Document name: Revision date:

Work Place Inspection Checklist 4/13/2021

Document number: Revision number:
PED-FRM-01-124 1

Operational Control Assurance: Work Place Inspection

Assessor Permit Number
( if applicable)

Assessor Role Site

Assessment Date Work Location

Housekeeping

N/A
Yes
No
1 Given the stage of work in progress, Is the general level of housekeeping sufficient? X
2 Are escape routes unobstructed? X
3 Are safety provisions (e.g. fire extinguishers) accessible? X
4 Are the floors clean, dry, free from debris, clutter and trip hazards? X
5 Are stairs and landings kept clear and unobstructed? Where applicable are barriers present? X
Comments

Permit To Work

N/A
Yes
No
6 Does the activity require a PTW? X
7 Is the work carried out in conformance with the Permit? X
8 Are the control measures as mentioned on the permit in place? X
9 Is the Permit displayed or available at the work site? X

10
Are personell aware of the relevant hazards and the control measures on the Permit?
(ask a worker) X
11 Are the tools used appropriate for the task and in good condition? X
Comments

Working Environment
N/A
Yes
No

12 Is the lighting adequate? X

13 Are the working clothes in line with the weather conditions when outside? X
14 Is the work party aware of the wind direction? X

15 When other work is performed in the vicinity of the work place, have arrangments been made?
X

16
Where potential exposure to hazardous substances exist, is the work party aware of the risks and required measures? Ref
SDS/WIK X

17 Are there no issues concerning noise? E.g. hearing protection, adequate communication possible.
X
Comments

Supervision
N/A
Yes
No

17 Is the Supervisor present in the work place? X

18 Have Petrodec visited the work place prior to this inspection? X
Comments

Preparedness to act on events and incidents

N/A
Yes
No
19 Does the workparty know who to contact in case of an emergency and how? X
20 Does the workparty know what to do in case of the different types of alarms? X

21 Is the workparty aware of the nearest location of eyewash bottles, fire extinghuishers and telephones?
X

22
Does the work party know what to do in the event of emergency (work site escape routes, musterpoint location, lifeboat
station)? X
Comments

General

N/A
Yes
No
23 Has everything reasonably possible being done to minimise the risk? X
24 Is the work performed as planned? X

25
Is the work party aware of which of the life saving rules are relevant to the work and what the applicable control measures
are? X

N/A
Yes
No
Bypassing Safety Controls
X

Confined Space

Hotwork

Safe Mechanical Lifting

X

Energy Isolation
X

Line of Fire
X

Work Authorisation
X

Driving

Working at height
Comments

I confirm that the above elements have been assessed for compliance.

Signature: