Citywide Paving Inc.

• Competent Person

• Conducted on

  Date

• Conducted by

• Location

• Weather

1.0 Workplace

• 1.1-Code 753 (Mark Outs)

  Yes

  No

  N/A

• 1.2-Inspector

  Yes

  No

  N/A

• 1.3-Competent Person

  Yes

  No

  N/A

2.0 Administrative

• 2.1- Documentation of Job Briefing

  Yes

  No

  N/A

• 2.2- HASP on-site & current

  Yes

  No

  N/A

• 2.3- Air Monitor Calibrated & Log

  Yes

  No

  N/A

• 2.4- Current permits posted & visible

  Yes

  No

  N/A

• 2.5- Complete Job Package on-Site

  Yes

  No

  N/A

• 2.6- First Aid Kit/Blood Bourne Pathogen Kit on-site & current

  Yes

  No

  N/A

• 2.7-Spill Kit on-site

  Yes

  No

  N/A

• 2.8-Fire extinguisher visible, Inspected, & immediately available

  Yes

  No

  N/A

• 2.9- Current RWLB matrix posted

  Yes

  No

  N/A

3.0 Work Area Protection

• 3.1-Flagger present

  Yes

  No

  N/A

• 3.2-Barricades/Cones/Stanchions complete & in compliance

  Yes

  No

  N/A

• 3.3-MUTCD signs in use where required

  Yes

  No

  N/A

• 3.4-Arrow board operating & in use when applicable

  Yes

  No

  N/A

• 3.5-Pedestrians provided with a safe & clear path of travel

  Yes

  No

  N/A

• 3.6-Plates Pinned, ramped, flush, skid resistant, & in compliance

  Yes

  No

  N/A

• 3.7-Slings & chains in good condition

  Yes

  No

  N/A

• 3.8-Rubber Electrical Gloves (KV) dated with expiration date

  Yes

  No

  N/A

• 3.9-Proper PPE in use

  Yes

  No

  N/A

• 3.10-Vehicle's engine turned off (Idling regulations)

  Yes

  No

  N/A

• 3.11-Wheels chocked when truck on standby

  Yes

  No

  N/A

• 3.12-All tools in good condition

  Yes

  No

  N/A

• 3.13-Adequate set-up

  Yes

  No

  N/A

• 3.14-Housekeeping in place on-site & in trucks to prevent slips, trips, and falls

  Yes

  No

  N/A

4.0 Excavation

• 4.1-Spoils & equipment 2' away from excavation

  Yes

  No

  N/A

• 4.2-Gas monitoring when required

  Yes

  No

  N/A

• 4.3-Ladders used at 4' depth or greater and extending at least 3' above landing

  Yes

  No

  N/A

• 4.4-Ladders in place every 25' of lateral travel

  Yes

  No

  N/A

• 4.5-Shoring/sheeting when required

  Yes

  No

  N/A

• 4.6-Daily excavation inspection conducted

  Yes

  No

  N/A

• Notes/Other:

Sign off

• On-site Representative

• Auditor's signature

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