ADB Field Assessment

• Document No.

• Crew leader/foreman

• Conducted on

  Date
• Location
  Address

• Client / Site

• Weather conditions

• Prepared by

General

• Pre-task cards reviewed by work crew? (At Risk = AUTO FAIL)

  Safe

  At Risk

  N/A

• Safe access to work site?

  Safe

  At Risk

  N/A

• Good house keeping?

  Safe

  At Risk

  N/A

• Fire extinguisher: good condition; current inspection tag; within 50ft?

  Safe

  At Risk

  N/A

• Utilities properly located/identified?

  Safe

  At Risk

  N/A

• First aid kit/ eye wash available?

  Safe

  At Risk

  N/A

• Barricades/debris/warning signs in place around pot holes?

  Safe

  At Risk

  N/A

Personal protective Equipment

• Hard Hats in use by all personal? (At Risk = AUTO FAIL)

  Safe

  At Risk

  N/A

• Eye protection in use by all personal?

  Safe

  At Risk

  N/A

• Reflective vest worn by all personal?

  Safe

  At Risk

  N/A

• Hearing protection in use when required?

  Safe

  At Risk

  N/A

• Proper foot wear?

  Safe

  At Risk

  N/A

Tools and Equipment.

• Tools and equipment in good condition?

  Safe

  At Risk

  N/A

• All equipment properly guarded?

  Safe

  At Risk

  N/A

• Electrical equipment connected properly, grounded and in good condition. GFCI automatic cut-off for woodworking tools?

  Safe

  At Risk

  N/A

• Machine guards/pinch points identified and protected?

  Safe

  At Risk

  N/A

• Rigging/ lifting equipment in good condition and inspected?

  Safe

  At Risk

  N/A

• Ladders in good condition; tied back; extended 3ft beyond landing?

  Safe

  At Risk

  N/A

Heavy Equipment

• Daily inspection complete?

  Safe

  At Risk

  N/A

• Fire extinguisher mounted and in good condition?

  Safe

  At Risk

  N/A

• Seatbelt worn during operation?

  Safe

  At Risk

  N/A

• Is the equipment located in a safe location.

  Safe

  At Risk

  N/A

Worksite

• Warning devices (signs and cones) properly placed according to MUTCD?

  Safe

  At Risk

  N/A

• Safety cones in good condition and placed correctly?

  Safe

  At Risk

  N/A

• Traffic taper correctly positioned?

  Safe

  At Risk

  N/A

• Breaks set on truck/chock on unhitched trailer?

  Safe

  At Risk

  N/A

• Equipment properly secured on the truck/trailer?

  Safe

  At Risk

  N/A

Trenching and Excavations

• Excavations / trenches properly protected? (At Risk = AUTO FAIL)

  Safe

  At Risk

  N/A

• Shoring properly installed/ tabulated data on site? (At Risk = AUTO FAIL)

  Safe

  At Risk

  N/A

• Spoil piles/tools 2 feet or further away from the trench? (At Risk = AUTO FAIL)

  Safe

  At Risk

  N/A

• No standing water in the trench? (At Risk = AUTO FAIL)

  Safe

  At Risk

  N/A

• Are there proper means of egress? (4 feet or more a ladder must be used) (At Risk = AUTO FAIL)

  Safe

  At Risk

  N/A

D. O. T.

• Lights/reflectors/bacons operational?

  Safe

  At Risk

  N/A

• Truck inspection completed?

  Safe

  At Risk

  N/A

• Truck cab neat/vehicle clean?

  Safe

  At Risk

  N/A

• Trailer properly mounted and free of debris?

  Safe

  At Risk

  N/A

• Tires within acceptable depth?

  Safe

  At Risk

  N/A

• Is the Incident Report Card in the truck ?

  Safe

  At Risk

  N/A