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General • Inspections

OSM 1.26 Exhibit 2 High Hazard Safety Observation

This form provides a structured record for high-hazard safety observations under OSM 1.26. Record the activity observed, relevant conditions and practices, and any actions needed to address identified concerns.
UNVR - 0913 - Chicago 68th St.
11/06/2026

OSM 1.26 Exhibit 2 High Hazard Safety Observation

The aim of this form is to document safety observations during high-hazard activities, identify unsafe conditions or practices, and assess whether required controls are being followed. It supports timely corrective action, reinforces safe work practices, and helps prevent incidents by recording findings and opportunities for improvement.

    High Hazard Safety Observation

    Name of Employees or Contractor being evaluated:

    Date of Observation:

    Observations

    Hot Work

    Is proper PPE available and being used correctly?

    • Yes
    • No
    • N / A

    Is the work area organized and free from any recognized hazards?

    • Yes
    • No
    • N / A

    Is the designated working area ≥50 feet from any process pipes or storage of flammable or combustible materials?

    • Yes
    • No
    • N / A

    Is designated hot work area map posted?

    • Yes
    • No
    • N / A

    Are combustible materials removed from Hot Work area or properly shielded

    • Yes
    • No
    • N / A

    Is there a fully-charged fire extinguisher readily available?

    • Yes
    • No
    • N / A

    Is hot work equipment being used in good condition?

    • Yes
    • No
    • N / A

    Was there an authorized fire watch present who remained in area for 30 minutes after work was completed?

    • Yes
    • No
    • N / A

    Are protective screens free from defects being used?

    • Yes
    • No
    • N / A

    s work on PSM-covered processes completed in compliance with Univar Solutions updated PSM plan?

    • Yes
    • No
    • N / A

    Was the hot work permit completely filled out and posted in the area where work is being performed?

    • Yes
    • No
    • N / A

    Are employees performing Hot Work listed on the Branch Authorized Employee list?

    • Yes
    • No
    • N / A

    Are employee/contractor training files complete including welder certifications?

    • Yes
    • No
    • N / A

    Confined Space

    Is proper PPE available and being used correctly?

    • Yes
    • No
    • N / A

    Is the work area organized and free from any recognized hazards?

    • Yes
    • No
    • N / A

    Entry-specific SOP available for work being performed?

    • Yes
    • No
    • N / A

    Has the atmosphere in the confined space been checked and monitored for oxygen, LEL, CO, H2S, and any other toxic gasses?

    • Yes
    • No
    • N / A

    Are all permit-required confined spaces clearly identified by warning signs? (Warning signs must be easy to read and free from defects)

    • Yes
    • No
    • N / A

    Has all LOTO been performed, documented, and reviewed by the employee/contractor performing the work?

    • Yes
    • No
    • N / A

    Are all retrieval devices (winch, tripod, etc.) being used free from defects?

    • Yes
    • No
    • N / A

    s a qualified rescue team present?

    • Yes
    • No
    • N / A

    Rescue team notified and available?

    • Yes
    • No
    • N / A

    s rescue equipment set up and ready?

    • Yes
    • No
    • N / A

    Are all permits filled out completely and posted in areas where work is being performed?

    • Yes
    • No
    • N / A

    Was a confined space pre-entry meeting performed using OSM 1.26 Exhibit 5?

    • Yes
    • No
    • N / A

    Was an initial inventory of all confined spaces performed using OSM 1.26 Exhibit 4: Confined Space Inventory

    • Yes
    • No
    • N / A

    Lockout/Tagout (LOTO)

    Is proper PPE available and being used correctly?

    • Yes
    • No
    • N / A

    Is the work area organized and free from any recognized hazards?

    • Yes
    • No
    • N / A

    Are all LOTO devices (hasps, clasps, locks, and tags) free from defects and used properly?

    • Yes
    • No
    • N / A

    Have all forms been completed and posted in areas where work is being performed?

    • Yes
    • No
    • N / A

    Have all affected employees been informed that LOTO work is being performed?

    • Yes
    • No
    • N / A

    Are all steps in the energy control procedure being followed?

    • Yes
    • No
    • N / A

    Do authorized employees understand their responsibilities under the LOTO procedure?

    • Yes
    • No
    • N / A

    s the current procedure adequate to provide the necessary protections?

    • Yes
    • No
    • N / A

    Have all equipment-specific procedures (OSM 1.22 Exhibit 1) been observed and certified annually?

    • Yes
    • No
    • N / A

    Working at Heights

    Are proper PPE and fall protection/prevention devices available and being used correctly? (e.g. lanyard, harness, etc.)

    • Yes
    • No
    • N / A

    Are portable, fixed, and rolling ladders free from defects?

    • Yes
    • No
    • N / A

    Are portable ladders that are not being used stored and secured?

    • Yes
    • No
    • N / A

    Are employees/contractors using fall protection correctly while performing work ≥ 4 feet?

    • Yes
    • No
    • N / A

    Are warning signs clearly visible next to storage tanks indicating “Authorized employees only-JSA must be performed-Employees must use fall protection device”?

    • Yes
    • No
    • N / A

    Are portable, fixed, and rolling ladders being used correctly and only for intended purpose?

    • Yes
    • No
    • N / A

    Are all straight, extension, and A-frame ladders <12’ in height?

    • Yes
    • No
    • N / A

    Is the work area organized and free from any recognized hazards

    • Yes
    • No
    • N / A

    If you observe any unsafe conditions, exercise stop work authority immediately

    Comments or Corrective Actions

    Hot Work

    Confined Space

    Lockout/Tagout (LOTO) - Record any deviations or inadequacies found during observation of OSM 1.22 Exhibit 1: Equipment Specific Procedures below.

    Working at Heights

    Completed by:

    Signature:

    Click here to sign
Source: UNVR - 0913 - Chicago 68th St. (Community Member)

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