Title Page

  • Job No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Rainfall

  • Did a stormwater event take place?

  • Amount?

Right-of-Way Construction

  • Silt Sock- installed and staked into ground before ground disturbance?

  • Super/Silt Fence- properly installed, staked into ground?

  • Top Soil- graded off ROW and piled on one side, compacted, seeded and mulched?

Everyday

  • LOD- nothing is outside of the LOD (runoff, sediment, BMP's, etc.)?

  • Silt Sock (CFS)- free of rips, tares, missing segments, sediment build up, staked into ground?

  • Silt Fence-bottom burried, free of sediment build up, material attached to stakes, not damaged?

  • Water Bars- maintained and functioning properly (catching and diverting water)?

  • Sumps- jhook installed around, free of sediment build up, proper size?

  • JHooks- located at the end of water bars/sumps, staked into ground, not damaged?

  • Bridge- silt Sock in place on sides and deck, deck clear of sediment?

  • RCE- at every access adjacent to a roadway, functioning properly, maintained?

  • Road (Private & Public)- surface clear of sediment, shovel, broom, and or road broom available?

  • Wash Rack- located in RCE, ramped access/egress, properly working?

  • Stabilized Topsoil- topsoil compacted,covered with temporary seed, and mulched?

  • Stabilized ROW- temporary/permanent seed, mulch, erosion blankets?

  • Containment-able to hold 110% of largest container's contents, less than 10% full of liquid, not damaged?

Water

  • Stream- free of foreign sediment (soil, muddy discharge), oil, trash?

  • Diversion Ditch- properly sloped, lined, rock filter outlet, discharging clean water?

  • Pumps- in containment, back up pump on site in containment, gas can in containment?

  • Silt Filter Bag- on flat vegetated surface, replacement bag available, GPM 1/2 recommended flow?

  • Wetland- easily defined by signage, fencing, flagging?

  • Refueling- 50' from top-of-stream bank and wetland?

  • Staging- hazardous materials and equipment at least 100' from top-of-stream bank and wetland?

Comments

  • Comments

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.