ESC Site Observation - vAug2013

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

Site / Location Info

• Location / Site / Job

• Site Leader / Crew

  Select OTHER G. Duininck Blaine S. D. Decker B. Wilson Randy W. Tubby D. Rigge R. Gruber A. King D. Weber D. Gafkjen M. Felt W. Sholtes Z. Brouwer G. Duininck K. Covert G. Rood J. Markus K. Steffens O. Lea S. Hintzman D. Webb D. Delfosse P. Barritt R. Prahm A. Habicht P. Deis S. Wolbeck T. Quisberg

  • OTHER
  • G. Duininck
  • Blaine S.
  • D. Decker
  • B. Wilson
  • Randy W.
  • Tubby
  • D. Rigge
  • R. Gruber
  • A. King
  • D. Weber
  • D. Gafkjen
  • M. Felt
  • W. Sholtes
  • Z. Brouwer
  • G. Duininck
  • K. Covert
  • G. Rood
  • J. Markus
  • K. Steffens
  • O. Lea
  • S. Hintzman
  • D. Webb
  • D. Delfosse
  • P. Barritt
  • R. Prahm
  • A. Habicht
  • P. Deis
  • S. Wolbeck
  • T. Quisberg

• Other Site Leader (if not in the list)

• Yes

  No

  N/A

FIRST AID / EMERGENCY

• Has a designated parking space been established?

  Yes

  No

  N/A

• Does 911 work in this area?

  Yes

  No

  N/A

• Has emergency response been notified of your work location?

  Yes

  No

  N/A

• Does Heartland have your current address (if your site is secured)?

  Yes

  No

  N/A

• Comments:

HOUSEKEEPING PRACTICES

• Does the job site have trip hazards?

  Yes

  No

  N/A

• Are fire extinguishers accessible? (Located well and not blocked

  Yes

  No

  N/A

• Have extinguishers been properly inspected?

  Yes

  No

  N/A

• Are ladders in good condition?

  Yes

  No

  N/A

• Is this site clean and orderly? (Garbage, toilets, trailers, etc.)

  Yes

  No

  N/A

• Select from range

• Comments

• Attach Housekeeping images

  Media

MAINTENANCE (include unit number)

• Comments

• What equipment needs attention?

Equipment

• Unit Number / Type

• Operator

• Describe the issue

• Attach maintenance images

  Media

PPE

• Hard Hats

  Yes

  No

  N/A

• Safety Vests

  Yes

  No

  N/A

• Fall Harness (above 6 feet)

  Yes

  No

  N/A

• Electrical Gloves being used (inspected)

  Yes

  No

  N/A

• Gas Detectors

  Yes

  No

  N/A

• Respiratory Protection

  Yes

  No

  N/A

• Hearing Protection (ear muffs/ear plugs)

  Yes

  No

  N/A

• Eye Protection (safety glasses or face shield)

  Yes

  No

  N/A

• Proper Footwear / Work Boats

  Yes

  No

  N/A

• Paperwork (daily, weekly inspections)

  Yes

  No

  N/A

• Comments

• Attach PPE images

  Media

TRUCKING / HEAVY EQUIPMENT

• Are lights, break lights, back up alarm and horn working on trucks/equipment in use?

  Yes

  No

  N/A

• Are the operators wearing their seat belts?

  Yes

  No

  N/A

• Load securement

  Yes

  No

  N/A

• Haul Road: route, road/approach conditions, traffic pattern

  Yes

  No

  N/A

• Daily truck Inspection-review paperwork

  Yes

  No

  N/A

• Is the unassigned equipment being taken care of properly? Clean / maintained / Etc.

• Comments

• Attach Truck/Equipment images

  Media

PICKUPS

• Are the pickups clean inside and out?

  Yes

  No

  N/A

• Pick Up: Cleanliness Rating

• Does the foreman have a supervisor book with all the necessary paperwork in it?

  Yes

  No

  N/A

• Does the pickup have an emergency kit?

  Yes

  No

  N/A

• Do drivers have the most current Insurance Card?

  Yes

  No

  N/A

• Comments

• Attach Pickup images

  Media

ELECTRICAL

• Are employees using lock out tag out?

  Yes

  No

  N/A

• Are wires and/or cords in good condition (nothing exposed or damaged)?

  Yes

  No

  N/A

• Are the electrical panels shut?

  Yes

  No

  N/A

• Comments

• Attach Electrical images

  Media

JOB SITE SPECIFICS

• Is the site leader fully aware of high voltage or high pressure gas lines?

  Yes

  No

  N/A

• Are the One Calls up to date?

  Yes

  No

  N/A

• Is proper trenching being used?

  Yes

  No

  N/A

• Is proper guarding in place?

  Yes

  No

  N/A

• Is traffic control properly in place?

  Yes

  No

  N/A

• Does the site leader have a good attitude?

  Yes

  No

  N/A

• Does the crew have a good attitude?

  Yes

  No

  N/A

• Are employees following the company cell phone / electronic device policy?

  Yes

  No

  N/A

• Are Employees lifting properly?

  Yes

  No

  N/A

• Has a designated parking space been established?

  Yes

  No

  N/A

• Is the parking space being used?

  Yes

  No

  N/A

• Comments

• Attach Images

  Media

NEEDS OR REQUESTS FROM THE SITE LEADER

• Comments

POSITIVE COMMENTS / OBSERVATIONS

• Comments

• Attach Positive images

  Media

ANY OTHER COMMENTS

• Other Comments

• Images for other comments

  Media

• Observer

  Select Trevor Lee Chris Rick Jason Judd Harris Tim

  • Trevor
  • Lee
  • Chris
  • Rick
  • Jason
  • Judd
  • Harris
  • Tim

• Initials (Site Leader)

• Site Leader Signature

  Sign