Field Observation Report

• Project Name:

• Conducted on

  Date

• Crews on site

  Select GRADE CREW PAVING CREW ADJUSTMENT CREW TRAFFIC CONTROL CREW DRIVERS QUALITY CONTROL ENVIRONMENTAL CLEAN UP CREW SEALING CREW GRINDING CREW

  • GRADE CREW
  • PAVING CREW
  • ADJUSTMENT CREW
  • TRAFFIC CONTROL CREW
  • DRIVERS
  • QUALITY CONTROL
  • ENVIRONMENTAL
  • CLEAN UP CREW
  • SEALING CREW
  • GRINDING CREW

• Prepared by

  Select Rob Carrington Risty Van Ogle Mike O'Neil John Bartkowski Cal Beyer

  • Rob Carrington
  • Risty Van Ogle
  • Mike O'Neil
  • John Bartkowski
  • Cal Beyer
• Location
  Address

• Yes

  No

  N/A

Project comments

Project type

• Select OVERLAY PROJECT PAVING OVER GRADE PAVEMENT REPAIR GRADE JOB TRAFFIC CONTROL PROJECT UTILITY ADJUSTMENTS EXCAVATION SIDEWALK REMOVAL SUB- CONTRACTOR WORK GRINDING

  • OVERLAY PROJECT
  • PAVING OVER GRADE
  • PAVEMENT REPAIR
  • GRADE JOB
  • TRAFFIC CONTROL PROJECT
  • UTILITY ADJUSTMENTS
  • EXCAVATION
  • SIDEWALK REMOVAL
  • SUB- CONTRACTOR WORK
  • GRINDING

Crew on site

• Select GRADE CREW PAVING CREW ADJUSTMENT CREW TRAFFIC CONTROL CREW DRIVERS QUALITY CONTROL ENVIRONMENTAL CLEAN UP CREW SEALING CREW GRINDING CREW

  • GRADE CREW
  • PAVING CREW
  • ADJUSTMENT CREW
  • TRAFFIC CONTROL CREW
  • DRIVERS
  • QUALITY CONTROL
  • ENVIRONMENTAL
  • CLEAN UP CREW
  • SEALING CREW
  • GRINDING CREW

Personnel on project

• Personnel on site

Employee Name

• Personnel

• High vis vests/ apparel

  Select Yes No

  • Yes
  • No

• Add media

  Media

Trucks Onsite

• Truck drivers on site

Drivers Name

• High vis vests/ apparel

  Select Yes No

  • Yes
  • No

• Add media

  Media

Contractors on site

• Contractors

Contractors Name

• High vis vests/ apparel

  Select Yes No

  • Yes
  • No

• Add media

  Media

PPE Requirement Question

• Hearing Protection

  Select Entire crew wearing them Partial crew wearing them corrected Hearing protected not required

  • Entire crew wearing them
  • Partial crew wearing them
  • corrected
  • Hearing protected not required

• Number of employees wearing hearing protection (Example 8 out of 10)

• How many employees are wearing dB blockers:

• High vis vests/ apparel

  Select Yes No

  • Yes
  • No

• Add media

  Media

• Day project

• Check Box if Night Gear is Required

• Hard hat required?

  Select YES NO NOT REQUIRED

  • YES
  • NO
  • NOT REQUIRED

• Add media

  Media

• Safety glasses

  Select YES NO NOT REQUIRED

  • YES
  • NO
  • NOT REQUIRED

• Add media

  Media

• Respiratory protection required?

  Select YES NO NOT REQUIRED

  • YES
  • NO
  • NOT REQUIRED

• Add media

  Media

• Hand Protection

  Select YES NO NOT REQUIRED

  • YES
  • NO
  • NOT REQUIRED

• Other PPE

Traffic

• Our traffic control?

  Select YES NO NOT REQUIRED

  • YES
  • NO
  • NOT REQUIRED

• Add media

  Media

• If no, who?

• Traffic plan

  Select LANE CLOSURE 1-LANE 2-WAY RIGHT LANE CLOSURE LEFT LANE CLOSURE ONE WAY / Pilot car SHOULDER CLOSURE TEMP. ROAD CLOSURE MULTIPLE LANE CLOSURES LANE SHIFT MOBILE OPERATION RAMP / ROAD CLOSURE SIDEWALK CLOSURE / DETOURS

  • LANE CLOSURE 1-LANE 2-WAY
  • RIGHT LANE CLOSURE
  • LEFT LANE CLOSURE
  • ONE WAY / Pilot car
  • SHOULDER CLOSURE
  • TEMP. ROAD CLOSURE
  • MULTIPLE LANE CLOSURES
  • LANE SHIFT
  • MOBILE OPERATION
  • RAMP / ROAD CLOSURE
  • SIDEWALK CLOSURE / DETOURS

• Traffic Control Comments

• Comments

  Media

• Is Traffic Control setup properly?

  YES

  NO

• Lighting Station Needed

  Select YES NO NOT REQUIRED

  • YES
  • NO
  • NOT REQUIRED

• Add media

  Media

• Arrow Board Used

  YES

  NO

  NOT REQUIRED

• Add media

  Media

• PCMS Used ( Portable Changeable Message Sign )

  YES

  NO

  NOT REQUIRED

• Add media

  Media

• Are all NCHRP 350 Traffic Control Devices being used

  Select Yes No

  • Yes
  • No

• Comments

  Media

• Warning Sign Being Used On This Project

  Select MOTORCYCLE USE EXTREME CAUTION ABRUPT LANE EDGE BUMP GROOVED PAVEMENT EXPOSED UTILITIES ROUGH ROADWAY SHOULDER DROP OFF

  • MOTORCYCLE USE EXTREME CAUTION
  • ABRUPT LANE EDGE
  • BUMP
  • GROOVED PAVEMENT
  • EXPOSED UTILITIES
  • ROUGH ROADWAY
  • SHOULDER DROP OFF

• Comment about warning signs

• Comments

  Media

TRAFFIC CONTROL PERSONNEL

• Flaggers
  

flagger name

• Flaggers name

• High vis vests/ apparel

  Yes

  No

• Add media

  Media

Two-Way radio communication:

• Does traffic control personnel all have radio communication to communicate with each other?

  Yes

  No

  N/A

• Add media

  Media

Broom Truck

• Broom Truck

Site audit item

• Is broom truck owned by Lakesides

  Yes

  No

  N/A

• Describe item

• Add media

  Media

• Is broom truck cab pressurized?

  Yes

  No

  N/A

• Describe item

• Add media

  Media

• Is broom truck cab door closed while sweeping

  Yes

  No

  N/A

• Describe item

• Add media

  Media

• Has operator inspected and clean the air filter inside the cab

  Yes

  No

  N/A

• Describe item

• Add media

  Media

Misc. items

• Miscellaneous Item

Site audit item

• Is item discuss in compliance?

  Yes

  No

  N/A

• Describe item

• Add media

  Media

Project Comments

• Add media

  Media