DIGCO SHREVEPORT

• Document No.

• Personnel

• Conducted on

  Date

• Client / Site

• Prepared by

• Location
  Address

GENERAL

• Locate Number

• Is the crew at the correct location?

  Yes

  No

  N/A

• Has the DVIR been properly completed?

  Yes

  No

  N/A

• Are seat belts being worn in company vehicles?

  Yes

  No

  N/A

• Is the equipment trailer in good safe condition? (Hitch, Tires, Boards)

  Yes

  No

  N/A

• Has the Job briefing been completed? (JHA, Tailboard meeting)

  Yes

  No

  N/A

• Are all O.Q. records available at the site?

  Yes

  No

  N/A

• Do employees have the proper photo I.D.?

  Yes

  No

  N/A

• Current Welding Qualification Card

  Yes

  No

  N/A

• Plastic Fusion Qualification Card

  Yes

  No

  N/A

• Has the Span of Control been observed?

  Yes

  No

  N/A

INSPECTION

• Inspection of Materials

  Yes

  No

  N/A

• Proper Depth/Cover

  Yes

  No

  N/A

• Proper underground clearance

  Yes

  No

  N/A

• Proper support Minimal Shear/Tensile Strength

  Yes

  No

  N/A

• Adequate coating on all steel

  Yes

  No

  N/A

• Proper installation of Tracer Wire

  Yes

  No

  N/A

• Proper Backfill

  Yes

  No

  N/A

• Purging/Purge Stack

  Yes

  No

  N/A

• Fusion Equipment

  Yes

  No

  N/A

• Proper Joining Procedures followed

  Yes

  No

  N/A

• Access to Procedures

  Yes

  No

  N/A

• General Housekeeping and Restoration

  Yes

  No

  N/A

EXCAVATION

• Is there a Competent Person Onsite?

  Yes

  No

  N/A

• Has the Soil Classification been determined?

  Yes

  No

  N/A

• Have Soil Conditions been Determined?

  Yes

  No

  N/A

• Have Utilities been properly Located?

  Yes

  No

  N/A

• Trenches/Excavations greater than 4' Sloped or Shored

  Yes

  No

  N/A

• Means of egress

  Yes

  No

  N/A

• Spoil back minimum 3' from edge or removed

  Yes

  No

  N/A

• Ladder in good condition

  Yes

  No

  N/A

• Water accumulation monitored

  Yes

  No

  N/A

• Water removal equipment monitored

  Yes

  No

  N/A

• Has unattended Excavation been Secured

  Yes

  No

  N/A

WORK ZONE PROTECTION

• Pedestrian Pathway Signage in place (sidewalk closed, walk this way, Keep Out)

  Yes

  No

  N/A

• Advanced Warning Signs (Arrow Boards, Utility Work Signs, Road Closure Signs)

  Yes

  No

  N/A

• Proper utilization of Safety Cones

  Yes

  No

  N/A

• Proper number of cones

  Yes

  No

  N/A

• Protection of the Work Area

  Yes

  No

  N/A

• Proper Placement of Vehicles

  Yes

  No

  N/A

• Safe placement of Tools

  Yes

  No

  N/A

• Safe placement of Materials

  Yes

  No

  N/A

• Controls for Public Safety

  Yes

  No

  N/A

• Company Name displayed clearly on Trucks and Equipment

  Yes

  No

  N/A

POTENIAL GASEOUS ATMOSPHERE

• Is it a Confined Space

  Yes

  No

  N/A

• Fire Extinguisher charged and properly placed (Downwind)

  Yes

  No

  N/A

• Fire Watch in Place

  Yes

  No

  N/A

• Ignition Sources Eliminated

  Yes

  No

  N/A

• Combustible Gas monitored

  Yes

  No

  N/A

• Oxygen Monitored

  Yes

  No

  N/A

• Fire Resistant Fire Suit for Entrants and Fire Watch

  Yes

  No

  N/A

• Flame Resistant Hood

  Yes

  No

  N/A

• Lanyard, Harness if needed

  Yes

  No

  N/A

• Self Contained Breathing Equipment in Good Condition and Properly Used

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Hard Hats

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Safety Vest

  Yes

  No

  N/A

• Proper Foot Protection

  Yes

  No

  N/A

• Proper Gloves

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Additional Personal Protective Equipment (Face Shield, Toe Caps, Dust Mask, etc.)

  Yes

  No

  N/A

LEAK REPAIR

• Remote Bellhole

  Yes

  No

  N/A

• Bellhole Wetted

  Yes

  No

  N/A

• Wet Burlap Procedure used

  Yes

  No

  N/A

• Tools properly Grounded

  Yes

  No

  N/A

• Tracer Wire Intact

  Yes

  No

  N/A

• Additional Comments

• AUDITOR

  Sign

• Foreman/Crew Leader

  Sign