Civil Inspector Daily Log

Title Page

Site conducted
Conducted on
PM Number
Notification Number (If multiple Notification numbers separate them by a comma.)
OIS Number
Inspector Name
Inspector LanID
Following the Lone Worker Requirements, do you have your device (i.e. Beacon or similar device) with you at all times and turned on?
Why don't you have one?
- I have never been issued one.
- I lost it.
- The battery doesn't hold a charge.
- It has been stolen. (i.e. Truck broken into.)
- Other - Add comments below.
Division
Group Location
MAT
Contractor Name (include subcontractor name if applicable)
Crew Foreman's name (First & Last)
Crew Size
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
- 31
- 32
- 33
- 34
- 35
- 36
- 37
- 38
- 39
- 40
- 41
- 42
- 43
- 44
- 45
- 46
- 47
- 48
- 49
- 50
- 51
- 52
- 53
- 54
- 55
Was there a Safety Professional present on the job site? (If so add their name/s)
What equipment was on-site?
Work Location
Job Scope
Circuit/Voltage (For Civil Work only if you are not working on an actual Circuit add N/A)
AFW Type and Switch log number (For Civil Work only if you are not working on an actual Circuit add N/A)
Was job found completed on arrival? (If YES, mark all questions N/A on the next page.)
Was the job cancelled? (If YES, give reason)

General Safety

1.0 Did you attend crew tailboard?
1.1 Was all required PPE used?
1.2 Were all Covid protocols followed? Mask, social distancing, visitor log etc
1.3 Was PSP (Programmatic Safety Plan) or PSSP (Project Site Safety Plan) on site?
1.4 Were adequate fire mitigation measures in place (per TD1464S)
1.5 Were safe worksite practices used including use of spotters, wheel chocks, parking brakes, outriggers, booms/buckets/forks lowered when parked or stored
1.6 Was traffic control needed? If so, was traffic control safe and effective?
1.7 Were there any issues with material availability?
1.8 Was any equipment leaking? If so, was environmental contacted?
1.9 Was Vegetation clearing needed (4' minimum clearance) and completed? Tag created if necessary?
1.10 Was a QEW required? Include QEW name or LAN ID.

2.0 Valid USA ticket on site? Please record ticket number. (Add photos of marks on USA ground)
2.1 Does the crew have valid permits to perform work? Encroachment, traffic control, etc?
2.2 PG&E Gas Ops on standby when excavating within 10 feet of known gas transmission line?
2.3 Air monitors in place, tested, calibrated and operational?
2.4 Potholing of existing utilities along proposed route performed?
2.5 Was any trenching needed?
2.6 Correct trench width used for conduit install?
2.7 Correct trench depth to achieve the minimum depth of cover over conduit once installed?
2.8 Utility crossing separation adequate?
2.9 Correct size conduit and type installed?
2.10 Concrete encasement requirements met?
2.11 Minimum conduit cover met?
2.12 What was the total amount of Primary Conduit (Feet) installed today?
2.13 Backfill requirements per PG&E and city specifications met?
2.14 Compaction and compaction testing performed?
2.15 Restoration requirements per City Standards planned or completed?
2.16 Correct sized mandrel used to mandrel conduit, and every conduit installed to be mandreled?

3.0 Was shoring installed for excavation deeper than 60''? If yes, what type of shoring was used?
3.1 Soil conditions reviewed/tested including identifying any soil classified as less stable due to factors like heavy traffic, pile driving etc.?
3.2 1-1/8” plywood sheeting used when needed per soil conditions evaluated by onsite competent person?
3.3 Trench box rated for excavation size and depth?
3.4 Rated rigging used during assembly and handling of shoring shields?
3.5 Equipment sized correctly while assembling and handling shoring shields?

4.0 Was boring needed? (If answer is NO, select N/A as the answer to questions 4.1 - 4.10)
4.1 Does the city allow bore operations within their jurisdictions?
4.2 Cross bore of sewers completed?
4.3 Potholing of existing utilities and size, type, top and bottom recorded on the street and in a potholing log?
4.4 Calibration of Sonde (tracking instrument) prior to bore operation?
4.5 Ample separation of existing utilities given during bore operations?
4.6 Return flow maintained during reaming and product pulling operations?
4.7 Daylight utilities while boring past or reaming back operations ?
4.8 Correct mud and polymer used per soil conditions?
4.9 Product installed at depth per design and standard?
4.10 Correct control and disposal of bore tailings and mud?

5.0 Correct size and type of enclosure installed per design?
5.1 Correct rated lid type and enclosure for the equipment being installed and area it is placed
5.2 Crushed rock base section placed?
5.3 Adequate compaction around enclosure perimeter?
5.4 Conduit placed in correct knockouts?

6.0 Did outage end on time? If not, why?
6.1 Was all work completed as planned (ready for closeout) or in progress over multiple days?
6.2 Did you encounter issues during planning or execution of the job? Include recommendations to prevent recurrence?
6.3 Was the job built to PGE safety, quality, and compliance standards? Describe any issues.
6.4 Attach multiple photos (Minimum 8) - These photos should capture work being completed at each location.
6.5 How many questions were marked Red?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
- 31
- 32
- 33
- 34
- 35
- 36
- 37
- 38
- 39
- 40
- 41
- 42
- 43
- 44
- 45
- 46
- 47
- 48
- 49
- 50
- 51
- 52
- 53
- 54
- 55
Signature