CONCO PUMPING

• Conducted on

  Date

• Prepared by

• Location
  Address

Evaluation Info:

• Operator Name:

• Trainer Name:

• Pump Unit #:

• Date of Eval:

  Date

At the Yard:

General

• Operator on time?

  Yes

  No

  N/A

• Proper Attire: Long pants, boots, 3" Min Sleeves,

  Yes

  No

  N/A

Walk Around

• Fluids-Fuel / Oil / Water / Hydraulic Oil - Fill Levels and Leaks

  Safe

  At Risk

  N/A

• Tires / Mirrors / Lights

  Safe

  At Risk

  N/A

• Cover / Safety Guards in place

  Safe

  At Risk

  N/A

• Hopper clean and free of debris

  Yes

  No

  N/A

• Cab Free of debris

  Safe

  At Risk

  N/A

Pre Checks

• Required system / accessories in good condition; loaded per job ticket

  Yes

  No

  N/A

• Tools - cleanout, spill kit, etc.

  Yes

  No

  N/A

• Boom Strapped Down

  Yes

  No

  N/A

• Outriggers Pinned / in travel position

  Yes

  No

  N/A

• E-Stop function test / reset

  Yes

  No

  N/A

• Job Site identified / routed

  Yes

  No

  N/A

• Paperwork

  Yes

  No

  N/A

• PPE on board: Hard Hat, Safety Glasses, Gloves, Hi Viz, Hearing Protection

  Yes

  No

  N/A

• Cycle the pump

  Yes

  No

  N/A

Driving to the Job

• NO SMOKING

  Safe

  At Risk

  N/A

• Seatbelt fastened

  Safe

  At Risk

  N/A

• Uses turn signals appropriately

  Safe

  At Risk

  N/A

• Adequate following distance - No Tailgaiting

  Safe

  At Risk

  N/A

• Changed lanes slowly; uses mirrors in advance

  Yes

  No

  N/A

• Proper gear used up / down hills

  Safe

  At Risk

  N/A

• Understands axle interlocks and how to use

  Safe

  At Risk

  N/A

• Obeyed all traffic laws - speed / signs / lights

  Safe

  At Risk

  N/A

At the Job Site

• PPE on and being worn correctly

  Safe

  At Risk

  N/A

• Located supervisor / contact person - instroductions

  Yes

  No

  N/A

• Extends courtesy to customers and others

  Yes

  No

  N/A

• Meet hoseman and covered pour plan; reviewed communication signals with crew

  Yes

  No

  N/A

• Surveyed setup area; identified obstructions - powerlines / buried utilities / embankments / etc.

  Safe

  At Risk

  N/A

• Finds out where to wash out before pour

  Yes

  No

  N/A

• Inquired of soil conditions

  Yes

  No

  N/A

• Backed up using spotter

  Yes

  No

  N/A

• Allowed adequate access for ready mixed trucks

  Yes

  No

  N/A

Set Up

• "One-to-One Rule" applied

  Yes

  No

  N/A

• 20' / 50' Power line distances maintained

  Yes

  No

  N/A

• Requested and obtained spotter for Power lines

• Provided spotter with visual aids for safe zone identification

• Secured unit from traffic - uses traffic cones when applicable

  Yes

  No

  N/A

• Leveled ground under outrigger pad or dunnage

  Yes

  No

  N/A

• Used outrigger pads supplied with pump

  Yes

  No

  N/A

• Outriggers fully extended and jacked down (per Manufactures instructions or if company policy allows unit to be short rigged)

  Yes

  No

  N/A

• Put full weight of unit on each outrigger; tested for sinking; followed proper procedures to stabilize outriggers

  Yes

  No

  N/A

• Leveled unit within three degrees

  Yes

  No

  N/A

• Extended boom over each outrigger; tested for sinking applied sufficient dunnage

  Yes

  No

  N/A

• Attached proper system

  Yes

  No

  N/A

• Used one safety sling and pinned all clamps on each piece of system suspended from the boom

• Used flexible hose if connecting separately laid pipeline to the boom

• Secured vertical pipeline - when rewired

  Yes

  No

  N/A

• Used the "Three-Point Rule" when climbing on or off the pump, or any object

  Yes

  No

  N/A

Basic Pump Operation

• Familiar with Remotes

  Yes

  No

  N/A

• How to hook up wired remote box

• How to boot up radio remote

• Manual pump controls

  Yes

  No

  N/A

• PTO Controls

  Yes

  No

  N/A

• Agitator controls

  Yes

  No

  N/A

• Hopper grate safety switch (keep hands out of hopper)

  Yes

  No

  N/A

• Horn - E-Stop

  Yes

  No

  N/A

• Main control box (local and rear panel)

  Yes

  No

  N/A

• Understands when / how to lock rear end

  Yes

  No

  N/A

Pumping at the Job

• Instructed hoseman about proper communication; including hand signals

  Yes

  No

  N/A

• Checked hydraulic hoses for rotation

  Yes

  No

  N/A

• Unfolded boom avoiding hazards

  Yes

  No

  N/A

• Used acceptable method for priming

  Yes

  No

  N/A

• Kept all personnel clear of the discharge while priming

  Yes

  No

  N/A

• Instructed ready mixed driver to keep hopper full

  Yes

  No

  N/A

• Kept all personnel clear of the discharge if the system is opened to remove a plug / to remove system / when restarting after a delay

  Yes

  No

  N/A

• Monitored outriggers for sinking

  Yes

  No

  N/A

• Employed use of a spotter if boom was within 20' / 50' of danger zones

  Yes

  No

  N/A

• Kept the tip hose at or above hoseman's knees

  Yes

  No

  N/A

• Monitored hose for kinking

  Yes

  No

  N/A

• Operated the boom smoothly and accurately - proficient with controls

  Safe

  At Risk

  N/A

• Maintained contact with the hoseman

  Yes

  No

  N/A

Moving on the Job (if applicable)

• Surveyed new site: identified conditions / hazards

  Yes

  No

  N/A

• Folded up and secured the boom for travel

  Yes

  No

  N/A

• Outriggers retracted and pinned

  Yes

  No

  N/A

• Gear stowed; including remote (if moving faster than 10mph)

  Yes

  No

  N/A

• Cleaned out - if necessary

  Yes

  No

  N/A

• Utilized same setup procedures as previously

  Yes

  No

  N/A

Emergency Items

• Provided and understands emergency phone list and procedures

  Yes

  No

  N/A

• Heat related Injury Prevention - water, shade, recognizing symptoms and prevention

  Yes

  No

  N/A

• Accident and injury reporting

  Yes

  No

  N/A

• Switching from remote to hard wire

  Yes

  No

  N/A

• Knows how to operate hand valves

  Yes

  No

  N/A

• How to locate a plug in the system

  Yes

  No

  N/A

• How to clear plug

  Yes

  No

  N/A

• How to install patch on a blown pipe

  Yes

  No

  N/A

• Able to use retarders in concrete properly

  Yes

  No

  N/A

• Knows when / how to use sugar in concrete

  Yes

  No

  N/A

• Knows how to use spill kit

  Yes

  No

  N/A

• Knows how to use blow out cap

  Yes

  No

  N/A

Cleaning out

• Established clean out area with contractor

  Yes

  No

  N/A

• Examined clean out are for overhead power lines / soft ground / embankments / capacity

  Yes

  No

  N/A

• Used a safe method to clean out (i.e. sucking a sponge)

  Yes

  No

  N/A

• Understands water wash method

  Yes

  No

  N/A

• Kept job site personnel clear of area

  Yes

  No

  N/A

• Set the out riggers if boom is to be lifted out of the cradle

  Yes

  No

  N/A

• Flushed water box and contained (keep hands out of box)

  Yes

  No

  N/A

• Open rear discharge, clean and replace blow out cover

  Yes

  No

  N/A

• Re-Placed all safety devices / guards

  Yes

  No

  N/A

Completing the job

• Boom folded / secured for travel

  Yes

  No

  N/A

• Tip hose and reducer removed and stowed

  Yes

  No

  N/A

• Retracted / locked out riggers

  Yes

  No

  N/A

• All gear properly secured on deck

  Yes

  No

  N/A

• Backed up using a spotter

  Yes

  No

  N/A

• Departed job on approved road

  Yes

  No

  N/A

Return to yard , rewatering and refueling

• Fuel saddle tanks and outriggers - NO SMOKING

  Yes

  No

  N/A

• Fill water tank and water box

  Yes

  No

  N/A

• Clean all trash from cab

  Yes

  No

  N/A

• Park in assigned, numbered spot

  Yes

  No

  N/A

• Complete DVIR and return to dispatch with job tag

  Yes

  No

  N/A

• Complete driver log

  Yes

  No

  N/A

• Job Well done - drive home safely

  Yes

  No

  N/A

Completion of Evaluation

• Operator Signature

  Sign

• Trainer Signature

  Sign

• Completion Date and Time

  Date