Allegheny Contracting Distribution Jobsite Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

• Crew Leader

• Crew Members

• Job Number

• Summary of Work

General

• Crew Leader Offered JSA for Review.

  Safe

  At Risk

  N/A

• Work Area Marked with Proper Signs.

  Safe

  At Risk

  N/A

• Flagger(s) Present If Necessary.

  Safe

  At Risk

  N/A

• Buffer Zones Established.

  Safe

  At Risk

  N/A

• Work Area Setup For Pedestrian Traffic.

  Safe

  At Risk

  N/A

• Vehicle Warning Lights Operating.

  Safe

  At Risk

  N/A

• Equipment Wheels Chocked.

  Safe

  At Risk

  N/A

• Keys Out of Vehicle Ignitions.

  Safe

  At Risk

  N/A

• Housekeeping - Vehicles

  Safe

  At Risk

  N/A

• Housekeeping - Work Zone

  Safe

  At Risk

  N/A

• Excavation Protected by Cones and/or Barriers.

  Safe

  At Risk

  N/A

• Monthly Safety Equipment Inspection Record Completed

  Safe

  At Risk

  N/A

• DOT Daily Inspection Completed

  Safe

  At Risk

  N/A

• Proper Vehicle Placement (Parked In Correct Direction)

  Safe

  At Risk

  N/A

Personal Protective Equipment

• Eye Protection.

  Safe

  At Risk

  N/A

• Head Protection.

  Safe

  At Risk

  N/A

• Foot Protection.

  Safe

  At Risk

  N/A

• Face Protection.

  Safe

  At Risk

  N/A

• Hand Protection.

  Safe

  At Risk

  N/A

• Fall Protection.

  Safe

  At Risk

  N/A

• Hearing Protection.

  Safe

  At Risk

  N/A

• Proper Clothing.

  Safe

  At Risk

  N/A

• High Visibility Clothing.

  Safe

  At Risk

  N/A

• All PPE in Clean & Serviceable Condition.

  Safe

  At Risk

  N/A

Excavation Safety

• No Mechanical Equipment in Tolerance Zone.

  Safe

  At Risk

  N/A

• Hand Dig Around Other Buried Facilities.

  Safe

  At Risk

  N/A

• Atmospheric Monitoring (CGI) When Crew Members In Excavation

  Safe

  At Risk

  N/A

• O2 Monitors Used and In Breathing Zone

  Safe

  At Risk

  N/A

• Egress Provided For +4 Feet Deep.

  Safe

  At Risk

  N/A

• Means of Egress Within 25 Feet of Employees.

  Safe

  At Risk

  N/A

• Ladder Extends 3 Feet Out of Excavation.

  Safe

  At Risk

  N/A

• Trench is not Greater Than 20 Feet Deep<br>Unless PE Designed Protective Systems.

  Safe

  At Risk

  N/A

• Shoring Extends 18" Above Edge of<br>Excavation (When Required).

  Safe

  At Risk

  N/A

• Spoil Pile, Tools and Equipment Placed 2 Feet<br>From Edge of Excavation.

  Safe

  At Risk

  N/A

• Shoring Space/Sloping in Greater Than 5 Feet<br>Depth.

  Safe

  At Risk

  N/A

• Precautions Taken to Protect Workers from Accumulation of Water.

  Safe

  At Risk

  N/A

Tools and Equipment

• Condition of Tools.

  Safe

  At Risk

  N/A

• Air Hoses and Fittings in Good Condition/<br>Properly Restrained.

  Safe

  At Risk

  N/A

• Ladder Available and Secured Properly.

  Safe

  At Risk

  N/A

• Equipment Calibrated.

  Safe

  At Risk

  N/A

• Guards on All Portable Tools.

  Safe

  At Risk

  N/A

Ergonomics

• Employees Away From Pinch Points.

  Safe

  At Risk

  N/A

• Proper Lifting Techniques Used.

  Safe

  At Risk

  N/A

• Employees Positioned Away From Moving Equipment and Parts.

  Safe

  At Risk

  N/A

• Proper Body Mechanics.

  Safe

  At Risk

  N/A

Suspended Load Operations

• Workers Prohibited from Working or Walking Under Suspended Loads.

  Safe

  At Risk

  N/A

• Lifting Devices In Safe Condition.

  Safe

  At Risk

  N/A

• Proper Rigging.

  Safe

  At Risk

  N/A

• Properly Load Rated.

  Safe

  At Risk

  N/A

Chemical Safety

• Chemical Information Available (SDS).

  Safe

  At Risk

  N/A

• Containers in Good Condition.

  Safe

  At Risk

  N/A

• Containers and Secondary Containers Are<br>Properly Labeled.

  Safe

  At Risk

  N/A

• Containers Closed and Sealed.

  Safe

  At Risk

  N/A

• Flammables in Safety/Approved Cans.

  Safe

  At Risk

  N/A

Electrical Equipment

• Cords Free of Cuts/Damage.

  Safe

  At Risk

  N/A

• GFCIs Used on all power supplies.

  Safe

  At Risk

  N/A

• Grounding Pin on Extension Cords and Power<br>Tools in Place.

  Safe

  At Risk

  N/A

Fire Protection/First Aid

• Fire Extinguisher Positioned Properly.

  Safe

  At Risk

  N/A

• Fire Extinguisher Inspected Monthly.

  Safe

  At Risk

  N/A

• Fire Extinguisher Tag Current.

  Safe

  At Risk

  N/A

• First Aid Kit Available and Inspected Monthly.

  Safe

  At Risk

  N/A

• Bloodborne Pathogens Kit Available.

  Safe

  At Risk

  N/A

• Any other findings noted in audit

  Yes

  No

• Any Best Practices or Safe Acts Noted In Audit

  Yes

  No