Title Page
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Conducted on
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Prepared by
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Location
Description of Coring Work
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Job Name:
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Job Number:
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Operator Name:
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Location of Coring:
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Description of Coring:
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The coring location has been scanned or x-ray?
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If no, explain why:
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The coring time and location have been approved by project supervision (and engineer when required)?
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If no, explain why:
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The location has been inspected for asbestos. If found, the asbestos was abated by authorized person prior to any coring operations?
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If no, explain why:
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If the location of the surface is painted, lead testing has been performed prior to coring?
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If no, explain why:
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Engineering/Administrative controls will be utilized to protect everyone from dust exposure, falling and flying debris?
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If no, explain why:
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The person performing the coring is trained to perform this specific task and to properly use all required tools, equipment and PPE?
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If no, explain why:
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The person performing the coring has and will use respiratory, hearing, eye/face and hand protection?
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If no, explain why:
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All equipment has been inspected, documented and are in proper working condition. Guards in place and GFCI in use?
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If no, explain why:
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The person performing the coring has a safe working surface or platform and has fall protection as required?
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If no, explain why:
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Electrical cords properly inspected and properly positioned to avoid contact with rotating components or standing water?
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If no, explain why:
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Method for water and core collection?
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Method for mechanical anchorage of rig?
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Type of protective cover for core hole?
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Person responsible for securing the cover?
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Signature of person performing CORING:
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Signature of SUPERVISOR:
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Time CORING was completed:
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Will coring continue to next shift/day?
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Comments:
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Verify the cover was installed.
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If no, explain why:
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Operator Signature:
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Supervisor Signature:
