Title Page
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Conducted on
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Select date
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Prepared by
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Location
PAGE 1
PROJECT INFO:
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Project Number & Name
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Foremen
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Superintendent
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Inspector
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Date
GENERAL REQUIREMENTS:
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Job Site Trailer or Towable trailer have proper signage (labor law , applicable safety signs, coronavirus info)
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First Aid kits inspected and documented.
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Weekly Tool Box Talks being conducted and documented.
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Emergency Contact Numbers posted and visible for crew / or Emergency Action Plan posted and reviewed.
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HAZCOM program reviewed an explained to crew memebers
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First Aid, CPR, AED trained people on site.
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Miss Utility Dig Ticket on site / or Foreman shows how to use LETS system.
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Vehicle Inspection up to date
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Vehicle have registration and current insurance cards
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Towable trailers inspection stickers & registrations & insurance cards.
Job Site Sanitation & Housekeeping:
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Work area clean & free from tripping hazards.
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Night time work well lighted for work to be performed.
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Waste containers at laydown yard being used properly & laydown yard organized
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Are Porta Johns cleaned and properly supplied to meet VOSH requirements.
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Eye Wash stations mounted in towable trailers or in site trailer.
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Drinking water in sanitizes cooler and adequate supply.
Fire Prevention & Flammables:
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Are their Adequate fire extinguisher and types required on site
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all flammable liquids in appropriately designated containers with proper labeling.
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Gas cylinders separated and secured properly if applicable.
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Any secondary containers used have proper HAZCOM labels to identify contents.
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No Smoking signs displayed in areas that need them (fueling stations, gas cylinders).
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Refueling stations barricaded properly
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Refueling stations fire extinguisher mounted 26' + from station with proper sinage
PPE & Equipment:
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All required PPE being utilized by all (hard hat, safety glasses, gloves, class III vest in roadway).
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Silica Dust are controls being utilized and adequate for application.
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Hearing protection utilized if over 85 dba.
Electrical:
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GFCI plugs being utilized and tested.
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Electrical cords free from damage and have the ground pin intact.
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Electrical hand tool outfitted with double insulation.
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Electrical dangers posted if needed when working around overhead lines.
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Equipment that requires a secondary ground being utilized peoperly.
Ladders:
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Ladders being used have proper labeling and legiable.
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Ladders being inspected (have crew demonstrate inspection)
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Ladders properly secured.
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Walk Throughs provided and used properly.
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Ladder training instruction provided and documented.
PAGE 2
RIGGING:
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15 Ton Swivel hook have latch, and no excessive wear.
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Shackles USA made, no excessive wear.
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Lifting chains all Tags legible and free from damage
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Webb slings no tear or damage if so remove from service.
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Tag lines being used while lift being performed.
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OTHER
EXCAVATIONS:
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Ladder in ditch 4' or deeper
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Excavations 5' or more utilizing either slope/ speed shore/ trench box.
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Competent person on site and have proper documentation.
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All spoils minimum 2' away from ditch and free from tripping hazards.
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Hand digging best practices being utilized (NO MECHANIZED EQUIPMENT within 2').
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Trench boxes have all pins with keepers in place, NO DUCT TAPE.
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Spreader bars in good condition no bends that could cause failure.
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Trench over 4' should be monitored for air contaminant's.
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OTHER
CONFINED SPACE:
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Competent Person on site and determines what is a Confined Space or Permit Confined Space.
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Permit Confined space proper documentation on site and being turned in to Safety Department for annual review.
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Competent person explained the Attendant and Entrant responsibilities.
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Gas Monitor been bump tested within 24 hours.
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Calibration being done annually or within parameter's of monitor being used.
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Emergency Action Plan been reviewed before entering hole.
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Is Confined Space Properly set up, to keep people not utilized outside work area.
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OTHER
HEAVY EQUIPMENT:
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Fire Extinguisher mounted, inspected & documented.
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Equipment Inspections being completed daily.
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Seat Belt being used.
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All back up alarms operational and demonstrated, equipped with horn.
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Proper Labeling inside cab for overhead power lines with 50kva or less.
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All Glass intact and free from damage.
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all mirrors intact and free from damage.
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OTHER
TRAFFIC CONTROL:
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Traffic Control set up according to MUTCD or Virginia Lane closure requirements.
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If Flaggers being used, do they have proper training and cards on their person.
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is Equipment in roadway with out Controls being utilized.
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If road detours in use are they maintained properly.
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Controls in place for the public to understand, and keep out of harms way from equipment.
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OTHER
FALL PROTECTION:
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Is Competent Person on site while being utilized.
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Is adequate protection in place for job being performed.
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Is work area set up to keep public out of harms way.
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Fall equipment Inspected and documented before each use.
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Anchor points being used able to withstand 5,000 lb.
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OTHER
