Danella Power ADSS FOC Safety Observation Report

• Customer

• Job Number

• Foreman/Sub

• Division

• Date

  Date
• Work Location
  Address

• Superintendent

• Type of Work

• Names of Employees on Site During Observation

1.0 Traffic Control (Vehicle & Pedestrian)

• 1.0 Construction Signs (MUTCD)

  Yes

  No

  N/A

• 1.2 Barricades / Fencing

  Yes

  No

  N/A

• 1.3 Traffic Cones / Barrels

  Yes

  No

  N/A

• 1.4 Arrow Board

  Yes

  No

  N/A

• 1.5 Flaggers w/ Paddles

  Yes

  No

  N/A

2.0 Personal Protective Equipment

• 2.0 Hard Hat

  Yes

  No

  N/A

• 2.1 Safety Glasses / Goggles

  Yes

  No

  N/A

• 2.3 Traffic Vest (or similar)

  Yes

  No

  N/A

• 2.4 Hearing Protection

  Yes

  No

  N/A

• 2.5 Face Shield

  Yes

  No

  N/A

• 2.6 Steel-Toed Work Boots

  Yes

  No

  N/A

• 2.7 Metatarsal Guards

  Yes

  No

  N/A

• 2.8 Rubber Gloves/Sleeves

  Yes

  No

  N/A

• 2.9 Flame-Resistant Clothing

  Yes

  No

  N/A

• 2.10 Chaps

  Yes

  No

  N/A

• 2.11 Body Harness / Lanyard

  Yes

  No

  N/A

• 2.12 Work Gloves

  Yes

  No

  N/A

• 2.13 Respirator

  Yes

  No

  N/A

3.0 Work Site Protection (Excavations & Manholes)

• 3.1 Job Briefing (JHA)

  Yes

  No

  N/A

• 3.2 Housekeeping

  Yes

  No

  N/A

• 3.3 Competent Person

  Yes

  No

  N/A

• 3.4 Excavation Protection

  Yes

  No

  N/A

• 3.5 Soil Type

• 3.6 Protective Measure

• 3.7 Tabulated Data

  Yes

  No

  N/A

• 3.8 Access/Regress

  Yes

  No

  N/A

• 3.9 Spoils 2' from Edge

  Yes

  No

  N/A

• 3.10 Utilities Located

  Yes

  No

  N/A

4.0 Confined Space

• 4.1 Entry Permit

  Yes

  No

  N/A

• 4.2 Manhole Gate/ Rescue

  Yes

  No

  N/A

• 4.3 Ventilation

  Yes

  No

  N/A

• 4.4 Air Monitor

  Yes

  No

  N/A

• 4.5 Attendant

  Yes

  No

  N/A

• 4.6 Fire Extinguisher Readily Accessible, Inspected & In Working Condition

  Yes

  No

  N/A

5.0 Tool Condition (Hand & Power)

• 5.1 Hand Tools

  Yes

  No

  N/A

• 5.2 Electric Tools & Cords

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 5.3 Tools Grounded/GFCI

  Yes

  No

  N/A

• 5.4 Air Tools in Proper Working Condition

  Yes

  No

  N/A

• 5.5 Whip Checks on Compressor Hoses Where Required

  Yes

  No

  N/A

• 5.6 Compressor Check Valve

  Yes

  No

  N/A

• 5.7 Gas-Powered Tools in Proper Working Condition

  Yes

  No

  N/A

• 5.8 Ladders

  Yes

  No

  N/A

• 5.9 Chains/Slings/Ropes

  Yes

  No

  N/A

• 5.10 Hazmat Containers

  Yes

  No

  N/A

6.0 Work Methods

• 6.1 Proper Tools

  Yes

  No

  N/A

• 6.2 Proper Tool Use

  Yes

  No

  N/A

• 6.3 Proper Equipment

  Yes

  No

  N/A

• 6.4 Proper Equipment Use

  Yes

  No

  N/A

• 6.5 Proper Work Position

  Yes

  No

  N/A

• 6.6 CPR Trained

  Yes

  No

  N/A

• 6.7 First Aid Trained

  Yes

  No

  N/A

• 6.8 DOT-Qualified Driver

  Yes

  No

  N/A

7.0 Equipment Condition / Set-up

• 7.1 Beacon/Lights on & Working Properly

  Yes

  No

  N/A

• 7.2 Back-Up Alarm

  Yes

  No

  N/A

• 7.3 Wheel Chocked

  Yes

  No

  N/A

• 7.4 Tires in Good Condition

  Yes

  No

  N/A

• 7.5 Equipment Housekeeping

  Yes

  No

  N/A

• 7.6 Secure Load & Trailer

  Yes

  No

  N/A

• 7.7 Fire Extinguisher

  Yes

  No

  N/A

• 7.8 First Aid Kit Within Expiration & Stocked

  Yes

  No

  N/A

• 7.9 Miscellaneous Repair Condition

  Yes

  No

  N/A

• 7.10 "How's My Driving" Decal on Vehicle

  Yes

  No

  N/A

• 7.11 Dielectric Test (Truck,Grounds,etc.)

  Yes

  No

  N/A

• 7.12 Spill Kit

  Yes

  No

  N/A

• 7.13 Drivers Vehicle Inspection

  Yes

  No

  N/A

• 7.14 DOT Annual Inspection

  Yes

  No

  N/A

• Other

Observer/Observer Information

• Day of the Week

• Arrival Time

• Departure Time

• Observer Name

• Observer Title

• Observer Signature

  Sign