Title:

DOCUMENT NUMBER

SAFETY AND HEALTH PROGRAM

ISS./REV. DATE

11/02/2012
1.0

JOB SAFETY CHECKLIST FOR FIELD

OPERATIONS

1510.1 Rev. 2
Page 1 of 7

PURPOSE

The purpose of this procedure is to establish the requirement that a site hazard survey shall be
conducted for each job and each worksite prior to beginning work, at shift changes, and whenever
job conditions change.
2.0

RESPONSIBILITY

2.1
It shall be the responsibility of the supervisor or lead technician with authority over the
work to ensure a thorough site hazard survey has been conducted before work begins.
3.0

EQUIPMENT AND MATERIALS

3.1
3.2

Job Safety Checklist (form 1510.1A),

Job Hazard Analysis (form 1510.2A)

4.0

PROCEDURE

4.1
A site hazard survey will be conducted in accordance with the Job Safety Checklist (form
1510.1A) by all employees at all job sites in accordance with this procedure.
4.2

The Job Safety Checklist Review

4.2.1
The Job Safety Checklist shall be reviewed by all crew members before work is begun.
Each crew member shall sign the checklist in the space provided signifying that he/she is aware of
the identified hazards, permit requirements and the Chem-Check requirements associated with the
job and the job site. The completed checklist will be maintained at the location until the job is
finished. On jobs that require some type of work permit, the checklist should be maintained with the
permit.
4.2.2
Whenever the job involves multiple shifts, the Job Safety Checklist and/or Job Hazard
Analysis developed by the previous shift will be reviewed by the supervisor/lead technician of the
on-coming shift. The identified hazards of the previous survey along with any measures taken to
mitigate those hazards will be reviewed and verified. The on-coming shift will then perform a
hazard survey in accordance with this procedure.
4.2.3
Consideration must always be given to the effects of any changes in the system or the
surroundings. Such changes may include (for example) significant alterations to external condition,
variation to conditions in the line, alterations to the equipment in use, modifications to the operating
procedure (either forced or unforced) etc. If the possible effect of any given change is uncertain,
appropriate engineering guidance must be sought. Changes should only be authorized by those
with the appropriate authority, experience and competence to make such a decision.
4.3

Procedure for Completion of the Job Safety Checklist (form1510.1A)

4.3.1
The Job Safety Checklist is a tool to be used to pre-plan a task and should not be
viewed or used to simply identify the requirements of a task. It is recommended that the Job Safety
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Title:

DOCUMENT NUMBER

SAFETY AND HEALTH PROGRAM

ISS./REV. DATE

11/02/2012

JOB SAFETY CHECKLIST FOR FIELD

OPERATIONS

1510.1 Rev. 2
Page 2 of 7

Checklist be completed as a consensus of the personnel assigned to the task. The following is a
basic, but not all inclusive, list of considerations that must be included in the review process.
a.
b.
c.
d.
e.
f.

What is going to be done?

What tools, materials, and equipment will be needed?
What are the hazards of the area, equipment, chemicals; both potential and actual?
What will be needed to eliminate or reduce the hazards to an acceptable level?
Will precaution be necessary to protect adjacent workers or facilities?
What can go wrong and what would be needed to neutralize the condition or situation?

4.3.2
The Job Safety Checklist must be completed prior to beginning work. Should the job
condition change, then the Checklist may need to be revised to address the changes.
4.3.3
The Job Safety Checklist is to be maintained by the Lead Technician until the job has
been completed and then turned in to the office with the job sheet. The Job Safety Checklist is to
be retained for a period of the duration of employment of the employee(s) listed on the checklist,
plus 30 years.
4.4

Execution / Implementation

4.4.1

Job Site Data

1.

Job number and date.

2.

Type of Work - Identify the nature of the work to be done.

3.

Name of technicians involved.

4.
System contents - Identify chemical(s) that may be contained in the system, review and
attach appropriate MSDS(s) on hazardous chemical(s) i.e., flammables, oxidizers, catalysts,
carcinogens, toxins, or corrosives. Review any MSDS precautions for substances provided to
Furmanite or provided by others and used by Furmanite employees.
5.
Was System Washed and Cleared Yes or No. If no, plan for worst case scenario or
request that system be decontaminated prior to work, if applicable.
6.
Is the system open to atmosphere? If yes, identify protections in place to ensure the
system remains open to atmosphere and that personnel will be notified if the system is to be
closed.
7.
Chem-Check required and Chem-Check number if required. Remember, any process
involving contents other than air, steam or water, a Chem-Check is required and that the results of
the Chem-Check has been reviewed with all personnel.
7.

System pressure and temperature.

8.

Location Customer and operating unit location.

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Title:

DOCUMENT NUMBER

SAFETY AND HEALTH PROGRAM

ISS./REV. DATE

11/02/2012

JOB SAFETY CHECKLIST FOR FIELD

OPERATIONS

1510.1 Rev. 2
Page 3 of 7

9.

Specific Equipment - Identify equipment/unit by name, service, and equipment number

4.4.2

Protective Actions

1.
Lockout and Tagout - If yes, indicate by check mark which energy sources need to be
included: if no, consider the energy source that may need to be protected against and what will be
necessary to neutralize the potential. It is required that the system be walked down to ensure lock
out and/or tag out devices have indeed been installed and that Furmanite locks have been installed
as appropriate.
2.
Are blinds, including vapor barriers required? If so, Furmanite technicians must be
aware of the purpose of the blinds and whether or not they will be maintained throughout the
activity. If there is a possibility that the blinds will not be maintained, Furmanite personnel must be
aware of the ramifications of their removal.
3.
System Under Pressure or Power? - If yes, consider what will be necessary to protect
technicians should energy be released during work activity. Any possibility of the unexpected
release of pressure must be considered and mitigated prior to beginning work. If it is claimed that
the system is not under pressure, methods of assurance that pressure has not accumulated must
identified and monitored.
4.
Are Any Contents Trapped, Lines Not Drained - If yes, Furmanite technicians must
understand what the contents are and how they may affect Furmanite operations. If Furmanite
personnel are to open lines that contain trapped contents, there must be a clear understanding of
how trapped contents are to be controlled and captured using equipment such as a low point bleed
device.
5.
Process/Chemical Hazards - If yes, identify hazard and methods to eliminate or
minimize hazard. Engineering controls shall be the first line of defense against exposure to these
hazards. Personal Protective Equipment shall be used only as a last resort.
6.
Test of Safety Shower/Eye Wash - The two safety shower/eye wash units closest to the
job site must be located and flushed (tested) to ensure that the unit flows clear water and operates
as required. Get permission from the unit operator to perform these tests some eye wash and
safety showers are connected to an automatic alarm. Be sure to replace protective caps on
eyewash heads.
7.

Ensure two escape routes are established and known to all crew members.

8.

Is asbestos present? If so, call the office for further instructions.

9.
Do adjacent operations present a hazard to Furmanite operations or do Furmanite
activities pose a hazard to adjacent operations? If so, notify the plant contact and mitigate the
hazard.
4.4.3

Area Protection / Cross-Craft Coordination

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Title:

DOCUMENT NUMBER

SAFETY AND HEALTH PROGRAM

ISS./REV. DATE

11/02/2012

JOB SAFETY CHECKLIST FOR FIELD

OPERATIONS

1510.1 Rev. 2
Page 4 of 7

1.
Fire, Hole, or Bottle Watch required. Ensure the watch is appropriately trained and
stationed.
2.
Area Roped Off or Barricaded - Will the nature of the work require that unnecessary
personnel be excluded from the area to avoid exposure to the potential hazards of the job.
Potential hazards would include overhead work, potential for falling objects, potential chemical
exposure, the lifting or lowering of equipment, material or supplies, etc. If a barricade is to be
installed it must be tagged (identified) then removed when work is completed or the hazard
eliminated. Barricades should only include the immediate area to be affected but not unnecessarily
restrict traffic in adjacent areas.
3.
Does Environmental Need Notifying - Does the nature of the job present potential for
any environmental impact such as gas release or generation of hazardous waste that can not be
routed to a process or chemical sewer.
4.
Will Adjacent Area(s) Be Affected - Will the nature of the job potentially affect other
workers or process areas which would require notification of those potentially affected employees?
If so, ensure the plant contact/operator is notified and that personnel in adjacent area are aware of
the hazard. Documentation of this notification is to be recorded on the Checklist.
5.
Overhead Work Protection - If an overhead job (elevated platform, scaffold, or structure)
poses a potential for falling objects, then a barricade is necessary. The barricade should include all
potentially occupied areas/ levels below the work site.
6.
Is Engineering Review Required? At various times, certain jobs will require
engineering review. When in doubt, call Engineering or the Service Line Technical Expert.
7.
Does Job Require NORM Procedures - All lines and equipment that are in propylene
service are potentially NORM contaminated which requires that NORM procedures be followed.
The Safety Department must be contacted.
8.
Is scaffolding required? If so, the scaffold must be complete and properly tagged. All
employees using the scaffold must be appropriately trained as a scaffold user. The area below the
scaffold must be barricaded. Furmanite employees are not authorized to either build or modify
scaffolds.
9.
Are Walking / Working surfaces adequate? All walking/working surface should be level
and free of slip, trip, and fall hazards.
10.

Other (Specify) - Other considerations or hazards not covered above?

4.4.4

Personal Protective Equipment

If a job presents a potential chemical splash of any hazardous chemical, employees must adhere to
the following in providing protection.
1.

Slicker Suits: Should be worn when minimal splash protection is necessary.

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Title:

DOCUMENT NUMBER

SAFETY AND HEALTH PROGRAM

ISS./REV. DATE

11/02/2012
2.

JOB SAFETY CHECKLIST FOR FIELD

OPERATIONS

1510.1 Rev. 2
Page 5 of 7

Chemical Protective Clothing

a.
Level A: Should be worn when the highest level of respiratory, skin, and eye protection
is needed.
b.
Level B: Should be worn when the highest level of respiratory protection is needed, but
a lesser degree of skin protection is needed.
c.
Level C: Should be worn when a lesser level of respiratory protection is needed than
Level B. Skin protection criteria are similar to Level B.
d.
Level D: Should be worn only as a work uniform and not on any site with respiratory or
skin hazards. It provides no protection against chemical hazards.
3.
Rubber Boots - Is there a potential for chemical exposure to the foot or lower leg? If so,
chemically resistant rubber boots must be worn, then decontaminated following the exposure.
PROCEDURAL NOTE: CHEMICAL PROTECTIVE CLOTHING MUST BE THOROUGHLY
INSPECTED TO ENSURE THERE ARE NO BREAKS OR CRACKS IN THE PROTECTIVE
MATERIALS PRIOR TO USE.
4.

Proper Gloves

a.
b.
c.
d.

Chemical - Neoprene, Nitrile or Rubber

Cut and/or Abrasion Resistant
Dirt/Grease - Cotton
Thermal Insulated

5.
Face Shield - All chip removal processes require full face shields over safety glasses,
some jobs with limited low hazard chemical exposure potential may also require face shields. Use
of a face shield is recommended for all operations involving a steam lance.
6.
Mono-goggles - Splash proof chemical goggles may be needed for potential exposure to
airborne particulate or low hazard liquid chemical exposures.
7.
Flash, approach, or proximity suit required? Area of high heat and/or the potential for
fire will require the use of heat protective clothing.
8.

Respiratory Protection

a.
Cartridge Respirator - Should be used where the permissible exposure level (PEL) is
greater than 100 parts per million (PPM) and the concentration is not expected to exceed 5 times
the permissible exposure level.
b.
Air Respirator with Egress Bottle - Must be used where the contaminant may exceed 10
times the PEL, the PEL is less than 100 PPM or the interruption of the air supply may expose the
user to an IDHL atmosphere.
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c.
the PEL.

JOB SAFETY CHECKLIST FOR FIELD

OPERATIONS

1510.1 Rev. 2
Page 6 of 7

Dust Mask - May be used only for non-toxic dust exposures that will not exceed 5 times

PROCEDURAL NOTE:ALL PERSONNEL THAT USE RESPIRATOR PROTECTIVE DEVICES

MUST BE MEDICALLY CAPABLE OF WEARING A RESPIRATOR, HAVE A CURRENT
RESPIRATOR FIT TEST CARD, USE THE DEVICE IDENTIFIED ON THE CARD AND BE CLEAN
SHAVEN.
9.
Fall Protection If fall protection is required, all affected employees must be properly
training prior to beginning work. Fall protection must be properly inspected prior to its use.
10.

Other (Specify) - to be used for other personal protection not addressed above.

4.4.5

Safety Tools

1.

Barricades.

2.

Radio - Does nature of job or area require that radio communication be used.

3.
Compressed Air Horn - If the job involves a confined space entry, then an air horn is
necessary unless radio communications are required for the attendant. The compressed air horns
should not be stored or placed where high temperature extremes are possible.
4.
Fire Extinguishers - If the job involves hot work, a minimum of one 10-lb. fire
extinguisher must be maintained at the site. The extinguisher must have a current inspection tag
and must also be inspected by the potential user.
5.
12 Volt Lighting - 12 volt lighting must be used in all confined spaces and in areas that
are classified electrically or where wet conditions are present or likely.
6.
Hand tools in good condition? Inspect all hand tools prior to use. Defective tools shall
not be used.
7.
Are air tools properly connected/pinned? All air-powered tools must be properly
connected and safety pins and strain relief must be used as required.
8.

Other

4.4.6

Permits

The supervisor/lead technician must always carefully read the work permit to ensure the scope of
work to be accomplished and the areas to be entered are adequately described on the permit. Any
restrictions must be noted and discussed with the crew before work begins. All requirements of the
permit and any time restraints or re-issue requirements described on the permit shall be strictly
followed.

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Title:

DOCUMENT NUMBER

SAFETY AND HEALTH PROGRAM

ISS./REV. DATE

11/02/2012
4.4.7

JOB SAFETY CHECKLIST FOR FIELD

OPERATIONS

1510.1 Rev. 2
Page 7 of 7

Respirator Usage

1.
Employee respirator usage must be tracked. Record the name of the employee, the last
four digits of their social security or employee number, and the duration of respirator usage.
4.4.8
The results of the Job Safety Checklist must be discussed with all crew members during
a tailgate meeting before work begins. Each crew member shall sign the checklist in the space
provided signifying that he/she are aware of the hazards, Chem-Check requirements and permit
requirements associated to the job and the job site.
4.4.9

Job Completion

1.
Upon completion of the job, the supervisor/lead technician will sign and date the space
provided at the bottom of page 2 of the form to signify that the requirements of this procedure have
been met.
2.
The supervisor or lead technician will attached the Job Safety Checklist and/or the Job
Hazard Analysis to the Furmanite job sheet and return it to the office with authority over the work.
3.
The Service Delivery Center Manger will ensure the Job Safety Checklist and/or the Job
Hazard Analysis is reviewed for completeness and take corrective actions whenever it is found that
the document has been completed incorrectly.
4.
The Service Delivery Center Manger will establish a method to track respirator usage
and ensure personnel who exceed the thresholds established for respirator usage are entered into
a Medical Surveillance program.

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