Title Page

  • Daily Work Zone Evaluation Project Description:

  • Conducting Work For:

  • Conducted on

  • Prepared By:

  • Location
  • Foreman:

Safety and Compliance Items

  • The attached document is provided as a means to identify evaluate and control potential job site hazards and maintain compliance through the PUC and NiSource. The Safety Coordinator must evaluate employee job performance and complete this document.

  • Vacuum Truck Operations

Work Zone

  • Work Zone Properly set up meeting MUTCD guidelines.

  • Workers, excavations, and vehicles protected by cones.

  • Sidewalk closed if applicable.

  • Qualified Flaggers utilized as necessary

  • Housekeeping adequate for the jobsite. No trip/fall hazards.

  • Fire extinguisher properly positioned and upwind of the excavation

PPE

  • Employees don and use correct PPE for the job.

Vehicles

  • Wheels chocked

  • First aid kit properly inspected for the month and contains minimum contents that is not expired

  • Fire extinguisher annually and monthly inspected and is secured

  • Secondary labels properly labelled and contains NFPA diamond pictogram.

  • Maintenance performed on vehicles as required

  • Locating Lines

  • Valid One Call

Tools/Equipment

  • Tools and equipment in operative condition and inspected prior to work

  • Safety Whip Check Safety Cords used on all air hose connections.

  • Employees utilize worker rotation and recognize potential hazards while operating equipment.

Procedures

  • O2 monitors properly bump tested

  • Employees safely use air striker and vacuum hose.

  • Employees recognize underground utilities and prevent damages.

  • Employees remove rocks as applicable

  • Corrosion Control

Procedures

  • Employees inspect interior and exterior of the pipe

  • Employees prepare pipe surface

  • Employees take CGI prior to burning anode

  • Employees safely apply anode and protect welds following the gas standards.

  • Abandons

  • Employees use proper methods to stop the flow of gas following the gas standards.

  • Employees use intrinsically safe tools to cut and abandon gas piping.

  • Employees properly cap cut end

  • Directional Drilling

Procedures

  • Equipment in operative condition and inspected prior to use.

  • Employees validate one call

  • Bore gel used for lubrication.

  • Employees recognize and react to underground utilities

  • Employees use equipment properly following manufacturers recommendations.

  • Weak link used on pulls 50 feet or greater

  • Employees back ream in appropriate diameter not to exceed 1.5 times the pipe diameter

  • Flagging

  • Employees set up work zone meeting MUTCD Requirements

  • All advanced warning signs in place and in proper location

  • Tapper area contains at least 6 devices

  • Proper equipment used

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.