Aegion FIELD SITE INSPECTION Form rev 1

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• General Data:

• Office

• Supervisor

• Work description

• Subcontractors Onsite

• Is the subcontractor approved?

  Yes

  No

  N/A

General Area

• Daily JSA complete and reviewed with workers

  Yes

  No

  N/A

• Workers instructed on site hazards and controls

  Yes

  No

  N/A

• Subs name

• Toolbox meeting conducted

  Yes

  No

  N/A

• Observations being conducted

  Yes

  No

  N/A

• Workers properly trained

  Yes

  No

  N/A

• Workers know Emergency Action Plan

  Yes

  No

  N/A

• Do employees know where the muster point is located?

  Yes

  No

  N/A

• Sufficient supply of PPE

  Yes

  No

  N/A

• First Aid on site, workers know location

  Yes

  No

  N/A

• Workers have Health Bridge Number

  Yes

  No

  N/A

• Are there sufficient first aid supplies in medical kits?

  Yes

  No

  N/A

• SDS available or accessible

  Yes

  No

  N/A

• Fire Extinguisher Onsite

  Yes

  No

  N/A

• Have the fire extinguisher been regularly inspected?

  Yes

  No

  N/A

• Underground utilities identified by one call

  Yes

  No

  N/A

• Add media

  Media

Electrical

• All extension cords inspected and tagged

  Yes

  No

  N/A

• Are rectifiers properly grounded?

  Yes

  No

  N/A

• How did you verify?

  Yes

  No

  N/A

• Generators grounded

  Yes

  No

  N/A

• GFCI in use

  Yes

  No

  N/A

• LOTO equipment available

  Yes

  No

  N/A

• Add media

  Media

Equipment

• Equipment inspections completed and documented

  Yes

  No

  N/A

• All guards installed

  Yes

  No

  N/A

• Derricks/booms lowered while moving equipment

  Yes

  No

  N/A

• Chains, tie downs, ropes inspected

  Yes

  No

  N/A

• Have PM's been completed on all equipment

  Yes

  No

  N/A

• Equipment is sufficient distance (min 20') from overhead lines

  Yes

  No

  N/A

• Add media

  Media

Personal Protective Equipment

• Are all employees wearing required amount

  Yes

  No

  N/A

• Safety glasses/goggles<br>Hart Hat<br>Ear plugs<br>Safety Boots<br>Reflective vests<br>FRC's<br>Face Shields

  Yes

  No

  N/A

• Is it being worn correctly

  Yes

  No

  N/A

• Is it appropriate for the hazards

  Yes

  No

  N/A

• Working near navigation waterways

  Yes

  No

  N/A

• Respirators required

  Yes

  No

  N/A

• Full Face Respirators<br>Half Face respirators<br>N95 Respirators<br>Dust Masks

  Yes

  No

  N/A

• Have they been medically cleared?

  Yes

  No

  N/A

• Have they been fit tested within the last 12 months?

  Yes

  No

  N/A

• Are the noise levels above 85 dB?

  Yes

  No

  N/A

• Are they wearing hearing protection?

  Yes

  No

  N/A

• Is it available?

  Yes

  No

  N/A

• Add media

  Media

Hand Safety

• Are employees aware of hazards

  Yes

  No

  N/A

• Have employees been trained in hand safety

  Yes

  No

  N/A

• The appropriate gloves available

  Yes

  No

  N/A

• Leather<br>Bulldog leather<br>Jersey or Knit<br>Skinny dipped<br>Kevlar<br>Skinny Dip Kevlar<br>PVC or Chemical

  Yes

  No

  N/A

• Pinch points identified on JSA

  Yes

  No

  N/A

• During cutting activities are Kevlar gloves on non cutting hand

  Yes

  No

  N/A

• Add media

  Media

Fall protection

• Equipment inspections completed

  Yes

  No

  N/A

• Fall plan required

  Yes

  No

  N/A

• Rescue plan verified

  Yes

  No

  N/A

• Is equipment appropriate

  Yes

  No

  N/A

• Add media

  Media

Excavation

• Competent person on site

  Yes

  No

  N/A

• Excavation inspection completed

  Yes

  No

  N/A

• Excavation guarded appropriately

  Yes

  No

  N/A

• Shoring<br>Trench box<br>Bell Hole<br>Slope<br>Bench

  Yes

  No

  N/A

• Adequate means of entry and egress

  Yes

  No

  N/A

• Excavation site secured

  Yes

  No

  N/A

• Add media

  Media

Confined Space Entry

• Permit required?

  Yes

  No

  N/A

• Permit in place and completed?

  Yes

  No

  N/A

• Gas monitor available and calibrated

  Yes

  No

  N/A

• Rescue plan in place

  Yes

  No

  N/A

• Add media

  Media

Vehicle Safety

• DOT logbooks up to date

  Yes

  No

  N/A

• Pre trip inspection completed

  Yes

  No

  N/A

• Vehicles clean and orderly

  Yes

  No

  N/A

• Add media

  Media

Other

• Anything removed from service

  Yes

  No

  N/A

• Items requiring repair

  Yes

  No

  N/A

• Safety concerns

  Yes

  No

  N/A

• Comments

  Yes

  No

  N/A

• Add media

  Media

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign