E-J Energy, LLC.- Field Inspection

• Competent Person

• Conducted on

  Date

• Conducted by

• Location

• 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 - Spotter present & escorting heavy equipment when necessary

  Yes

  No

  N/A

• 3.3 - MUTCD signs in use where required

  Yes

  No

  N/A

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

  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

• 5.1 - Contact Pyrometer

  Yes

  No

  N/A

• 5.2 - Manual Fusion machine

  Yes

  No

  N/A

• 5.3 - Facer

  Yes

  No

  N/A

• 5.4 - Heating Iron

  Yes

  No

  N/A

• 5.5 - Hydraulic Fusion Machine

  Yes

  No

  N/A

• 5.6 - Electrofusion Machine

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 5.8 - Harness & Line

  Yes

  No

  N/A

• 5.9 - Escape Kit current (Masks & O2)

  Yes

  No

  N/A

• 5.10 - GMI Current

  Yes

  No

  N/A

Sign off

• Auditor's signature