Information
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Asphalt Plant Name
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Asphalt Plant #
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Employee(s) that work at this plant
Employee
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Employee Name:
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Conducted on
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Prepared by:
- Mike O'Neil
- John Bartkowski
- Rob Carrington
- Cal Beyer
- Risty Van Ogle
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Location
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ASPHALT PLANT SAFETY OBSERVATIONS:
Safety Observation
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NOTES:
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PERSONAL PROTECTIVE EQUIPMENT:
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Hard hat
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Safety glasses
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Proper gloves
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Composite toed boots
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Does plant personnel coveralls have reflective tape sewn on it?
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Does plant personnel all have radio communication to communicate with each other?
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Hearing Protection
Type of device
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Type of Device
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Respiratory Protection (Clean and Stored Properly)
Respiratory device
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Is Respirator(s) Clean and Stored Properly?
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Mask
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Compliant with NFPA 70E PPE
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Assured Grounding Program or Ground-Fault Circuit Interrupter (WAC 296-155-447)
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Fall Protection Training (WAC 296-155 Part C-1)
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Confined Space Policy (WAC 296-809)
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Lock-out/Tag-out Policy (WAC 296-803)
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Respiratory Protection Policy (WAC 296-842)
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Chemical Hazard Communication Policy (WAC 296-800-170)
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Heat Stress Program (WAC 296-62-095)
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Has a designated hardhat area been painted out or designated for your site?
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Has the Silo clearance height been posted under or around Silo's?
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Is Supervisors’ First Aid/CPR cards up to date
General safety practices
1
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Good House Keeping
House Keeping Area
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Is the plant keeping good house keeping practice
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House Keeping
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2
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Are extra hard hats, safety glasses and vests available for everybody making a plant visit
PPE For Plant Visitors
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Are extra hard hats, safety glasses and vests available for everybody making a plant visit
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Extra safety glasses and vest
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3
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Has Confined space air monitor been bump tested before each uses:
Confined Space Monitor
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Has Confined space air monitor been bump tested before each use:
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Air Monitor
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4
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Confined Space Paperwork:
Paperwork
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Is Their Confined Space Paperwork Completed Correctly:
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Confined Space Paperwork
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5
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Hot Work Permit:
Paperwork
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Is Their Hot Work Permit Completed Correctly:
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Hot Work Permit:
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6
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Does plant have an emergency evacuation plan in place
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7
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Are plant personnel familiar with emergency procedures
8
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Are First-Aid Kit Fully Stock & Available
First-Aid Kit
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First Aid kit
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First Aid Kit
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9
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Pressure Vessels Inspection Certification
Pressurized Vessel
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Is the Pressure Vessels Inspected Certification Up To Date:<br><br><br><br><br><br><br>
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Pressure Vessel
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10
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Are all compressed gas bottles separated by type, flammable, and nonflammable and separated by a minimum of 20 feet:
Compressed Gas bottles
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Are all compressed gas bottles separated
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Bottles
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11
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Is a back flash arrester in place on all Oxy-acetylene tanks?
12
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Are the valve protection caps covering the valve stems of tanks?
13
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Flammable and combustible liquids separated and stored in a fireproof cabinet:
Flammables & Combustibles
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Are flammable and combustible liquids separated and stored in a fireproof cabinet:
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Flammables and Combustible liquids
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14
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Air compressors need to have service record
Air Compressor
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Do all Air compressors have service record
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Air compressor
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15
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All secondary container (Oil, kerosene , diesel , release agent, etc.) must be labeled indicating the contents and hazard associated with the material
Container
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All secondary container (Oil, kerosene , diesel , release agent, etc.) must be labeled indicating the contents and hazard associated with the material
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Secondary Container
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16
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All handtools, compressors and any other moving parts such as drive motors must have guards in place
Guards
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Guarding in place
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Guards
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17
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Are guards on bench grinders adjusted within 1/8th of an inch from the grinding wheel or brush?
18
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Is the spark arrester and the tool rest in place and properly adjusted on bench grinder?
19
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Are hand and power tools in good working condition
Tools
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Are hand and power tools in good working condition
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Hand or Power Tool
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20
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Has extension cords been inspected replace when pins, cut or damaged:
Extension Cords
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Are the extension cords that are being used in good condition
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Extension Cord
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21
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All storage tanks need to have stickers installed on all sides, "No Open flames/combustible" sticker needed when applicable
Storage Tanks
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Does tank have a sticker identifying what it contains<br><br><br><br><br><br><br>
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Type of Storage Tank
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22
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Are liquid asphalt storage tanks have walkways guarded with handrails. If the walkways are not used, they must be removed or blocked to avoid a fall from occurring.
Asphalt Storage Tanks
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Does liquid asphalt storage tanks walkway have handrails:
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Asphalt Oil Storage Tank
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23
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Are emergency showers functional and signed properly:
Drench showers
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Are emergency showers functional and signed properly:
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Drench Shower
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24
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Are emergency showers area clear of all debris that may hinder access?
Drench showers
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Emergency showers area:
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Drench Shower Area
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25
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Is the emergency drench showers located in the proper area:
Drench showers location
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Emergency showers located in properly (Not in an area that a tank overflow would cover the shower area):
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Drench Shower Location
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26
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Are upload valves to oil tanks Marked so you can tell if they're on or off?
Upload valves to asphalt oil tanks
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Are the valves to asphalt oil tanks marks properly?
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Valves to asphalt Oil Tanks
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27
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Are ladders being used in good working condition with readable label and a means to tie them up when in use:
Ladder
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Ladders in good working condition, readable label, means to tie them up when in use:
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Ladder
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28
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Has fire extinguisher been inspected and signed off on a monthly basis:
Fire Extinguisher
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Has fire extinguisher been inspected and signed off on a monthly basis:
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Fire Extinguisher
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29
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Fall Protection Needs to be inspected on a regular basis and replaced when needed:
Fall Protection Device
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Fall Protection Inspection
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Does Fall Protection have an in service date?
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30
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Confined Space stickers or signs needed at all entry way to any confined space:
Confined Space
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Are Confined Space stickers or signs at all entry way to any confined spaces:
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Confined Space
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31
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Are walking and working area free of slips, trips and fall hazards
Walking & Working Surfaces
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Are walking and working area free of slips, trips and fall hazards
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Surfaces
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32
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Has all exposed shaft ends that protrude more than a 1/2" been guarded:
Exposed Shaft Ends
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Has all exposed shaft ends that protrude more than a 1/2" been guarded
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Exposed Ends
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33
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All moving belts must be protected
Protection use for moving belt
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Are all belts protected
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Moving Belt
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34
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Electrical Control Panel (Can not have any missing panels, every breaker labeled & if it's in active it must be label)
Electrical Panel
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Control Panel
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Panel
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35
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Wire Throughout the plant must be protected
Electrical Wire
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Is Wire Throughout the plant protected ( when traveling over & through metal framework )
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Electrical Wire
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36
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Electrical wiring connections into motor junction boxes, MCC boxes, etc.
Electrical Connections
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Are all electrical wiring connections into motor junction boxes, MCC boxes, etc. with appropriate couplers
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Electrical Connections
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37
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Is the truck spray racks free of any hazards
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38
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Is the ticket access racks free of any hazards
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39
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Plant vehicle inspected report
Pre & Post Trip Inspection Report
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Has Vehicle been documented on a daily basic:
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Vehicle
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40
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Plant Equipment inspected report
Pre & Post Trip Inspection Report
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Has Equipment been documented on a daily basic:
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Equipment
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41
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Plant signage in place (CB Channel, Hard hat area, Ect.)
Sign
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Are all required plant signage in place:
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Sign
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42
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Man Lift / All terrain reach truck Inspection
Man lift / Reach Truck / Forklift
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Are Man Lift / Forklift /All terrain reach truck been Inspected on a daily basic:
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Lifting Equipment
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43
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Is man basket been certified and approved for use?
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44
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Rigging Hardware Inspection
Rigging Devices
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Has all rigging hardware been inspected:
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Rigging Hardware:
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45
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Arc Flash
Labels, Rubber Gloves, Clothing
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Is Arc flash protection in place:
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Labels, Rubber gloves, Fire retardant clothing, Ect.
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46
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Misc item
Misc. Item
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Is miscellaneous item in compliance
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Description of miscellaneous items:
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WORK PRACTICE'S OBSERVE:
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Work Practices Observed
Work Practice Observation
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Work Practices Observed
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Is follow-up Audit needed within the next 30 days?
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If Yes, Why is follow-up needed?