level, low level)?
*
Satisfactory
Unsatisfactory
N/A
Shutdowns Comments
Shutdowns Picture
Browse Files
Cancel
of
Lighting - is the lighting adequate; intrinsically safe?
*
Satisfactory
Unsatisfactory
N/A
Lighting Comments
Lighting Picture
Browse Files
Cancel
of
Catadyne Heaters - guards in place; liquids not present; shutoff regulator functional (not tied down)?
*
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters Comments
Catadyne Heaters Picture
Browse Files
Cancel
of
Fire Fighting Equipment - hung up/stored properly; protected from the elements; inspected monthly/serviced annually?
*
Satisfactory
Unsatisfactory
N/A
Fire Fighting Equipment Comments
Fire Fighting Equipment Picture
Browse Files
Cancel
of
Hearing Protection - signage in place?
*
Satisfactory
Unsatisfactory
N/A
Hearing Protection Comments
Hearing Protection Picture
Browse Files
Cancel
of
Eyewash Bottle - in place and functional; contents not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Bottle Comments
Eyewash Bottle Picture
Browse Files
Cancel
of
ESD - accessible, protected from accidental engagement?
*
Satisfactory
Unsatisfactory
N/A
ESD Comments
ESD Picture
Browse Files
Cancel
of
Other Building Button
Other Building
Building Type
*
Doors - open freely; panic hardware in place and functional?
*
Satisfactory
Unsatisfactory
N/A
Doors Comments
Doors Picture
Browse Files
Cancel
of
Signage - in place and legible, not faded and contains the correct information?
*
Satisfactory
Unsatisfactory
N/A
Signage Comments
Signage Picture
Browse Files
Cancel
of
Housekeeping - are plugs and caps installed?
*
Satisfactory
Unsatisfactory
N/A
Housekeeping Comments
Housekeeping Picture
Browse Files
Cancel
of
Grounding/Bonding - pails/tanks grounded?
*
Satisfactory
Unsatisfactory
N/A
Grounding/Bonding Comments
Grounding/Bonding Picture
Browse Files
Cancel
of
Chemical Tanks - have secondary containment, GHS product label; site glasses protected from breakage; level indication is visible; upstream isolation valve installed?
*
Satisfactory
Unsatisfactory
N/A
Chemical Tanks Comments
Chemical Tanks Picture
Browse Files
Cancel
of
Shutdowns - annual function test (fire, gas, high level, low level)?
*
Satisfactory
Unsatisfactory
N/A
Shutdowns Comments
Shutdowns Picture
Browse Files
Cancel
of
Lighting - is the lighting adequate; intrinsically safe?
*
Satisfactory
Unsatisfactory
N/A
Lighting Comments
Lighting Picture
Browse Files
Cancel
of
Catadyne Heaters - guards in place; liquids not present; shutoff regulator functional (not tied down)?
*
Satisfactory
Unsatisfactory
N/A
Catadyne Heaters Comments
Catadyne Heaters Picture
Browse Files
Cancel
of
Fire Fighting Equipment - hung up/stored properly; protected from the elements; inspected monthly/serviced annually?
*
Satisfactory
Unsatisfactory
N/A
Fire Fighting Equipment Comments
Fire Fighting Equipment Picture
Browse Files
Cancel
of
Hearing Protection - signage in place?
*
Satisfactory
Unsatisfactory
N/A
Hearing Protection Comments
Hearing Protection Picture
Browse Files
Cancel
of
Eyewash Bottle - in place and functional; contents not expired?
*
Satisfactory
Unsatisfactory
N/A
Eyewash Bottle Comments
Eyewash Bottle Picture
Browse Files
Cancel
of
ESD - accessible, protected from accidental engagement?
*
Satisfactory
Unsatisfactory
N/A
ESD Comments
ESD Picture
Browse Files
Cancel
of
Submit Button
Additional Comments
Submit
Should be Empty: