e APS Field Services EHS Site Inspection Sheet GE APS Field Services EHS Site Inspection Sheet (reverse

GE APS Field Services EHS Site Inspection Sheet (reverse side)

Location: ___ Date:_________ Please enter all findings below - can include suggestions for future improvement
Job: _____________________ Tick means Finding Action Recommended / Action Taken Action Party Date
OK
No. Closed
No. EHS Preparation & Inspection Checklist Finding
= "X" None
1 Work Preparation
a Project work scope and responsibilities clear ?
b Method Statement or Hazard Analysis required and communicated?
c All persons with necessary safety and technical training (by law or by customer)?
d All (sub-)Contractors briefed on EHS requirements ?

e GE accident & spill reporting procedures clear & communicated to all involved?

2 Work Permits & Safe Working Procedures

a Customer work permits & procedures clear & communicated?
b Have all energy sources been isolated and LOTO used (or to be used) ?
c Confined spaces applicable, communicated and being followed ?
d Working at heights applicable (fall protection required >4 ft / 1.25 m - see also 4b) ?
e Heavy manual lifting required ? (ensure correct/ergonomic lifting techniques)
f Concurrent activities in same working area (e.g. other contractors or customer operations) ?
g Customer site EHS-orientation already given to all GE staff and contractors ?
3 Fire Safety, Emergency and Medical Preparation
a Customer emergency & evacuation rules posted in area & communicated ?

b Emergency routes / exits visible and access not restricted ?

c Emergency eye-baths / showers available & in good condition ? (flush them!)

d Fire Extinguishers and First Aid kits available and in good visible condition? CUSTOMER INVOLVEMENT: The above should be discussed/agreed with the Customer Rep. If possible its
recommended to involve the customer rep in the EHS preparation & site inspection itself.

e Off-site medical care/clinics/hospital information available and communicated ?

f Any particular fire & explosion hazards existing ? Have inspection findings & EHS preparation been discussed/agreed with customer rep ?
4 Tools, Equipment & PPE SAFETY TOOLBOX: Checklist items marked in BOLD and all inspection findings & required actions
Correct PPE available, in use & in good condition ? (e.g. safety glasses, gloves, safety shoes, MUST be communicated to ALL GE Staff & Contractors on-site, who are required to sign below to confirm
a this has been one.
overalls, hearing protection, fall protection, or as applicable)
b All work tools used by GE employees and contractors in good condition ? Name Signature Name Signature
c Lifting equipment, cranes, slings etc. in good condition & inspected (check next inspection date) ?
d Machine guards & safety barriers in place / in use ? (e.g. rotating couplings, manholes)
5 Housekeeping & General Working Conditions
a No slip, trip or fall hazards around the work areas ? (e.g. slipperly floors, obstacles, holes)
b Good santation/cleanliness of provided facilities (e.g. toilets & changing rooms) ?
c Sufficient lighting and healthy working climate ?
6 Use, Storage & Disposal of Hazardous Materials & Waste All new staff & contractors arriving later on-site MUST be briefed on above and sign before starting work
a MSDS's available for oil & chemical products used on site ? (communicate location) Name: Date:
b Oils & Chemicals properly & clearly labelled and stored ? Lead Rep.
c Waste disposal procedures clear & communicated (site rules and arrangements) ? Signature:
7 Other Site Specific Hazards & EHS Concerns ? (please specify overleaf)
Note: All Findings MUST have an Action and Action Party specified overleaf Note: Keep copy and send original to Field Service Manager
Please also indicate overleaf important EHS information (e.g. significant hazards, non-standard site specific Please attach an additional page for more Findings and/or more staff attending Toolbox
training requirements, etc.) that should be included on APS Site Directory
For Jobs > 1 wk please send copy of all reports at end of job with Customer/job report.
Customer Name: 0
Customer Facing #: 0
Project Name: 0
Location: 0
Weekending Date: 0

Week Ending: Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Date: Date: Date: Date: Date: Date: Date: Total
GE Technician Hours Name ST OT ST OT ST OT ST OT ST OT ST OT ST OT ST OT
Mechanic TA #1
I&C 0 0
Travel 0 0
Warranty 0 0
Punch List 0 0
Mechanic TA #2
I&C 0 0
Travel 0 0
Warranty 0 0
Punch List 0 0
Elec/Control TA #1
I&C 0 0
Travel 0 0
Warranty 0 0
Punch List 0 0
Elec/Control TA #2
I&C 0 0
Travel 0 0
Warranty 0 0
Punch List 0 0

Mechanic TA #1 Signature/ Print Name: Date Customer Signature/ P Date

Mechanic TA #2 Signature/ Print Name: Date

Elec/Control TA #1 Signature/ Print Name: Date

Elec/Control TA #2 Signature/ Print Name: Date

 Submission Instructions:
Customer Name: 1. Complete report on a weekly basis (1 report/site)
Notes: 2. Save report w/ the following filename format: Project name_(Week
Customer Facing #: 1) The weekly report should document all activities impacting the Ending Date)_WR.xls
Project Name: execution of the I&C manual. 3. Create email & attach report w/ the following in your subject line:
2) The expectations are to receive 1 weekly report from each project site
Location: and the report should be a collaboration of ALL GE FS reps on the site.
Project Name (Customer Facing Project Number...e.g. 7201726)
Weekending Date: 4. Send report/timesheet to your project manager, Resource
3) A copy of this report should be maintained in the I&C manual. Coordinator (Jack Rosenbarker), and I&C FS Mgr (Kevin Sampson),
3) Contact the resource coordinator or I&C FS Mgr should you have any Project Manager
questions/concerns.

Project Configuration
Unit #
Engine Model (PC, PD, etc)
Engine Serial #:
Work Order #:
Generator Serial #:
Unit # Unit # Unit #
Engine Model (PC, PD, etc) Engine Model (PC, PD, etc) Engine Model (PC, PD, etc)
Engine Serial #: Engine Serial #: Engine Serial #:
Work Order #: Work Order #: Work Order #:
Generator Serial #: Generator Serial #: Generator Serial #:

Today's Date:

Expected Mech Comp:
Expected backfeed power
available:
Expected fuel available:
Expected water available:
Expected FF:
Expected Comm Closeout:
Expected Mech Comp: Expected Mech Comp: Expected Mech Comp:
Expected backfeed power Expected backfeed power Expected backfeed power
available: available: available:
Expected fuel available: Expected fuel available: Expected fuel available:
Expected water available: Expected water available: Expected water available:
Expected FF: Expected FF: Expected FF:
Expected Comm Closeout: Expected Comm Closeout: Expected Comm Closeout:

Weather Civil Progress Mechanical Progress Controls Progress

Monday
Temperature:
Sky Conditions
Wind
Site Condition

Tuesday
Temperature:
Sky Conditions
Wind
Site Condition

Weekly Report 05/29/2021 3

 Wednesday
Temperature:
Sky Conditions
Wind
Site Condition

Thursday
Temperature:
Sky Conditions
Wind
Site Condition

Friday
Temperature:
Sky Conditions
Wind
Site Condition

Saturday
Temperature:
Sky Conditions
Wind
Site Condition

Sunday
Temperature:
Sky Conditions
Wind
Site Condition

CONSTRUCTION DELAYS:

Weekly Report 05/29/2021 4

Weekly Report 05/29/2021 5
ject name_(Week

our subject line:

.e.g. 7201726)
source
evin Sampson),

ogress

Weekly Report 05/29/2021 6

Weekly Report 05/29/2021 7
Weekly Report 05/29/2021 8
 On-Site Contractor Log
Customer Name: 0
Customer Facing #: 0
Project Name: 0
Location: 0
Weekending Date: 0

Labor (Document support provided) Monday Tuesday Wednesday Thursday Friday Saturday
Mechanical Assistance # # # # # #

Elec/Controls Assistance # # # # # #

Contractor Activities
Monday:

Tuesday

Wednesday

Thursday

Friday
Friday

Saturday

Sunday
Sunday
#