Information

  • Project Name:

  • Conducted on

  • Crews on site

  • Prepared by

  • Location

Project comments

Project type

Crew on site

Personnel on project

  • Personnel on site

  • Employee Name
  • Personnel

  • High vis vests/ apparel

  • Add media

Trucks Onsite

  • Truck drivers on site

  • Drivers Name
  • High vis vests/ apparel

  • Add media

Contractors on site

  • Contractors

  • Contractors Name
  • High vis vests/ apparel

  • Add media

PPE Requirement Question

  • Hearing Protection

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

  • How many employees are wearing dB blockers:

  • High vis vests/ apparel

  • Add media

  • Day project

  • Check Box if Night Gear is Required

  • Hard hat required?

  • Add media

  • Safety glasses

  • Add media

  • Respiratory protection required?

  • Add media

  • Hand Protection

  • Other PPE

Traffic

  • Our traffic control?

  • Add media

  • If no, who?

  • Traffic plan

  • Traffic Control Comments

  • Comments

  • Is Traffic Control setup properly?

  • Lighting Station Needed

  • Add media

  • Arrow Board Used

  • Add media

  • PCMS Used ( Portable Changeable Message Sign )

  • Add media

  • Are all NCHRP 350 Traffic Control Devices being used

  • Comments

  • Warning Sign Being Used On This Project

  • Comment about warning signs

  • Comments

TRAFFIC CONTROL PERSONNEL

  • Flaggers

  • flagger name
  • Flaggers name

  • High vis vests/ apparel

  • Add media

Two-Way radio communication:

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

  • Add media

Broom Truck

  • Broom Truck

  • Site audit item
  • Is broom truck owned by Lakesides

  • Describe item

  • Add media

  • Is broom truck cab pressurized?

  • Describe item

  • Add media

  • Is broom truck cab door closed while sweeping

  • Describe item

  • Add media

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

  • Describe item

  • Add media

Misc. items

  • Miscellaneous Item

  • Site audit item
  • Is item discuss in compliance?

  • Describe item

  • Add media

Project Comments

  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.