Denver VA Audit Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Housekeeping

• Areas clean and free of clutter

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Material stored appropriately

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Nothing hits the ground implemented

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Trash containers available

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Walking and Working Surfaces

• Walkways free of tripping or slip hazards

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Access to work area / path of travel

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Job Hazard Analysis

• JHA in place and reviewed by crew

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Does it reflect task at hand

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

MSDS and Hazard Communication

• Material Safety Data Sheet in place (known location)

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Last reviewed

  Date

• Containers identified

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Secondary containment available (if applicable)

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Fall Protection and Prevention

• Job specific fall protection plan in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Competent Person in area

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Equipment inspection performed

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Equipment used correctly

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Appropriate anchorage point

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Guardrail systems in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Holes covered, secured and identified "HOLE"

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Personal Protective Equipment

• Proper PPE for the task

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• PPE used properly

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• PPE in good condition and free of defects

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• PPE USED

  Select Safety glasses Hard Hats Class II vest Gloves Work boots Faceshield Respirator Hearing Protection other

  • Safety glasses
  • Hard Hats
  • Class II vest
  • Gloves
  • Work boots
  • Faceshield
  • Respirator
  • Hearing Protection
  • other

• PPE USED

  Select Safety glasses Hard Hats Class II vest Gloves Work boots Faceshield Respirator Hearing Protection other

  • Safety glasses
  • Hard Hats
  • Class II vest
  • Gloves
  • Work boots
  • Faceshield
  • Respirator
  • Hearing Protection
  • other

• PPE USED

  Select Safety glasses Hard Hats Class II vest Gloves Work boots Faceshield Respirator Hearing Protection other

  • Safety glasses
  • Hard Hats
  • Class II vest
  • Gloves
  • Work boots
  • Faceshield
  • Respirator
  • Hearing Protection
  • other

• PPE USED

  Select Safety glasses Hard Hats Class II vest Gloves Work boots Faceshield Respirator Hearing Protection other

  • Safety glasses
  • Hard Hats
  • Class II vest
  • Gloves
  • Work boots
  • Faceshield
  • Respirator
  • Hearing Protection
  • other

• PPE USED

  Select Safety glasses Hard Hats Class II vest Gloves Work boots Faceshield Respirator Hearing Protection other

  • Safety glasses
  • Hard Hats
  • Class II vest
  • Gloves
  • Work boots
  • Faceshield
  • Respirator
  • Hearing Protection
  • other

First Aid and Sanitation

• Eye wash station in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Potable drinking water available and employees aware of location

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Portable toilets available

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Scaffolds

• Competent person in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Scaffold inspected and tagged

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Scaffold permit in place and signed off

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Appropriate footing in use

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Braces and other components in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Guardrails in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Electrical

• GFCI in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Electrical cord free of damage

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Electrical cord used properly (organized, pinch points, tripping hazards, etc.)

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Portable generator grounded

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Electrical equipment inspected regularly

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Electrical panel free of defects or damage

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Mobile Equipment

• Pre-Operation inspection performed and documented.

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Designated operator in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Seatbelt in use by operator

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Lights on in use

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Back up alarm operational

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Equipment spotter in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• Fire extinguisher in place

  Safe

  At Risk

  N/A

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Cranes and Rigging

• Pre-Operational inspection and documentation

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Designated operator in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Crane swing radius in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Qualified rigger in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Qualified signal person in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Proper rigging practices in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Rigging free of defected or damage

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Tag lines in use

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Other comments, observations, or improvements to note

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Excavations and Trenching

• Permit in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Utilities located

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Competent person at excavation or trench

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Excavation protection at four feet deep in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Means of access and egress in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Utilities supported

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Excavation/trench barricaded

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Hand and Power Tools

• Tool free from defect or damage

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Tool guards in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Employee using tool properly

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Ladders and Stairs

• Ladders last policy implemented

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Ladder free of defects or damage

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Ladder meets project capacity requirement

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Ladder used properly (3 points of contact, etc.)

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Ladder secured, good positioning

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Fire Protection

• Fire extinguishers in place and accessible

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Fire extinguisher inspection up to date

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Location of extinguisher identified

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Welding/Cutting

• Hot work permit in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Tools and equipment free from damage or defects (gauges, hoses, leads, etc.)

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Flash arresters in place on torch and on cylinder

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Fire extinguisher in place at least 35' from operation

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Fire watch in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Employee PPE in use

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

Confined Space

• Confined space program in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Confined space permit in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Competent person in the area

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Employees trained

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Air monitoring in place and used

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________

• Rescue plan and equipment in place

  Safe

  At Risk

  N/A

• Responsible Party:

  S/H

  KT

  FIORE

  AD

  COGGINS

• KT REP:

  Select Terry Elder Dave Heston Matt Woodall Randy Wicke Bart Extrand Steve Gadberry Mike Keith

  • Terry Elder
  • Dave Heston
  • Matt Woodall
  • Randy Wicke
  • Bart Extrand
  • Steve Gadberry
  • Mike Keith

• Corrected By

  Date

• Corrective Action: Date: _______________