Information

  • Conducted on

  • Prepared by

  • Location
  • Completed On

1. Subcontractor Inspected

  • Subcontractor Name

  • Work Performed / Location

  • CWP/JHA Package for work being performed is on site and signed

  • PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  • Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  • Fall Protection (Anything over 6' - At heights or leading edges)

  • Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  • Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  • Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  • Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  • Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  • Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  • Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  • Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  • Any additional observations (Note them here)

  • Subcontractor Name

  • Work Performed / Location

  • CWP/JHA Package for work being performed is on site and signed

  • PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  • Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  • Fall Protection (Anything over 6' - At heights or leading edges)

  • Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  • Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  • Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  • Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  • Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  • Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  • Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  • Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  • Any additional observations (Note them here)

  • Subcontractor Name

  • Work Performed / Location

  • CWP/JHA Package for work being performed is on site and signed

  • PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  • Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  • Fall Protection (Anything over 6' - At heights or leading edges)

  • Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  • Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  • Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  • Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  • Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  • Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  • Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  • Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  • Any additional observations (Note them here)

2. Atkinson Inspections

  • Foreman's Name

  • Work Performed / Location

  • CWP/JHA Package for work being performed is on site and signed

  • PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  • Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  • Fall Protection (Anything over 6' - At heights or leading edges)

  • Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  • Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  • Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  • Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  • Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  • Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  • Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  • Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  • Any additional observations (Note them here)

  • Foreman's Name

  • Work Performed / Location

  • CWP/JHA Package for work being performed is on site and signed

  • PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  • Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  • Fall Protection (Anything over 6' - At heights or leading edges)

  • Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  • Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  • Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  • Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  • Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  • Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  • Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  • Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  • Any additional observations (Note them here)

  • Foreman's Name

  • Work Performed / Location

  • CWP/JHA Package for work being performed is on site and signed

  • PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  • Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  • Fall Protection (Anything over 6' - At heights or leading edges)

  • Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  • Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  • Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  • Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  • Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  • Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  • Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  • Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  • Any additional observations (Note them here)

  • Foreman's Name

  • Work Performed / Location

  • CWP/JHA Package for work being performed is on site and signed

  • PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  • Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  • Fall Protection (Anything over 6' - At heights or leading edges)

  • Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  • Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  • Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  • Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  • Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  • Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  • Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  • Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  • Any additional observations (Note them here)

  • Foreman's Name

  • Work Performed / Location

  • CWP/JHA Package for work being performed is on site and signed

  • PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  • Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  • Fall Protection (Anything over 6' - At heights or leading edges)

  • Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  • Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  • Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  • Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  • Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  • Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  • Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  • Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  • Any additional observations (Note them here)

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