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July 2012Page 1 of 17

USGC Gulfstream ProgramThe Dow Chemical Company

Hydroblasting Checklist (July 2012)

Checklist Instructions:

This checklist shall be used to identify hazards, implement safeguards and authorize hydroblasting work.

Hydroblasting Company Requirements:

1) The hydroblasting crew must first verify that the hydroblasting equipment to be used is listed on the Dow Hydroblasting Technology List (A print copy is available from Dow)

2) The hydroblasting crew shall complete this Hydroblasting Checklist as a planning document before requesting a Safe Work Permit from Dow to set up hydroblasting equipment.

3) The hydroblasting crew upon the receipt of the safe work permit will insure the requirements identified within this checklist will be implemented and followed.

Company Name: ______________________ Date of Job:___________

Location of Job: (Facility)____________________________(Equipment)___________________________________________

Person Completing this Checklist (Print name)__________________________(Signature)______________________________

Safe Work Permit Issuer: The follow information must be communicated during the SWP issuance process as a reminder of the Dow Hydroblasting Standard expectations to be adhered to.

Check each

1. HYDROBLASTING TECHNOLOGY: The hydroblasting equipment to be used has been verified as listed on the current Dow Hydroblasting Technology List

2. HEAT EXCHANGERS WITH EXPOSED TUBE PLUGS: A Dow operating procedure must be attached and followed

3. WATER CUTTING: The water cutting operating procedure must be attached and followed

4. RECIRCULATION OF WATER: A Dow operating procedure must be attached and must be followed

5. MINIMUM SHOTGUN LANCE LENGTH: Manual shotgun lances must be at least 66 inches (1.7 meters) in total length, and 48 inches (1.2 meters) the length from tip to the nearest trigger.

6. AWD: An Anti-Withdrawal Device must be used unless the cleaning method is fully automatic

7. EQUIPMENT SET-UP: The safety of the equipment set-up must be reviewed by Contractor supervision or alternate and documented on this checklist prior to pressurizing the system

HOSES: Hoses that may cause trip hazards must be avoided

BARRICADING: Work areas must be barricaded to prevent access

VARIANCE REQUIRED: Any “No” answer in any section of the Hydroblasting Checklist must be addressed with an approved variance before any hydroblasting work can be done. Variances to any of the requirements of the Standard must be obtained via the EH&S Variance Process. Where local governmental requirements are more stringent, they apply instead of this Standard.

“NA” (Not Applicable) can only be answered on the checklist if the scope of work does not include the bolded words in each item.

Hydroblasting Checklist This is a controlled document. No un-authorized modifications. Health, Safety, and Environmental

DOW CONFIDENTIAL – Do not share without permission



SWP Issuer communicating expectations (Print name)___________________________________________Date:____________

Required Review Prior To Pressurizing System:

1) A mandatory safety review of the equipment setup is required after the initial SWP issuance but prior to pressurizing the equipment or hydroblasting begins.

2) This review shall insure the equipment to be used is on the Dow Hydroblasting Technology list and is installed properly. All safeguards are in place, the checklist has been completed and the personnel operating the equipment have been trained to do so. Document the review by signing below of Contractor Supervision or an alternate person (Contractor or Dow) who is experienced with hydroblasting.

Contractor Supervisor/alternate:(Initial set up): (Signature)________________________________ Date:_______________

Multiple Hydroblasting Methods Used:

1) If multiple hydroblasting methods are employed (ex: shotgun lancing followed by automatic tube lancer), the equipment setup must be reviewed again and documented below. This independent second review must be done by a person separate from the hydroblasting crew.

Contractor Supervisor/alternate:(Equipment change) (Signature)________________________________ Date:_______________

Job Closure or Continuing Job:

1) After job completion, the hydroblasting crew shall return the completed Checklist to the designated area for

Safe Work Permit closeout.

2) This checklist cannot be transferred between crews and a new Checklist must be completed for each shift of work.





Hydroblasting technology to be used: (Check all equipment that will be used for this job)

Single or dual trigger failsafe valve(s) on a shotgun lance (e.g. arrows illustrate minimum length measurement for dual triggers):

The overall length of the lance (distance between arrows "A" and "B" in photo below must be at least 66 inches / 1.7 meters. The length from the nozzle tip to the nearest trigger (between arrows "B" and "C") must be at least 48 inches / 1.2 meters.

Remote operated lance

Flex gun (example of flex gun and associated equipment)



A B



Line mole with stinger (arrow illustrates proper measurement reference for determination of adequate length: measure rigid portion of assembly as shown below)

Automatic hand-held Lance with Anti-Withdrawal Device (example)

Hand-held rigid pipe lance (example shown below)



Line mole with rigid stinger with length equal to 3X largest pipe diameter

Example of special line mole situation with “Tee” or other large opening:

Length of rigid stinger prevents reversal of mole in larger pipe reached

Larger diameter pipe



Other Flexible lance: (specify type)

________________________________________________________________________

SPECIAL CASE: Moleing on process lines containing a “Tee” or where piping being cleaned opens into larger diameter piping:

Added stinger length is required to avoid the potential for unintended reversal of the line mole. If there is a “Tee” fitting or the line being cleaned opens into a larger diameter line, then the minimum stinger length must equal 3X the diameter of the largest pipe or pipe fitting.Examples:1. Line moling a 6 inches diameter pipe having a “Tee” fitting requires a stinger length of 18 inches.2. Line moling a 3 inches pipe that opens into a 6inches pipe requires a stinger length of 18 inches

Anti-withdrawal device: a mechanical safety device physically attached to the equipment being





cleaned and used to prevent the flexible lance from being able to unintentionally fully-withdraw from the equipment being cleaned. The AWD is required on all hydroblasting jobs, except manual shotgun lancing)

Examples of Anti-Withdrawal Devices: (AWD’s)

Alternate type of hydroblasting equipment not pictured above

Describe:

Foot pedal control (dead-man switch) of hydroblast water, controlled by operator of lance.

Examples of failsafe operating valves - in these cases these are foot operated:

Scope of Work: Read each item and check the





appropriate box

When the scope of work includes the use of recirculated water, use of remotely-operated equipment and a Standard Operating Procedure is required. Details of hydroblasting water recirculation methods:

1) spent hydroblasting water from the cleaning process is collected, filtered and re- used (contamination and temperature risk)

2) clean hydroblasting water is recirculated directly via piping back to the pump at high volume and into a reservoir for re- use. Due to the risk of uncontrolled temperature rise, direct recirculation of clean water is prohibited unless done with a large enough reservoir to absorb the heat input from the pump, or other method described in the Recirculated Water Operation Procedure.

A Standard Operating Procedure defining requirements for collection, retention, filtering, protection against personnel exposure to contaminated and / or hot recirculated hydroblasting water) is in use

No: Yes: NA:





Equipment Requirements: Read each item and check the appropriate box.

Automated Equipment and/or Remotely Operated equipment has been considered and will be used where possible:

Automated Equipment: Types of hydroblasting hardware that are designed to reduce the manual labor involved with the hydroblasting process, improving the efficiency of the hydroblasting operation. Remotely Operated: Hydroblasting conducted using equipment having the controls of the lance and water pressure located a safe distance from the lance entry or protected by a barrier that prevents the lance operator’s exposure to hydroblasting water or a failure of the lance. “Safe distance” depends on the specific job and equipment setup.

Both Automated and Remotely Operated Hydroblasting Equipment utilizing flexible lances require the use of anti-withdrawal devices

No: Yes: NA:

When using a flexible lance (hand-held or remote operated), then the flexible lance installation includes an Anti-Withdrawal Device (AWD) or is equipped with an anti-withdrawal mechanism to prevent unexpected withdrawal of the lance. The gap between end of the AWD and exchanger tube sheet must not exceed one inch (2.5 cm)

No: Yes: NA:

When using hand-held lances or hand-held flexible lances other than shotgun lances, the design of the orifice openings has been explained or demonstrated that they minimize backwards thrust of the lance.

No: Yes: NA:

When performing water cutting operations, a secondary (redundant) means of securement of the cutting head track is in place to prevent unplanned movement of the water jet.

No: Yes: NA:

When using shotgun lances, they shall have a trigger guard and a minimum length of 66 inches (1.7 meters) from the end of the stock to the nozzle and 48 inches (1.2 meters) from tip to the nearest trigger, so that the operator is incapable of shooting his own foot or other body part.

No: Yes: NA:

When the scope of work includes hydroblasting in a confined space using a shotgun lance then lances have a dual trigger type failsafe operating valve. No: Yes: NA:





When the scope of work includes hydroblasting while using breathing air, then protections will be in place to prevent damaging or restricting the breathing air supply.

No: Yes: NA:

When manual lancing using a line mole, then the mole has a piece of rigid tubing (stinger) that is 1.5 times the diameter of the pipe attached. If there is a “T” in the piping, then the minimum stinger must be 3X the largest pipe diameter.

EXCEPTION: A stinger section is not required only for the automated line mole, which allows the operator to stay outside the barricade. In addition, the solid AWD is used and installed with a gap less than 1 inch (2.5 cm).

No: Yes: NA:

All equipment setups for line moleing include an anti-withdrawal device.No: Yes: NA:

Equipment Requirements Continued: Read each item and check the appropriate box.

All hydroblasting hoses used with shotgun lances have been protected at least 6 feet (2 meters) nearest to the lance for operator protection with a safety shroud.

When using hoses in higher pressure services (>20,000 psig or 1379 bar) then the hoses have been shrouded from the pumping unit to the failsafe operating valve.

No: Yes: NA:

The operating pressures will be less than the MAWP (Maximum Allowable Working Pressure) of the hoses.

Operating Pressure:________________ Hose MAWP:_____________________No: Yes:

All hoses have been pressure tested in the last 3 months. Hoses that are part of Remotely Controlled Hydroblasting Systems (see definition) shall be inspected/tested annually.

Date of last pressure test:__________________

No: Yes:

The pumping equipment can measure pressure, relieve excess pressure and has been inspected/tested in the last 3 months.

Date of last test:_________________

No: Yes:





The hydroblasting crew has been trained to use the equipment according to Manufacturer’s recommendations. Manufacturer’s recommendations or the hydroblasting company’s standard operating procedures are available for the crew to use during the job.

No: Yes:

Equipment Set Up: Read each item and check the appropriate box.

When working on exchangers with exposed tube plugs, the following preparations have been verified complete:

Specify type of tube plugs present: _______________________________________

Count of plugs on upstream end of exchanger: ____________ Count of plugs on downstream end of exchanger: ___________

Compare both ends of exchanger to verify all tubes plugged at both ends

Both sides of the exchanger have been depressurized*

*see Hydroblasting Standard for situations where slight pressure is permitted

Personnel exposure to tube plugs will be minimized through barricading or shielding with an adequate physical barrier (Example: ¾” (19 mm) plywood or ¼” (6 mm) polycarbonate sheet)

No: Yes: NA:

No: Yes: NA:

No: Yes: NA:

Equipment Set Up: continued Read each item and check the appropriate box.

All high pressure hose connections will have secondary safety connections (whip checks) installed.

No: Yes:





All hoses will be visually inspected prior to use (no broken braids, flat surfaces, damaged threads or coatings, physical wear or obvious damage).

Hydroblasting crew member documentation that inspection completed

(signature):________________________

No: Yes:

The failsafe operating valve will be in place and protected from inadvertent operation.

The failsafe valve will be used to protect operator during any tasks that may result in exposure to high pressure water

No: Yes:

Pumping equipment relief devices oriented to minimize potential exposure to venting from the relief device. No: Yes:

Hoses will not be placed where they could be tripping hazards and will not be placed in vehicular traffic or on hot lines or where abrasion could damage them.

No: Yes:

Hoses will be secured to prevent unintentional movement (especially over guard rails).

When hoses will be strung up the side of a structure, they will be supported and routed between railings (not over) to minimize the bend radius.

No: Yes:

A stable, non-skid work surface will be provided as is practical.No: Yes:

Hydroblasting pumping equipment will be grounded. No: Yes:




USGC Gulfstream ProgramThe Dow Chemical Company Uncontrolled temperature buildup will be avoided by not piping/recirculating/bypassing high volume clean hydroblasting water back to the pumping unit unless a sufficiently large reservoir exists to absorb the energy from the pump.

No: Yes: NA:

When hydroblasting near electrical / instrumentation equipment, steps will be taken to protect the electrical equipment.

No: Yes: NA:

When hydroblasting from scaffolding, a Complete Scaffold will be installed where the gap between the edge of the scaffolding and the equipment being worked on meets minimum gap requirements (gap less than 12 inches / 0.3 m).

No: Yes: NA:

When hydroblasting from mobile platforms, only mobile platforms that are rated to support the total weight, including the weight of hydroblasting equipment and water will be used.

Estimated weight of equipment & water:___________________________

No: Yes: NA:

When hydroblasting from mobile platforms, methods will be used to stabilize the platform from movement created by the thrust of the hydroblasting lance. No: Yes: NA:

When hydroblasting from mobile platforms, the hoses going in and out of the mobile platform will be supported and have enough slack to accommodate the movement of the mobile platform.

No: Yes: NA:

When hydroblasting from mobile platforms, the platform will not be moved while the hydroblasting equipment is being operated. No: Yes: NA:

When the pumping equipment is mobile, chock blocks will be properly positioned on the pumping equipment to prevent unexpected movement.

No: Yes: NA:





Safe Work Permitting: Read each item and check the appropriate box

As part of the Safe Work Permitting process, the environmental protection and waste disposal requirements are understood and documented. No: Yes: NA:

When hydroblasting in areas with flammable materials, the Hot Work permitting section of the SWP will be completed and define requirements for continuous atmospheric monitoring of the work area. No: Yes: NA:

When conducting automated or remotely operated hydroblasting activities that require tool or nozzle changes, specify method used to isolate the high pressure water energy, such as disconnection of water supply hose. No: Yes: NA:

Personnel Protection: Read each item and check the appropriate box.

The work area will have barricades on all sides of the equipment being hydroblasted. Barricades will be located at a distance of at least 20 feet / 6 meters from the entry, hoses and exit points for the high pressure water. The distance of the barricades is to prevent access to areas where there is potential for the lance (or line mole, etc.) to reach outside of the equipment being hydroblasted. Hoses running vertically to upper levels that are not feasible to barricade will be routed to avoid pedestrian traffic (away from stairwells, etc.)

Example, If the equipment being hydroblasted requires greater than a 20 ft/ 6 m lance (or mole line, etc.), the barricade will be located at the longer length.

No: Yes:

Barricades will be clearly marked with signs, tags or labeled banner tape to only allow the hydroblasting crew in the area during operation of the equipment.

No: Yes:

Splash guards will be used to protect personnel from flying debris at all entry & exit points of the equipment being hydroblasted. No: Yes:





When the scope of work includes work on exchangers, then devices to deflect the water blast away from the operator and other personnel will be in place. No: Yes: NA:

Both the shell and tube sides of heat exchangers being hydroblasted have been de-pressurized. No: Yes: NA:

When multiple hydroblasting jobs are in the same area, then each job will be separated by at least 20 feet / 6 meters or a protective barrier (e.g., temporary wall between work crews) will be in place. Note: Consider work in all directions – side-to-side, above-below.

No: Yes: NA:

There are no other jobs active within the barricaded areas during operation of the equipment. No: Yes:

Lighting will be adequate to perform the hydroblasting job safely. No: Yes:

Hydroblasting work will not be done from ladders or stairs. No: Yes:

When the pumping equipment will be louder than 85 dBA then a perimeter for minimum hearing protection will be established at a point where the noise level is 85 dBA. This perimeter will be clearly marked & labeled as requiring hearing protection.

When hydroblasting tasks expose personnel to noise levels in excess of 105 dB, manage the exposure in accordance with Dow hearing conservation requirements. Tasks of potential concern include shotgun lancing inside vessels, vacuuming operations and areas adjacent to the pumping unit. In these cases, double hearing protection may be needed to manage the exposure.

No: Yes: NA:





Job Procedures: Read each item and check the appropriate box.

At least one member of the hydroblasting crew will act as a Safety Attendant during all hydroblasting work. No: Yes:

The Safety Attendant is trained to shut down the equipment immediately in case of emergency. No: Yes:

The Safety Attendant understands his/her responsibilities to continually observe the actions of the operator and conditions. No: Yes:

The Safety Attendant knows who is to be notified and how to immediately notify SWP issuer or Immediate Response Leader in the event of an emergency.

Describe notification expectations:__________________________________________

______________________________________________________________________

Safety Attendants (initials/signatures):________________________________________

No: Yes:

A line of sight or other continuous, two-way communication method will be established among the lance operator, safety attendant and operator of the pumping equipment and shall be maintained during all hydroblasting work.

No: Yes:

The hydroblasting crew understands the requirement that all hoses shall be visually inspected at the start of each shift and before a re-start after a break (no broken braids, flat surfaces, damaged threads or coatings, wear or damage).

Crew leader Signature: _______________________________

No: Yes:





Hydroblasting crew understands their responsibility to ensure that only authorized personnel wearing the required Personal Protective Equipment shall have access to the barricaded area while hydroblasting work is being performed. For lance operators, full PPE is required: Face shield

Hard hat

Hood (or equivalent)

Monogoggles

Hearing protection

Chemical splash suit

Gloves

Rubber metatarsal boots

…plus any PPE required for process area

Other Hydroblasting crew members shall use PPE consistent with the process area.

No: Yes:

The hydroblasting crew understands that if any leaks are found that the equipment shall be shut down and the leaking equipment shall be replaced or repaired.

No: Yes:

The person closest to the nozzle (usually the lance operator) shall always control the failsafe operating valve. No: Yes:

The lance operator(s) understands that:1. The failsafe operating valve shall never be bypassed or overridden.

2. He/she shall prevent the inadvertent removal of the lance from the equipment while under pressure.

3. He/she shall maintain two points of contact with the lance while under pressure.

4. He/she shall never use a body part to hold or stabilize the equipment being blasted.

Lance Operators:

Print name _____________________Signature__________________________

Print name _____________________Signature__________________________

No: Yes:





All equipment operators are trained and qualified by their company to operate the hydroblasting equipment according to manufacturer’s recommendations.

Supervisor / Crew Leader (initials/signature):___________________________________________________________

Crew Members Names and Signatures that have been assigned to this job and understand the requirements:

Print name _______________________________Signature__________________________





Print name _______________________________Signature_______________________




No: Yes:

Local Requirements: There may be local/site requirements for hydroblasting. Read each item and check the appropriate box. Discuss with Dow rep and add as necessary.

No: Yes: NA:

No: Yes: NA:



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