A-Core Highway Division - Jobsite Audit

• Division

  Select

• Audit Title:

• Conducted on:

  Date

• Prepared by:

• Document Number:

• Customer / Project Name / Job Number:

• Highway Office:

• P.M., Supervisor, or Crew Lead on job:

• A-Core Personnel on job: Operators, Drivers, Sealers, and Laborers:

Introduction

• This inspection/audit has been undertaken by A-Core's Safety Department. The purpose of the inspection/audit is to ensure the Highway Division's compliance with the Health and Safety at Work Act 1974 and any relevant subordinate legislation, including but not restricted to, OSHA Standards. The report aims to identify any areas where A-Core's Highway Division needs improvement to meet the requirements of all relevant health and safety regulations and industry best practice procedures.

General project information & Safety Requirements

• Project Type

  Select Highway City Streets Airports & AirBase Commercial

  • Highway
  • City Streets
  • Airports & AirBase
  • Commercial

• Green, Rehab, or Panel Replacement

  Saw & Seal

  Rehab

  Panel Replacement

• Are there any subcontractors (other contractors) on site

  Yes

  No

  N/A

• Contractors on site

• Other Contractors on site putting A-Core Personnel at risk

  Yes

  No

  N/A

• What risk(s) or hazards is A-Core Personnel exposed to

1. Site / Enclosure

• Access/Egress

  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

• Site Tidiness

  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

• Overall site appearance & set up

  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

• Traffic Control set up

  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

• Appropriate signage indicating construction zone

  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 vehicles set up to protect 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

• Crash Truck in place and in safe location

  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

• Pedestrian Segregation

  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

• Safe Working Area/Exclusion Zone

  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

2. A-Core Vehicles & Trailers

• A-Core vehicles and equipment maintained in clean orderly fashion

  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

• All A-Core vehicles have DVIR completed daily

  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 or Whoopie lights on vehicles working

  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

• Back up alarms 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

• Necessary placard's utilized (Hot Pour Machine)

  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

• Tires appear to be in safe operating 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

• Registration current and compliant with state laws

  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

• Vehicles & Trailers are compliant with DOT regulations (Registration, Extinguishers, First Aid, Triangles, 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

• Drivers are compliant with DOT 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

3. First Aid

• First Aid Kits accessible

  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

• Supply's adequate for manpower

  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

• CPR / First Aid Certified Personnel 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

4. PPE

• Hard Hats worn by all personnel (Unless wind is gusting high enough that they become a hazard)

  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 Glasses worn by all personnel

  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 Vests worn by all personnel

  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

• Proper foot protection worn by all personnel

  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 by all personnel exposed to high noise levels

  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

• Respirator or Dust Masks worn by personnel exposed to silica dust

  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

• Leather Chaps or Apron worn during Hot Seal Operations

  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

• Adequate PPE supplies 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

5. Fire Prevention

• Fire Plan Developed

  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

• Extinguishers adequate for job type and risk

  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

• Extinguishers are inspected and compliant

  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

• Personnel on site aware of plan and their role if a fire starts

  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

• All Vehicles, Mobile Machinery, and Hot Pour Machines equipped with extinguishers

  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

6. Core Drilling

• Operating any Core Drill on site

  Yes

  No

  N/A

• All necessary PPE

  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

• No 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

• LOTO procedures followed

  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

• All tools are inspected before 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

• 110v, 220v, and 480v power tools compliant

  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 compliant

  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

• Hydro Drills compliant

  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 Drilling no larger than 3" diameter

  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

• Ride it Drills inspected prior to use and 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

• Operator has been trained on safe Drilling Operations

  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

7. Ride It Saw, Flat Saw, Demo Saw

• Crew is Operating Ride it Saw, Flat Saw, or Demo Saw on job

  Yes

  No

  N/A

• Daily Saw Inspections before use - Ride it Saw, Flat Saw, Demo Saw

  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

• Hub, Bolt, and Blade(s) 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

• All necessary guards are 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

• LOTO safe practices are followed

  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

• Saws are greased and oil levels checked

  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

• Belts are tensioned 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

• Integrated Water Delivery System in use with adequate water supply to eliminate silica dust

  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

• Water hose, fittings, and pumps 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

• Operators deemed competent

  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

• Legal Slurry removal and disposal methods

  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

• SWWP in place to prevent slurry entering drains

  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

8. Deep Saw Cutting

• Deep Flat Saw or Deep Ride it Saw Cutting

  Yes

  No

  N/A

• Operator is competent running spinning large diameter blades

  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 step cutting practices are followed

  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

• Saw is inspected & maintained 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

• Blades are 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

• Blade Hub, Bolt, and Blade Shaft 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

• All guards are 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

• Blade RPM as per Manufacturers recommendation

  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

• All Silica and Slurry are eliminated 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

9. Joint Preparation

• Pressure Washing

  Yes

  No

  N/A

• Pressure washer 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

• Hose and wands inspected prior to use and are in safe operating 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

• Safe fueling procedures followed

  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 tip used

  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

• PPE requirements met and followed

  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

• Effective communication when moving water truck or tank

  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

• Sand Blasting

  Yes

  No

  N/A

• Air Compressor 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

• Sand Pot 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

• Sand Blast Hose 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

• Face Shield used

  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 Respirator used

  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 used

  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 planning in place to avoid damaging cars or pedestrians

  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

• Hook Crew

  Yes

  No

  N/A

• All necessary PPE used

  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

• Personnel are aware of their surroundings

  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

• Stretch and Flex to prevent strains and sprains

  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

• Backer Rod being installed

  Yes

  No

  N/A

• Crew is aware of surroundings

  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

• Crew communicates and watches their backs when working near traffic

  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

• Blowing Joints

  Yes

  No

  N/A

• Air Compressor 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

• Air hose and wand 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

• Whip Checks used (or approved alternative)

  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

• Face Shield and safety glasses being used

  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 Respirator being used

  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 used

  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 planning to prevent damage to vehicles or pedestrians

  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

• Driver is focused and attentive on blower

  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

10. Vacuum

• Vacuum Truck is being used

  Yes

  No

  N/A

• Truck is 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

• Driver has been trained and deemed competent

  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

• All Oil levels have been checked

  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

• Legal dump site used to empty vacuum

  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

• PPE worn when washing/cleaning back of 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

• Vac-Tron is being used

  Yes

  No

  N/A

• Vacuum is 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 been trained and deemed competent

  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

• Hose and Wand inspected and in safe operating 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

• Hearing protection worn during 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

• All Oil levels have been checked

  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

• Legal dump site used to empty vacuum

  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

• PPE worn when washing/cleaning back of tank

  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

11. Joint Sealant

• Hot Pour Joint Seal application

  Yes

  No

  N/A

• Machine 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

• Oil temperature monitored in safe operating temp

  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

• Safe back suck procedures followed

  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

• Safe machine filling procedures followed

  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 PPE used during operation

  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

• Driver is focused and attentive to sealer

  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

• Seal wand and hose 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

• Burn Kit available

  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

• Fire Extinguisher readily available on machine

  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

• Sealer and Driver are deemed competent

  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

• Silicone Joint Seal application

  Yes

  No

  N/A

• Silicone Pump 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

• SDS for joint seal product available

  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 PPE used during operation and when changing barrels

  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

• Driver is focused and attentive to sealer

  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

• Whip Checks used

  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

• Air Compressor inspected prior to use and oil levels checked

  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

• Air Pressure maintained at safe operating levels

  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

• All gauges are in safe operating 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

• Seal wand and hose 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

• Sealer and Driver are deemed competent

  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

• Compression Seal application

  Yes

  No

  N/A

• Seal Machine 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

• Machine is set up for seal width and depth

  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 for glue available

  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 PPE used during operation

  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

• Safe Lifting Measures in place when handling large rolls of seal

  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

  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

12. Dowel Bars

• Utilizing Rock Drill Machine

  Yes

  No

  N/A

• Rock Drill 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

• Steel and Drill head 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

• Air Compressor 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

• Hoses and Fittings 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

• Whip Checks (or approved alternative) used

  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 Equipped, vacuum system in proper 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

• All necessary PPE worn - Eye protection, Respirator, Gloves, Hearing Protection, 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

• Others exposed to silica are wearing proper PPE

  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

• Dowel Bar Installation

  Yes

  No

  N/A

• Epoxy machine 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

• SDS available

  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

• All necessary PPE worn - Gloves, Eye protection, respirator if SDS calls for it, 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

13. Spall Repair

• Crew is repairing spalls on job

  Yes

  No

  N/A

• Silica Dust is eliminated or proper PPE being used when Saw Cutting

  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

• Silica Dust is eliminated or proper PPE being used when jackhammering, chipping, 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

• Silica Dust is eliminated or proper PPE being used when blowing

  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 mixing patch material, proper PPE being used

  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 available for patch material

  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

• Crew is maintaining a clean jobsite

  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

14. Demolition

• Crew is removing concrete on job

  Yes

  No

  N/A

• Safe Demolition practices are being used

  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

• Machinery is inspected prior to use each day

  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

• Machinery is adequate for the task

  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

• Operators are trained to operate the machinery being used

  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

15. Other Divisions

• Other A-Core Divisions on site

  Service Division

  Demolition Division

  Grinding & Grooving

  Concrete Pouring

• Are other Divisions aware of known hazards on this project

  Yes

  No

  N/A

• What known hazards have not been communicated?

• What will be done to ensure proper safety communication is done

16. Documentation

• Superintendents conduct and document daily JHA's and weekly toolbox talks with all A-Core Personnel 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

• Daily Paperwork/Diary/Photos 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

• If applicable, are all necessary permits obtained and are current

  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

• Training Records

  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

17. Comments / Observations / Workforce Feedback

• undefined

• undefined