E-J Energy, LLC.- Field Inspection

• Safety Inspection

• Conducted on

  Date

• Conducted by

• Location

• Supervisor

• Competent Person

• Weather

1.0 Workplace

• 1.1-Code 753 (Mark Outs)

  Yes

  No

  N/A

• 1.2-Competent Person

  Yes

  No

  N/A

• 1.3-Fire extinguisher visible, current, & immediately available

  Yes

  No

  N/A

• 1.4-First Aid Kit/Blood Bourne Pathogen Kit on-site & current

  Yes

  No

  N/A

• 1.5-Burn Gel & Burn Blanket current

  Yes

  No

  N/A

• 1.6-Spill Kit on-site

  Yes

  No

  N/A

• 1.7-Air monitor in use, calibrated, & current

  Yes

  No

  N/A

2.0 Administrative

• 2.1-Documentation of Job Briefing

  Yes

  No

  N/A

• 2.2-HASP on-site & current

  Yes

  No

  N/A

• 2.3-Current permits posted & visible

  Yes

  No

  N/A

• 2.4-Complete Job Package on-site

  Yes

  No

  N/A

• 2.5-Current RWLB matrix posted

  Yes

  No

  N/A

3.0 Work Area Protection

• 3.1-Flagger present

  Yes

  No

  N/A

• 3.2-Barricades/Cones/Stanchions complete & in compliance

  Yes

  No

  N/A

• 3.3-MUTCD signs in use where required

  Yes

  No

  N/A

• 3.4-Spotter present & escorting heavy equipment when necessary

  Yes

  No

  N/A

• 3.5-Pedestrians provided with a safe & clear path of travel

  Yes

  No

  N/A

• 3.6-Road/sidewalk plates in compliance

  Yes

  No

  N/A

• 3.7-Slings/chains in good condition

  Yes

  No

  N/A

• 3.8-Rubber Electrical Gloves (KV) dated with expiration date

  Yes

  No

  N/A

• 3.9-Proper PPE in use when required

  Yes

  No

  N/A

• 3.10-Vehicle's engine turned off (Idling regulations)

  Yes

  No

  N/A

• 3.11-Wheels chocked when truck on standby (driver not in cab)

  Yes

  No

  N/A

• 3.12-All tools in good condition

  Yes

  No

  N/A

• 3.13-Adequate set-up

  Yes

  No

  N/A

• 3.14-Housekeeping in place on-site & in trucks to prevent slips, trips, and falls

  Yes

  No

  N/A

4.0 Excavation

• 4.1-Spoils & equipment 2' away from excavation

  Yes

  No

  N/A

• 4.2-Gas monitoring where required

  Yes

  No

  N/A

• 4.3-Ladders used at 4' depth or greater & extending 3' above landing

  Yes

  No

  N/A

• 4.4-Ladders in place every 25' of lateral travel

  Yes

  No

  N/A

• 4.5-Shoring/sheeting at 5' or greater or when required

  Yes

  No

  N/A

• 4.6-Daily excavation inspection conducted

  Yes

  No

  N/A

5.0 Gas/Fusion Equipment

• 3.1-Contact Pyrometer

  Yes

  No

  N/A

• 3.2-Manual Fusion machine

  Yes

  No

  N/A

• 3.3-Facer

  Yes

  No

  N/A

• 3.4 Heating Iron

  Yes

  No

  N/A

• 3.5 Hydraulic Fusion Machine

  Yes

  No

  N/A

• 3.6-Electrofusion Machine

  Yes

  No

  N/A

• 3.7-Airline Respirator complete including inhalation valve, exhalation valve, hose assembly, speaking diaphragm, gaskets, connections, regulator, alarm, and hoses

  Yes

  No

  N/A

• 3.8-Harness & Line

  Yes

  No

  N/A

• 3.9-Escape Kit current (Masks & O2)

  Yes

  No

  N/A

• 3.10-GMI Current

  Yes

  No

  N/A

Sign off

• Auditor's signature