HSE Inspection Plan

ABB Lummus Global Inc.
FORM LGH SFOR - 6407-02.001
SAFETY PROGRAM AUDIT

CONTRACTOR NAME: AUDIT DATE:
CONSTRUCTION MANAGER: AUDITOR(S):
FINAL SCORE 0.00
AUDIT SCORE SUMMARY IMMINENT DANGER TO LIFE & HEALTH (IDLH)
MAX ASSESSED TOTAL COMPLIANCE A. IDLH =

POSSIBLE TOTAL COMPLIANCE STANDARD Instances
SCORE & % ACHIEVED
ADMINISTRATIVE 245
B. 15% of Assessed =
FIELD EXECUTION 680 Subtotal
HOUSEKEEPING 50
C. IDLH Points =
IDLH POINTS (SUBTRACT) (A X B)
REPEATED DEFICIENCIES
(SUBTRACT)
D. REPEAT DEFICIENCY =
DEDUCTIONS
TOTAL 975
* REPEATED DEFICIENCIES = -10 MAX POSSIBLE

** IDLH = 15% REDUCTION OF AUDIT SCORE
*** MINIMUM COMPLIANCE STANDARD = 80%
Construction HSE Revision 0 (12/24/17) Page 1 of 35

SAFETY AUDIT
DETAILED AUDIT SCORE SUMMARY
ADMINISTRATION
SCORE SET STANDARD REDUCTION

MAXIMUM ASSESSED MINIMUM MET / NOT * REPEAT ** IDLH
SECTION SECTION NAME POSSIBLE TOTAL STANDARD MET DEFICIENCY
1 Occupational health & safety policy statement 14
2 Safety and medical record keeping practices 16
3 Emergency preparedness 17
4 Hazard communications program 15
5 Confined spaces 21
6 Mobile Equipment 27
7 Inspection Procedures 19
8 Respiratory protection 29
9 Enforcement and discipline 6
10 Education and training 12
11 Performance indicators 17
12 Accident / incident investigation 16
13 Contractors 17
14 Management / Supervision 19
TOTALS 245

** IDLH = 15% REDUCTION OF TOTAL AUDIT SCORE

SCORE PENALTY
MAXIMUM ACTUAL * REPEATED ** IDLH (X) ASSESSORS COMMENTS
POSSIBLE SCORE DEFICIENCY (X)
1 HEALTH & SAFETY POLICY STATEMENT

A. Policy Statement is in writing. 2
B. Policy Statement dated. 2
C. Health & Safety objectives clearly stated. 2
D. Health & Safety responsibilities defined. 2
E. Management commitment is stated. 2
F. Posted for all employees to read. 2
G. All employees are made aware of the policy content. 2
TOTAL 14
2 SAFETY & MEDICAL RECORDKEEPING
PRACTICES
A. Injury statistics tabulated and utilized to identify positive / negative 2
trends.
B. The previous years' statistics are available. 1
C. Occupational injury / illness report utilized. 2
D. Supervisors' injury / illness investigation form utilized. 2
E. First Aid log utilized / current / accurate. 2
F. Required First Aid supplies are available / stored / dispensed in an 2
approved manner.
G. Prescription medications are available / stored / dispensed with 1
approval of medical doctor.
H. Person(s) administering First Aid are trained and certified. 2
I. Employee exposure and medical records are maintained. 2
TOTAL 16
3 EMERGENCY PREPAREDNESS
A. The emergency plan is in writing. 3
B. There is a coordinator appointed. 2
C. Supervisor First Aid training has been conducted. 2
D. Required emergency lighting and power are available. 2
E. Required emergency rescue equipment is available. 2
F. Emergency team training drills have been conducted. 2

SCORE PENALTY
G. Radios and other communication items are available. 2
H. Periodic emergency evacuation drills are conducted for all employees. 2
TOTAL 17
4 HAZARD COMMUNICATION PROGRAM

A. A written program, specific to the operation, is in place and complete 3
(i.e., training, labeling, MSDS review, designated coordinator, inventory
listing, etc.)
B. Training is documented. 2
C. MSDS's for all materials on site are available. 2
D. Copies of on site contractor hazcom program based on responses to 2
questions.
E. Employees are knowledgeable of the hazcom program based on 2
responses to questions.
F. Vessels and material containers are labeled as required. 2
G. Hazard information posters / signs are displayed to inform employees. 2
TOTAL 15
5 CONFINED SPACES
A. A confined space entry procedure, which meets requirements, is in 3
place.
B. Lighting and electrical tools used inside confined spaces are 12 volt or 3
GFCI protected.
C. Required emergency equipment is available (i.e., body harness, 3
S.C.B.A., fire extinguisher, etc.)
D. Stand-by ("Hole Watch") person9s) are used and are knowledgeable of 3
confined space procedures.
E. Air sampling performed. 3
F. Energy isolation / lock-out is implemented relative to confined space 3
work.
G. Entry permits, which meet requirements, are used, and sign-off for 3
responsible parties is provided and adhered to.
TOTAL 21
6 MOBILE EQUIPMENT OPERATIONS

A. There is a maintenance schedule for all mobile equipment and the 1
schedule is followed.
B. Daily pre-operational inspections are performed on all equipment. 1

SCORE PENALTY
C. Annual crane / re-certification inspections are performed. 2
D. Mobile equipment accidents are investigated and reported. 2
E. Suspended work baskets are certified as safe and utilized for 3
personnel as required.
F. Suspended work baskets are built according to approved designs. 3
G. Suspended work baskets are labeled as required to show maximum 3
weight capacity, maximum number of persons allowed and total basket
weight (actual empty weight.)
H. Permits are utilized and retained for suspended work basket usage. 3
I. Critical lift permits are utilized where 70% of the crane capacity is 3
exceeded.
J. Operator certification program is utilized for aerial lifts, heavy 3
equipment and vehicles.
K. A load test has been performed that established a safety factor of 2 3
times for the suspended work basket.
TOTAL 27
7 INSPECTION PROCEDURES
A. Regular safety inspections of the site / operation are conducted and 3
documented.
B. There is an inspection program for power tools. 2
C. There is an inspection program for personal protective equipment. 2
D. There is an inspection program for portable ladders. 2
E. There is an inspection program for electrical extension cords, 2
temporary electrical distribution installations and electric (ARC)
welding equipment.
F. There is an inspection program for rigging equipment and hoisting 2
devices.
G. There is a follow-up procedure established for the correction of 3
deficiencies noted during inspections.
H. There is an inspection program for emergency rescue equipment. 3
TOTAL 19
8 RESPIRATORY PROTECTION
A. There is a written respiratory protection program which addresses the 3
respiratory protection exposure / need as required
B. Fit test is provided for all employees required to wear respirators. 2
C. Respirators used are selected according to the hazard present. 2
D. Respiratory protection training is conducted. 2

SCORE PENALTY
E. Records of training, medical evaluation and fit testing available and 2
meets requirements.
F. Breathing air for supplied air respirators meet breathing air 2
requirements.
G. If a breathing air compressor is used it is equipped with the following:
1 A proper filtration system. 2
2 A carbon-monoxide alarm. 2
3 A reserve air tank. 2
4 A compressor failure alarm. 2
5 Hose couplings that are incompatible with other couplings. 2
H. The air quality from the breathing air compressor is periodically 2
sampled.
I. Breathing air cylinders are labeled as required. 2
J. The quantity of air available is breathing air cylinders is monitored to 2
assure there is sufficient air to exit the area.
TOTAL 29
9 ENFORCEMENT AND DISCIPLINE

A. Employee Health & Safety responsibilities have been communicated to 2
all employees.
B. Supervisor Health & Safety responsibilities have been communicated 2
to all supervisors.
C. Records of employee safety related discipline are maintained (i.e., 2
verbal / written warning, retraining, termination, etc.)
TOTAL 6
10 EDUCATION AND TRAINING

A. New employee orientation is provided for employees. 2
B. Safety training programs are conducted for management and 2
supervisors.
C. Task specific training is conducted. 2
D. Safety meetings are conducted for all employees, supervisors and 2
management.
E. Emergency preparedness and evacuation training is in place. 2
F. Visitor safety induction program is in place. 2
TOTAL 12
11 PERFORMANCE INDICATORS

SCORE PENALTY
A. There has not been a lost time injury in the workplace during the past 10
six months.
B. The year-to-date recordable injury frequency rate (RIFR) case is at or 4
below the established goal. Actual, YTD _______ Current Goal
_________
C. Contractor / sub-contractor experience is reported and measured. 3
TOTAL 17
12 ACCIDENT / INCIDENT INVESTIGATION

A. There is a written accident / incident policy. 2
B. Accident / incident policy complies with ABB reporting requirements. 2
C. A standard investigation format is used. 2
D. Injury and near miss information are communicated to management 2
personnel.
E. Site management reviews all incident/accident reports. 3
F. There is a remedial follow-up and action plan to prevent recurrence of 3
accidents / incidents.
G. Accident / incidents information is shared with other operations / 2
projects.
TOTAL 16
13 CONTRACTORS
A. Written qualifications are established for the selection of contractors. 2
B. Past Health & Safety performance is factored into contractor selection. 3
C. Contractors are required to provide a copy of their safety program. 2
D. Prior to starting work on-site, contractors are provided site orientation. 2
E. Prior to starting work on-site, contractors are Provided the operations 2
health and safety rules, and emergency procedures.
F. Prior to starting work on-site, contractors are made aware of any 2
chemicals they may encounter on-site.
G. Prior to bringing any chemicals on-site, contractors are required to 2
inform the operation of the chemicals and provide a materials safety
data sheet (MSDS.)
H. Contractors are required to follow the same health and safety rules. 2
TOTAL 17
14 MANAGEMENT / SUPERVISION

SCORE PENALTY
A. Supervision has attended Safety Supervisory Training session. 3
B. Supervisors provide corrective action through Safety Violation 3
Notification System.
C. Supervision is present during work activities. 3
D. Management and supervision attend weekly Safety Walk-throughs. 4
E. Supervisory review JPSA's. 3
F. Safety discrepancies are corrected promptly. 3
TOTAL

SAFETY AUDIT
DETAILED ASSESSMENT SCORE SUMMARY
FIELD EXECUTION

1 Health & Hygiene 13
2 Work Area Lighting 11
3 Personal Protective Equipment (P.P.E) 68
4 Hand Tools 9
5 Powder Actuated Tools 18
6 Power Tools and Power Equipment 19
7 Hot Work (Welding, Heating, Burning) 54
8 Electrical 41
9 Equipment Operations
114
10 Excavation and Trenching 30
11 Steel Erection and Floor and Wall Opening 47
12 Material Handling Storage 18
13 Signs, Signals, Barricades 10
14 Fire Prevention and Protection 42
15 Ladders, Scaffolds and Elevated Work Platforms 100
16 Concrete, Concrete Forms, Shoring, Masonry 22
17 Demolition 15
18 High-Pressure Water Cleaning 40
19 Community Exposure 9
TOTALS 680

SCORE PENALTY
MAXIMUM ACTUAL * REPREATED ** IDLH (X) ASSESSORS COMMENTS
1 HEALTH & HYGIENE

A. The required number of toilets are provided (1 toilet for every 29 2
workers)
B. Provisions for servicing / cleaning toilets have been made. 2
C. Toilets are kept clean and sanitary. Toilet paper is in place. 2
D. Washing facilities are available for worker use prior to lunch / breaks 2
when required.
E. Vermin (rodents, insects, etc.) control is provided. 1
F. Ventilation in work areas is provided for the type of work being 2
performed.
G. Local exhaust ventilation is used where necessary. 2
TOTAL 13
2 WORK AREA LIGHTING

A. Required lighting is provided for the work being performed. 2
B. Portable light plants are maintained and kept operational. 2
C. Portable light plants are positioned to provide maximum lighting where 1
required.
D. Portable light plants are easily moved and positioned. 1
E. Portable light plant masts are easily raised and lowered. 1
F. Portable light plants are grounded prior to use. 2
G. G.F.C.I.s are provided for all temp. lighting circuits. 2
TOTAL 11
3 PERSONAL PROTECTIVE EQUIPMENT (P.P.E.)

A. Head Protection
1 Worn where required. 2
2 Bills worn to the front. 1
3 Hard Hat suspension systems maintained in a safe manner. 1
B. Eye Protection 2
1 Worn where required. 2
2 Side shields required and used. 1
3 Lens cleaning stations and materials are provided. 2
4 Face shields are worn when required. 2

SCORE PENALTY
5 Signs are posted at bench grinders "Face shields required."
C. Fall Protection
1 Safety harness is required and used where fall exposure > 6 ft. is 10
present.
2 Lanyards are equipped with shock absorbers. 4
3 Lanyard hooks are provided with locking safety latch to prevent "Roll 4
Out".
4 Lanyards are secured to a substantial object - fall distance is 4
maintained to a minimum.
5 Fall protection equipment is only used for fall protection. 4
6 Static / cautionary lines are installed to facilitate tie-off and will support 4
a force of 5,400 lbs.
7 Fall protection equipment is inspected on a regular basis and tagged 4
accordingly.
D. Hearing Protection
1 Noise areas are posted as areas where hearing protection is required. 2
2 Noise surveys are performed periodically and documented. 1
3 Hearing protection is properly worn where and when required. 2
E. Foot and Toe Protection
1 All employees wear protective foot wear. 2
2 If steel toe protection is required, they are used where required. 2
F. Hand protection is provided by gloves that are selected according to 2
specific hazards, anticipated or present.
G. Employees working near heavy equipment operations wear high 2
visibility and reflective safety vests.
H. Employees working non-daylight hours are provided with reflective 2
striped clothing, vests or other high visibility material.
I. Employees working non-daylight hours have reflective tape on their 2
hard hats.
J. Reflective vests are provided to stand-by men, riggers and flagmen. 2
K. All employees receive information and/or training on the proper use 2
and care of PPE.
TOTAL 68
4 HAND TOOLS
A. Correct tools are used for the work being performed. 2
B. Tools are used in an approved manner. 2
C. Tools are carried and stored properly. 1

SCORE PENALTY
D. Chisels, hammer wrenches and other "striking tools" are dressed at 2
the striking end to prevent "mushrooming".
E. Job made / home made tools are prohibited and none were observed. 2
TOTAL 9
5 POWDER ACTUATED TOOLS

A. Employees using powder-actuated tools have been trained and 2
certified.
B. Correct load strengths are known and used. 3
C. Loads are removed while the tool is stored or left unattended. 3
D. Proper P.P.E. is worn by the tool operator while using the tool. Proper 3
P.P.E. includes hard hat, face shield, safety glasses and hearing
protection.
E. The tool and all loads are stored in a locked cabinet. 3
F. The tool and all loads are issued only to trained and certified 2
employees.
G. The tool is inspected on a regular basis and tagged to show that it has 2
been inspected.
TOTAL 18
6 POWER TOOLS AND POWER EQUIPMENT

A. All power tools are inspected on a regular basis and tagged to show 3
that they have been inspected.
B. Required safety guards are in place and functional. 3
C. Work rests on bench grinders are adjusted within ¼" of the wheel. 2
D. Wheels on bench and stand grinders are dressed as required. 2
E. Discs on portable grinders are compatible with the equipment's 3
maximum RPM's.
F. Electrical cords are elevated, protected, or otherwise arranged so as to 3
prevent damage to the cord or create a tripping hazard.
G. Employees are trained and certified (when required) in safe operation 3
of power tools.
TOTAL 19
7 HOT WORK (Welding, Heating, Burning)

A. Hot work in or near areas or processes that involve flammable, 4
combustible or explosive materials or chemicals is performed under a
safe work or hot work permit.

SCORE PENALTY
B. A fire extinguisher is immediately available and operable at all Hot 3
Work locations.
C. Welding screens are used around all ground or floor level arc welding 3
operations.
D. Arc welding is performed with a required electrical grounding. 3
E. Welding cables and ground cables are free of damage and non- 3
insulated connections.
F. Welding cables and ground cables are inspected on a regular basis 3
and are tagged or color coded to show that they have been inspected.
G. Where cables are suspended or secured, they are done so by using 2
non-conductive materials.
H. Cables, cords and hoses are elevated or protected to prevent tripping 2
hazards.
I. Compressed gas cylinders are labeled as required. 2
J. Compressed gas cylinders are stored and capped as required. 3
K. Reverse flow or flash back arrestors are used on all oxygen / acetylene 3
rigs.
L. Regulator gauges are attached as required and in good condition. 3
M. Compressed gas cylinder valves are turned off when not in use. 2
N. Strikers are used to light torches. 2
O. Weld rods are stored as required and rod stubs are placed in a 2
container to prevent a tripping hazard.
P. Welding rods are not left in the electrode / rodholder while not in use. 2
Q. Compressed gas cylinders are located outside of closed areas and are 3
not exposed to slag or sparks.
R. Gas cylinders are moved and transported in the required manner. 3
S. Hot slag and sparks are maintained and controlled as required to 2
prevent fires and contact with employees.
T. Required P.P.E. is worn for the hot work activity being performed or 2
immediately exposed to, including eye protection, clothing, gloves and
respirator if needed.
U. Oxygen / acetylene hoses are maintained free of oil and grease. 2
TOTAL 54
8 ELECTRICAL
A. Electrical equipment is marked as to the amount of voltage and the 3
control source.
B. The required "lock out - tag out" procedure is implemented where 4
circuits are de-energized due to maintenance, repair or other activity.
C. Employees performing low, medium, or high voltage work are trained 4
and certified.

SCORE PENALTY
D. Protective gear (rubber gloves, blankets, hot sticks, etc.) is inspected 4
by an independent testing firm.
E. Tests are performed to determine if current carrying parts are "Hot" or 4
de-energized.
F. All line parts are guarded or protected against contact. 4
G. GFCI controlled outlets and panels are labeled and tested. 3
H. Electrical cords are inspected and approved for the type of usage and 3
are free of breaks in the insulation.
I. Outlets, receptacles, junction boxes, etc., are approved and maintained 3
as required.
J. Where electrical cords are suspended or secured, they are done so by 2
using non-conducting materials.
K. Electrical cords are elevated over passage ways, or are protected from 3
damage when crossing roads or passage ways.
L. Temporary lighting is installed as required using approved materials. 2
M. Light bulbs and fluorescent tubes are guarded as required. 2
TOTAL 41
9 EQUIPMENT OPERATIONS
A. Crane Operations
1 Load charts are posted and utilized. 3
2 The swing radius of the counter weight is barricaded. 3
3 The crane is operated level with all out riggers fully extended. 3
4 Moving and travel practices are utilized to include the use of a flagman. 3
5 The operator is trained and certified for the specific crane being 4
operated.
6 Specific attention to power line clearance is given. 3
7 Flagmen are used to signal crane operators when raising, lowering and 3
swinging the hook, loaded or unloaded.
8 Load monitoring indicators (LMI) are available and utilized with each 3
crane.
9 An anti-two-block limit switch is in place and functional on all cranes. 3
B. General Equipment
1 Seat belts are provided and used with ROP structures. 3
2 All lights are operational 2
3 Horns are operational 2
4 Back-up alarms are operational. 2
5 Equipment is operated at a safe travel speed. 2

SCORE PENALTY
6 Flagmen are used to signal equipment operators working in confined or 3
congested areas.
7 All equipment operators have a valid Equipment Operators license. 2
8 Seat belts are worn by driver and all passengers in equipment provided 2
with seat belts.
C. Haulage Operations
1 Elevated roads are protected by berms and/or guard rails. 2
2 Warning signs are posed at intersections, steep grades, and blind 2
corners, as required.
3 Traffic flow is regulated and enforced. 2
4 Speed limits are posted and observed. .
5 Only authorized vehicles and equipment are allowed on the haulage 2
roads.
6 Refueling maintenance activities are performed away from haulage
road traffic areas.
7 Haulage roads are maintained in good condition. 2
8 Storm water is channeled / controlled to minimize haulage road 2
hazards.
9 Dust control is implemented effectively when and where required. 2
D. Rigging Equipment
1 Approved rigging practices are used. 3
2 Rigging equipment is maintained and free of damage, excess wear or 3
defect.
3 All crane and sling hooks are equipped with a functional safety latch. 3
4 Monthly inspections of rigging equipment are performed and the 3
equipment is color coded accordingly.
5 The load capacity of each rigging device is known by label, tag, placard 3
or other substantial marking attached to the device.
6 Certifications are provided for all rigging equipment and Safe Working 3
Load (SWL) is visible on all lifting equipment.
7 The throat of load hooks are measured periodically to detect change in 2
hook gap.
E. Warning Methods
1 Reflective triangles are provided for all equipment and vehicles. 2
2 Reflective triangles are employed to warn of equipment breakdown / 2
accident or road hazards as required.
3 Flashing lights and/or strobes are used on all slow moving vehicles 2
that operate in the vicinity of large excavation and haulage equipment.
F. Equipment Inspections
1 All equipment on site has been inspected, and documentation on file. 2

SCORE PENALTY
2 Monthly color code has been placed on the windshield of each piece of 2
equipment.
3 Contractors are making routine equipment inspections and recording 2
results on a monthly basis.
4 Defective equipment has been removed from site for repairs. 2
G. Machine and Equipment Guarding
1 Guards around pinch points, rotating equipment, shafts, pulleys, belt 3
drives and chain drives are guarded to prevent accidental contact.
2 Equipment guards are firmly attached and are of a material or design 3
that will prevent contact by hands, clothing, tools or material, or any
other accidental worker contact.
3 Where rotating equipment maintenance work is performed, the 3
maintenance is performed with all guards in place. If the guard(s)
must be removed, the equipment is locked out and tagged.
4 Emergency stop cords are installed on all conveyor belt lines. The 2
emergency stop cords are functional and tested on a periodic basis.
5 Employees servicing or working near pinch points or rotating 3
equipment are not wearing loose clothing or any other loose articles.
TOTAL 114
10 EXCAVATION AND TRENCHING

A. A Supervisor is in charge of excavation and trenching. 3
B. Required Excavation permits are utilized. 3
C. Documented daily inspections performed including adverse weather 3
changes.
D. Spoil dirt is at least 1 meter from the edge. 3
E. Correct slope angle is maintained. 3
F. Shoring used where required and approved installation and removal 3
procedures are followed.
G. Proper access and egress required. 3
H. Physical barricades are provided 3
I. Approved barricades are erected at the edge of all open trenches and 3
excavations as required.
1 Prior to beginning any excavation or trenching, all underground utilities 3
in the work area are located.
TOTAL 30

SCORE PENALTY
11 STEEL ERECTION AND FLOOR AND WALL
OPENING
A. Required access and egress provided. 3
B. Required perimeter cables are used and approved installation 4
procedures are followed.
C. Wall and floor openings are guarded or covered as required. 4
D. Elevated areas are free of loose excess materials and debris that could 3
fall to levels below.
E. Static lines, catenary lines, etc., installed to facilitate employee tie-off. 4
F. Bolt-up requirements are met. 3
G. Bolt buckets are used to contain bolts. 3
H. Decking requirements are met. 4
I. Approved rigging techniques are used. 3
J. Barricades and signs are posed in the area to warn employees as 3
required.
K. Employees providing hand signals have received hand signal training. 3
L. Signals or warnings are provided when loads are raised. 3
M. All employees are wearing and using required PPE (safety harnesses 4
and lanyards.)
N. Taglines are used to control movement of all suspended loads. 3
TOTAL 47
12 MATERIAL HANDLING STORAGE

A. All materials are stacked and stored in an approved manner. 2
B. Aisles, passageways are maintained clean and unobstructed. 2
1 Employees have been trained in safe material handling techniques and 2
use safe handling techniques.
C. Materials are stacked to prevent displacement and falling. 2
D. Employees have been trained in proper lifting methods and use proper 2
lifting methods.
E. Material handling equipment is used to handle / move material when 2
possible.
F. Materials handling equipment (mono-rails, A-frames, etc.) is labeled to 2
identify load capacity.
G. Softeners are used to protect wire and nylon chokers where needed. 2
H. Employees use gloves to protect hands when handling materials. 2

SCORE PENALTY
TOTAL 18
13 SIGNS, SIGNALS, BARRICADES

A. Accident prevention signs, symbols and tags are used as required to 2
warn employees where potential hazards exist.
B. Flagmen used where required. 2
C. Barricade methods used to prevent all unauthorized entry. 2
D. Barricades are used to warn of potential hazards. 2
E. A barricade procedure has been established. 2
TOTAL 10
14 FIRE PREVENTION AND PROTECTION

A. Fire extinguishers are provided as required.
1 Located adjacent to each stairway on each floor level. 2
2 Where more than 18 liters of flammable or combustible liquids are 3
used.
3 At least one 9 kg extinguisher at fuel dispensing areas. 3
B. Required access to fire extinguishers is maintained. 3
C. Extinguishers are identified as required. 2
D. Inside storage of flammable liquids does not exceed 90 liters outside of 3
an approved cabinet.
E. Inside storage cabinets are labeled as required, and maximum limits 3
(225 liters / cabinet and 3 cabinets / area are not exceeded.
F. Materials that react to water are not stored with flammables. 3
G. Containers are electrically interconnected (bonded) when flammable 3
liquids are transferred from one container to another.
H. Portable storage tanks containing liquid flammables are located at least 3
6 meters away from buildings.
I. "NO SMOKING - NO OPEN FLAMES" signs are posted where 3
flammable liquids are used or dispensed or stored.
J. LPG containers are not stored inside buildings. 3
K. Smoke detectors are provided in sleeping quarters and are tested on a 3
regular basis.
L. Fire suppression systems are inspected on a regular basis to assure 3
functional availability.
M. Employees have been trained on how to operate a fire extinguisher. 2
TOTAL 42

SCORE PENALTY
15 LADDERS, SCAFFOLDS AND ELEVATED WORK
PLATFORMS
A. Ladders
1 Are in good condition. 2
2 Built and used in an approved manner. 3
3 Secured in an approved manner and placed at the correct angle. 3
4 Exceed the landing area by 1 meter or have a grab rail. 3
5 Are not used where they can be displaced by doors, equipment, etc., 3
unless protected by guards or barricades.
6 Metal ladders are not used where contact with electrical energy is 4
possible.
7 Fixed ladder landing areas are kept clear. 3
B. Scaffolds
1 Provided with required access and egress. 3
2 Has a standard guard rail (106 cm top rail, 53 cm midrail, and 10 cm 3
toe board) whenever possible.
3 Scaffold tags are used to identify incomplete scaffolds and 2
requirements for safe use.
4 Complete decking is provided whenever possible. 3
5 Employees who erect and dismantle scaffolds are qualified and 3
competent.
6 Scaffolds are free of defects and built per specifications. 3
7 Overhead protection is provided where there is exposure. 3
8 Casters are locked and pinned on mobile scaffolds when in use and no 3
riding allowed.
9 Outriggers are provided and used or the scaffold is secured to the 3
structure when the height exceeds 4 times the minimum base
dimension.
10 An approved base is provided. 3
11 Scaffold boards are secured. 3
12 Two-point suspension scaffolds are erected in an approved manner. 3

a. Approved design. 3
b. Approved life lines are provided. 4
c. Approved rope grab lanyards provided. 4
d. Tie-off fall protection used. 4

SCORE PENALTY
C. Elevated work platforms (high-jackers, scissors lifts, JLG's, etc.)
1 Elevated scaffold platforms are of substantial construction and secured 3
properly.
2 A means of tie-off is provided and used. 4
3 Required access and egress is provided. 3
4 Elevated work platforms are used in accordance with manufacturer 3
recommendations.
a. Outriggers provided and used as required. 3
b. Ground controls operational. 3
c. Operators trained and certified. 3
d. Fall protection provided and used. 4
e. Employees maintain both feet on the platform, and do not use 3
equipment as a means of access / egress, and do not work
from guard rails.
TOTAL 100
16 CONCRETE, CONCRETE FORMS, SHORING,
MASONRY
A. Required access and egress provided. 3
B. All exposed rebar ends protected from exposure, both vertical and 4
horizontal.
C. Masonry saws are guarded with a semicircular enclosure cover. 3
D. All shoring erected to contain and / or support concrete is the required 3
type and approved installation procedures are followed.
E. Precast and lift slab operations are performed in accordance with 3
respective standards.
F. PPE required for these operations is provided and used which would 3
include safety glasses, gloves, proper clothing and foot wear.
G. All connections on air hoses and pipes are secured to prevent 3
displacement.
TOTAL 22
17 DEMOLITION
A. All operations are planned ahead. 3
B. Required access and egress provided. 3
C. Material removal (floor holes, skip-pan, chutes, etc.) is conducted in an 3
approved manner.

SCORE PENALTY
D. Any and all asbestos containing material was removed prior to 3
demolition.
E. Structural member removal is conducted in an approved manner. 3
TOTAL 15
18 HIGH-PRESSURE WATER CLEANING

A. Operators are wearing rain suits, gloves, face shields, hard hats, 3
safety glasses with side shields, rubber steel toe boots or metatarsal
guards.
B. Standby Operator(s) is wearing hard hat and safety glasses with side 3
shields.
C. Operators are not allowing any part of their body to be placed in front of 4
the water jet.
D. Operators are not handling hose within one foot of hone-to-hose 4
connections.
E. Operators are trained annually at a minimum. 3
F. Hose data such as manufacturer's symbol, serial number, working and 3
test pressure, and certified rating which will provide a safety factor of 3
to 1 against burst is recorded and retained at the project.
G. Work area is barricaded at a minimum of 4.5 meters and signs stating, 3
"DANGER - HIGH PRESSURE WATER CLEANING."
H. Equipment to be cleaned is dismantled / isolated, locked and tagged as 4
required.
I. All Fittings and components meet manufacturer's guidelines. 3
J. Records of high pressure water cleaning equipment inspection are on 1
file.
K. Lance or mole marker 60 cm from nozzle end. 3
L. Shotguns have a 2 meter shroud and are a minimum of 165 cm in 3
length.
M. Safety equipment has not been altered or by-passed. 3
TOTAL 40
19 COMMUNITY EXPOSURE
A. Signs are posted to warn of equipment and vehicle traffic. 3
B. Pedestrian / vehicle crossing areas are marked and provided where 3
required.
C. Permits have been obtained from the proper authorities to begin work 3
outside construction areas.
TOTAL 9

FORM - LGH SFOR - 6407-02.001
SAFETY AUDIT
DETAILED ASSESSMENT SCORE SUMMARY
HOUSEKEEPING

1 Housekeeping 50
TOTALS 50


FORM - LGH SFOR - 6407-02.001
SCORE PENALTY
POSSIBLE SCORE DEFICIENCY
(X)
1 HOUSEKEEPING
A. Material, tools and equipment and tied, stacked, or choked to prevent
rolling or falling. 3
B. Provisions have been made for routing trash collection and disposal.
2
C. Trash receptacles are provided in all work areas.
2
D. Scrap lumber is free of protruding nails or other puncture hazards.
2
E. Glass containers are prohibited, none were observed.
2
F. Electrical cords, hoses, welding leads, etc., are elevated to prevent
tripping hazards. 4
G. Butt cans, where used, are maintained free of combustible material
and emptied routinely. 3
H. Floors are clear of tools, rod ends, and metal shavings.
4
I. Spilled liquids are cleaned immediately.
3
J. Material on warehouse shelving is stored safely and neatly.
3
K. Bridges and walkways are kept clean / free of debris.
3
L. Roads are clear of material / debris.
3
M. Rod stub buckets are provided to welders to store rod ends.
3
N. Toilet facilities are cleaned on a regular basis.
3
O. Signs are provided to encourage housekeeping.
3
P. Office/clinics are clean and trash removed daily.
3
Q. Elevated areas are maintained clear of debris, material, tools, etc.,
where such items could fall to areas below. 4
TOTAL
50

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

FORM - LGH SFOR - 6407-02.001

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FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

SAFETY PROGRAM AUDIT

CONSTRUCTION MANAGER: AUDITOR(S):

FINAL SCORE 0.00

AUDIT SCORE SUMMARY IMMINENT DANGER TO LIFE & HEALTH (IDLH)

MAX ASSESSED TOTAL COMPLIANCE A. IDLH =

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE

Construction HSE Revision 0 (12/24/17) Page 1 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

SCORE SET STANDARD REDUCTION

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE

Construction HSE Revision 0 (12/24/17) Page 2 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

1 HEALTH & SAFETY POLICY STATEMENT

2 SAFETY & MEDICAL RECORDKEEPING

Construction HSE Revision 0 (12/24/17) Page 3 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

4 HAZARD COMMUNICATION PROGRAM

6 MOBILE EQUIPMENT OPERATIONS

Construction HSE Revision 0 (12/24/17) Page 4 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

Construction HSE Revision 0 (12/24/17) Page 5 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

9 ENFORCEMENT AND DISCIPLINE

10 EDUCATION AND TRAINING

Construction HSE Revision 0 (12/24/17) Page 6 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

12 ACCIDENT / INCIDENT INVESTIGATION

Construction HSE Revision 0 (12/24/17) Page 7 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

Construction HSE Revision 0 (12/24/17) Page 8 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

SCORE SET STANDARD REDUCTION

Construction HSE Revision 0 (12/24/17) Page 9 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

1 HEALTH & HYGIENE

2 WORK AREA LIGHTING

3 PERSONAL PROTECTIVE EQUIPMENT (P.P.E.)

Construction HSE Revision 0 (12/24/17) Page 10 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

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FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

5 POWDER ACTUATED TOOLS

6 POWER TOOLS AND POWER EQUIPMENT

7 HOT WORK (Welding, Heating, Burning)

Construction HSE Revision 0 (12/24/17) Page 12 of 35

FORM LGH SFOR - 6407-02.001

SAFETY PROGRAM AUDIT

Construction HSE Revision 0 (12/24/17) Page 13 of 35

FORM LGH SFOR - 6407-02.001