Protecting People
and the
Environment
since 1984
Corporate Office:
(504) 348-3098
Texas Branch:
(409) 333-4090
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Safety Attendant
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Safety Attendant
Safety Attendant Questionnaire
Step
1
of
2
50%
Can you carry equipment up to 60LBS for a distance of at least 100 feet at least four times per shift?
*
Yes
No
Can you control a charged fire hose (60-140 psi)?
*
Yes
No
Can you perform tasks that require bending at the waist/knees and lifting with your legs up to 20 times/hour?
*
Yes
No
Can you stand in one location for extended periods of time (10-12 hours)?
*
yes
No
Can you climb vertical ladders on structures greater than 150 feet tall at least four times per shift?
*
Yes
No
Can you work in an environment that may contain chemicals?
*
Yes
No
Can you pass a background test?
*
Yes
No
Do you have a TWIC card?
*
Yes
No
Do you have a high school diploma/GED?
*
yes
No
Can you Read/Write/Speak English?
*
Yes
No
Do you have reliable transportation?
*
yes
No
Can you stay awake for a 12 hour work shift?
*
yes
No
Can you be without your cell phone for a 12 hour work shift?
*
Yes
No
Can you work continuously without a break for a period of at least 4 hours?
*
Yes
No
Can you wear personal protective equipment such as; PVC suits, Alky gear, disposable suits, rain suits, for extended periods of time (4 hours)?
*
Yes
No
Are you currently using or have you in the last six months used illegal drugs, including those that might be detected on a drug test?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
Are you afraid of heights?
*
Yes
No
Have you ever worked in an industrial setting, such as Chemical or Petroleum refinery before?
*
Yes
No
Do you have any experience personally performing Confined Space Attendant duties?
*
Yes
No
Do you have any issues working in excessive heat or cold (over 90*F/under 32*F)?
*
yes
No
Do you have an active OSHA Basic Card?
*
Yes
No
Do you have any experience personally performing Bottle Watch duties?
*
Yes
No
Have you ever personally completed a Job Safety Analysis or Job Hazard Analysis?
*
Yes
No
Have you ever worn personal fall protection?
*
Yes
No
Do you have an active fit test card?
*
Yes
No
Are you capable of traveling for periods up to 8 weeks?
*
Yes
No
Name
*
Phone
*
Email
*
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