Title Page
-
Safety Inspection
-
Conducted on
-
Conducted by
-
Supervisor
-
Location
-
Competent Person
-
Weather
1.0 Workplace
-
1.1-Code 753 (Mark Outs)
-
1.2-Inspector
-
1.3-Competent Person
2.0 Administrative
-
2.1-Documentation of Job Briefing
-
2.2-HASP on-site & current
-
2.3-Air monitor in use, calibrated, & current
-
2.4-Current permits posted & visible
-
2.5-Complete Job Package on-site
-
2.6-First Aid Kit/Blood Bourne Pathogen Kit on-site & current
-
2.7-Spill Kit on-site
-
2.8-Fire extinguisher visible, current, & immediately available
-
2.9-Current RWLB matrix posted
3.0 Work Area Protection
-
3.1-Flagger present
-
3.2-Barricades/Cones/Stanchions complete & in compliance
-
3.3-MUTCD signs in use where required
-
3.4-Arrow board operating & in use when applicable
-
3.5-Pedestrians provided with a safe & clear path of travel
-
3.6-Plates Pinned, ramped, flush, skid resistant, & in complete compliance
-
3.7-Slings & chains in good condition
-
3.8-Rubber Electrical Gloves (KV) dated with expiration date
-
3.9-Proper PPE in use when required
-
3.10-Vehicle's engine turned off (Idling regulations)
-
3.11-Wheels chocked when truck on standby (driver not in cab)
-
3.12-All tools in good condition
-
3.13-Adequate set-up
-
3.14-Housekeeping in place on-site & in trucks to prevent slips, trips, and falls
4.0 Excavation
-
4.1-Spoils & equipment 2' away from excavation
-
4.2-Gas monitoring where required
-
4.3-Ladders used at 4' depth or greater and extending 3' above landing
-
4.4-Ladders in place every 25' of lateral travel
-
4.5-Shoring/sheeting at 4'6" or greater or when required
-
4.6-Daily excavation inspection conducted
-
Notes/Other:
Sign off
-
On-site Representative
-
Auditor's signature
