A-Core Core Drill - Jobsite Audit

• Branch / Division:

  Select

• Audit Title:

• Conducted on:

  Date

• Prepared by:

• Client / Site:

• Location:
  Address

• Job details:

• Audit Number:

• A-Core Personnel on site:

Service Truck

• Pre-Trip Inspection of the vehicle(s) has been documented

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Truck is clean and orderly

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Truck has all required DOT items (Fire Extinguisher, Triangles, First Aid Kit, Strobe Lights, etc.)

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• SDS Binder is located on the truck

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Truck has been inspected within 12 months

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Operator completed a JHA, and communicated all hazards with other A-Core staff on site?

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Required Posters/Signs posted and legible

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Measures in place to protect the public or other trades from hazards created by A-Core

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Operator communicated with others in the area that could be exposed to hazards created by A-Core

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• If needed, a SWWP is developed prior to work starting

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• There is sufficient lighting to work and move around safely on the project

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Hard Hats worn by all A-Core personnel on job

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Eye & Face protection worn as required

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Hearing Protection worn as required

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Safety Toed foot protection worn

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• High Visibility shirt or vest being worn

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Hand Protection worn as required

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Respiratory Protection worn as required

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

Fall Protection

• Job task requires elevated work 6' or higher from ground or working near a leading edge

  Yes

  No

  N/A

• Operator is utilizing a Ladder, Scaffold, Scissor Lift, or Boom Lift to reach drilling location

  Yes

  No

  N/A

• The tool or equipment being used to gain elevation been inspected prior to use?

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• If using a lift, the Operator possesses required certifications

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Operator is using proper fall protection

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• The harness, lanyard, or yoyo has been inspected prior to use

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Operator has a documented "Fall Rescue Plan" in place

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• The tie off point has the ability to withstand 5000 LBS or force per person

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

Excavation, Trenching, and Shoring

• Job task require workers to enter an excavation of 5' or deeper

  Yes

  No

  N/A

• The excavation is properly shored, sloped, or benched per OSHA Regulations

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Spoils, materials, and equipment are set back a minimum of 2' from the edge of excavation

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Means of egress are within 25 lateral feet from workers

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Workers are protected from loose rock or soil

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• If trench boxes or shoring are used, have they been inspected and have proper pinning/bracing installed

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Excavation is protected according to the soil type

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Work area is kept clean and clear of material or debris

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Slurry being created is vacuumed, funneled, and disposed of legally

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Cords & Hoses strung or routed to prevent trip and fall hazards

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Cords strung or routed to prevent being cut, sliced, crushed, or damaged

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Tools and power cords have been tested and color coded meeting A-Core's Assured Grounding Program

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Ground fault circuit interrupters provided on all temporary electrical circuits

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Extension cords have 3-prong plugs and all 3 prongs are intact

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Cords are in good working condition (no splices, frays, ground prong being removed, and cord ends tight)

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Operator is using the right tool for the job

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Hand tools are maintained in safe working condition

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Rotor Hammer Drills are maintained in safe condition

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Dustless attachment is being utilized on Hammer Drill

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Hammer Drill Bit being used is the right diameter for anchor size

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Hammer Drill Bit has legal side clearance for safe anchor setting procedure

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Core Drill is maintained in safe working condition

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• 110v, 220v, and 480v powered drills have been inspected following the Assured Grounding Program

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Hydraulic Drill has been inspected prior to use (Hoses, Fittings, Gear Box)

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• When Hydraulic Drilling, Operator has Kill Switch (dead man) nearby while drilling

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Proper GPM are being used for Core Drill as per Manufacturers Recommendations

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Hand Drills have been inspected prior to use

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Vacuum Base and Pump are in safe working condition

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Integrated Water Delivery System working properly

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• LOTO observed when changing/removing bit(s)

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Proper Anchoring used for drilling application

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Operator is not wearing any loose fitted clothing

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Operator is deemed competent for task(s)

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Work being performed requires Traffic Control

  Yes

  No

  N/A

• Proper Signs placed on road to alert drivers of construction work ahead

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• A-Core truck placed so to help protect the worker(s)?

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Strobe Lights are used when driving or working inside the enclosure

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Drilling location possesses risk of utility strike

  Yes

  No

  N/A

• Utility Locates have been called prior

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Operator asked customer if we could potentially strike any utility

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• If stop box is being used, is it grounded appropriately

  Select Safe / Compliant Level 1 Failure - Must be corrected ASAP Level 2 Failure - Must be corrected within 2 weeks Level 3 Failure - Must be corrected immediately N/A

  • Safe / Compliant
  • Level 1 Failure - Must be corrected ASAP
  • Level 2 Failure - Must be corrected within 2 weeks
  • Level 3 Failure - Must be corrected immediately
  • N/A

• Drilling location GPR Scanned prior

  Yes

  No

  N/A

• Customer signed ticket prior to drilling

  Yes

  No

  N/A