Title Page
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Jobsite
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Conducted on
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Prepared by
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Material:
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Pump Type:
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Foremen:
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Is PPE being worn correctly?
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Was a radio check done before starting?
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Choker cables in place?
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Coupler clamps secured with pins/wires?
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Danger cones at hose connections?
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Proper Danger / Caution signage used?
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Plastic sleeves located at each hose connection?
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Is housekeeping being done?
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Is shut-off valve located at the alum injection valve, not at the nozzle, and is controlled by the floor man?
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Is Blow out ball in place?
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What size is the blow out ball?
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Has the lift / scaffold been inspected?
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Is total hose length under 400'?
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What is the total length of hose?
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Notes
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Inspector signature
