Title Page
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Document No.
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Audit Title
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Job#
- 160800-A (Furnish EM-1 Electrical Equipment)
- 160800-B (Install EM-1 Electrical Equipment)
- 160800-C (EM-1Ductbank)
- 160800-D (EM-1Demo)
- 160800-E (PSE&G Service Entrance)
- 160800-F (Interconnection With Atlantic Power)
- 160800-G (EM-1 EPMS System)
- 160800-H (EM-1 Substation)
- 160800-I (Furnish EM-2 Electrical Equipment)
- 160800-J (Install EM-2 Electrical Equipment)
- 160800-K (Permanent Service To EM-2)
- 160800-L (EM-1 to EM-2 Ductbank)
- 160800-M (EM-2 Ductbanks)
- 160800-N (EM-2 Demolition)
- 160800-O (EM-2 EPMS)
- 160800-P (EM-2 Substation)
- 160800-Q (EM-1 Cables 5KV)
- 160800-R (EM-2 Cables 5KV)
- 160800-S (5KV Ductbank Replacement)
- 160800-T (Replace Downstream 5KV Cables)
- 160800-U (K22 Ductbank)
- 160800-V (K18 Renovation)
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Site
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Conducted on
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Prepared by
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State of manhole
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Is the confined space permit fully filled out and signed off of
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YOU MUST GET PERMIT SIGNED OFF PRIOR TO GOING INTO ANY MANHOLES!! NO WORK CAN BE DONE UNTIL THIS IS COMPLETE
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Has the Fire Chief been contacted by phone
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Time call was made
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Time response was received
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Was the OK given to go into manholes
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YOU ARE NOT ALLOWED TO GO INTO MANHOLES TODAY!!
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Give reason why you were not allowed into manholes today
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IF FIRE CHIEF HAS NOT BEEN CONTACTED BY PHONE AND GIVE THE OK YOU MAY NOT GO INTO THE MANHOLE!!
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Time of courtesy call to fire chief
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Has John Ski been contacted by phone
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YOU CAN'T GO INTO MANHOLES WITHOUT JOHN'S APPROVAL
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Time call was made
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Did John approve going into the manholes?
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YOU CANNOT GO INTO MANHOLES TODAY!!
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Give reason why John said we can't go into manholes today
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Is your SPA filled out
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A SPA must be filed out prior to going to work
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Have you reviewed with the workers?
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Review with workers prior to doing ANY work
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Have the workers signed off
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ALL workers must sign off on the SPA
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Is your Permit to work filled out
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Permit to work MUST be filled out prior to doing any work!
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Has all the workers signed the permit to work
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All workers must sign the permit to work
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Is the evacuation roster report filled out with cell numbers of the workers
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Every workers name and number MUST be on the evacuation roster report stop and get everyone's name and number prior to going into manholes
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Is email sent to: <br>Andy Frey, Ray DeBiasse, Adam Ashton, Rick Port, Ray Kleban, John Ski, Frank Clemente, Frank Rosner, Larry Golic and Anthony Giuliano
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Must Happen prior to going into any manholes
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Add media
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Does anyone going into the manholes have a pacemaker
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ANYONE WITH A PACEMAKER CAN NOT GO INTO THE MANHOLE
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Does anyone going into the manholes have a defibrillator in their chest
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ANYONE WITH A DEFIBRILLATOR CAN NOT GO INTO THE MANHOLE
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Does anyone going into a manhole have hearing aids
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ANYONE WITH HEARING AIDS CAN NOT GO INTO THE MANHOLE
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Does anyone going into a manhole have any other imbedded electronic devices
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IF SOMEONE HAS AN ELECTRONIC DEVICE IMBEDDED IN THEM THEY CAN NOT GO INTO THE MANHOLE UNLESS APPROVED BY FOREST AND MERCK MANAGEMENT
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These are the manholes that we will be entering today
- EMH-A
- Existing Manhole
- Handhole #1
- Manhole
- Vault #1
- Vault #1A
- Vault #2
- Vault #2A
- EMH #1
- EMH-2(2)
- Vault #3
- Vault #4
- Vault #8
- Vault #9
- Vault #10
- Vault #4A
- Vault #5
- Vault #5A
- Vault #6
- Vault #6A
- EMH #7
- MH #16
- Vault #7
- EMH #5
- Vault #15
- EMH #2
- EMH #2A
- EMH #2B
- EMH #2C
- H-1-MH
- H-2-MH
- H-3-MH
- H-4-MH
- K15-2
- K15-1
- K15-3
- K15-4
- K15-4A
- K15-4B
- K15-5
- K15-6
- K15-7
- K22-2
- K22-1
- EMH-5
- Vault-15
- Other
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Describe what you will be entering
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Sign off that this has all been completed
