Information

  • Document No.

  • Job Name / Job Number

  • Conducted on

  • Prepared by

  • Location
  • Date and Time of Inspection:

Part I. General Information

  • Site Information

  • Feeder Line / WO#:

  • Photos Taken:

Weather

  • Estimate Storm Beginning: (Date and Time)

  • Estimate Storm Duration: (Hours)

  • Estimate Time Since Last Storm: (Days or Hours)

Inspection Information

  • Inspector Name and Title:

Good Housekeeping for Construction Materials

  • Stockpiled construction materials not actively in use are covered and bermed

  • Failure or Other Short Comings?

  • Action Required?

  • Action Implementation Date:

  • All chemicals are stored in watertight containers with appropriate secondary containment, or in completely enclosed storage shed.

  • Failure or Other Short Comings?

  • Action Required?

  • Action Implementation Date:

Good Housekeeping for Waste Management

  • Portable toilets are contained to prevent discharges of waste

  • Failures or Other Short Comings?

  • Action Required?

  • Action Implemented Date:

  • Stockpiled waste material is securely protected from wind and rain if not actively in use

  • Failures or Other Short Comings?

  • Action Required?

  • Action Implementation Date:

  • Procedures are in place for addressing hazardous and non-hazardous spills

  • Failures or Other Short Comings?

  • Action Required?

  • Action Implementation Date:

  • Equipment and materials for cleanup of spills is available onsite

  • Failures or Other Short Comings?

  • Action Required?

  • Action Implementation Date:

  • Washout areas (e.g., concrete) are contained appropriately to prevent discharge or infiltration into the underlying soil

  • Failures or Other Short Comings?

  • Action Required?

  • Action Implementation Date:

Good Housekeeping for Vehicle Storage and Maintenance

  • Measures are in place to prevent oil, grease, or fuel from leaking into ground, storm drains, or surface waters

  • Failures or Other Short Comings?

  • Action Required?

  • Action Implementation Date:

  • All equipment or vehicles are fueled, maintained, and stored in a designated area with appropriate BMP's

  • Failures or Other Short Comings?

  • Action Required?

  • Action Implementation Date:

Sediment Controls

  • Entrances and exits are stabilized to control erosion and sediment discharges from the site

  • Adequately Designed, Implemented and Effective?

  • Action Required?

  • Action Implementation Date:

  • Linear sediment control along toe of slope, face of slope and at grade breaks.

  • Adequately Designed, Implemented and Effective?

  • Action Required?

  • Action Implementation Date:

Descriptions of BMP Deficiencies

  • Repairs Implemented:
    Note: Repairs must be within 72 hours of identification and complete repairs as soon as possible.

  • Deficiency:

  • Photo(s):

  • Start Date:

  • Action:

  • Deficiency:

  • Photo(s):

  • Start Date:

  • Action:

  • Deficiency:

  • Photo(s):

  • Start Date:

  • Action:

  • Deficiency:

  • Photo(s):

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.