Field Safety Inspection - 2.0

• Date and Time

  Date

• Customer

  Select GC PEPCO-Cond + MH Other BGE GAS Manhole Assmt. Columbia Gas Pepco-MH Cert. BGE Civil

  • GC
  • PEPCO-Cond + MH
  • Other
  • BGE GAS
  • Manhole Assmt.
  • Columbia Gas
  • Pepco-MH Cert.
  • BGE Civil

• Site Supervisor

  Select Joe Johnson Garland (Nick) Howell Tony Cordova Jose Cordova Luis Gutierez Jerry Franklin Troy Souder B. Garnett Jelver Lopez Mauricio Bonilla Jonas Salinas Dock Workman Alberto Ornales Miguel Castro Jaime Vaz Nigel Reeder Antuan McQuaige Keith Jones Kenneth Banks Davon Wilson Emmanuel Green Zak Graybill Melvin Valintine Dan Poe Ryan Lloyd Tom Bridgett Frank Fudrow Sub Contractor Jamarr Watson William Dee Roberts Humberto Maceda Ramon Mareno Oscar DelCid Carlos Tejada William Carrington Walt Bullock Paul Hapbell Josh Layton Gilmar Diaz Maldonado Shawn Riley Charlie Brown James Despertt Kyle Gray Kenny Massioni Michael Stewart Chris O'hara Daniel Horton Ervin Barnes Ryan Rupert Paul Golden Allen Reeder Ray Carroll Michael Stewart David Wade Mark Gray Jr. Kretiene Fokou Kevin Richardson Gerson Vargas

  • Joe Johnson
  • Garland (Nick) Howell
  • Tony Cordova
  • Jose Cordova
  • Luis Gutierez
  • Jerry Franklin
  • Troy Souder
  • B. Garnett
  • Jelver Lopez
  • Mauricio Bonilla
  • Jonas Salinas
  • Dock Workman
  • Alberto Ornales
  • Miguel Castro
  • Jaime Vaz
  • Nigel Reeder
  • Antuan McQuaige
  • Keith Jones
  • Kenneth Banks
  • Davon Wilson
  • Emmanuel Green
  • Zak Graybill
  • Melvin Valintine
  • Dan Poe
  • Ryan Lloyd
  • Tom Bridgett
  • Frank Fudrow
  • Sub Contractor
  • Jamarr Watson
  • William Dee Roberts
  • Humberto Maceda
  • Ramon Mareno
  • Oscar DelCid
  • Carlos Tejada
  • William Carrington
  • Walt Bullock
  • Paul Hapbell
  • Josh Layton
  • Gilmar Diaz Maldonado
  • Shawn Riley
  • Charlie Brown
  • James Despertt
  • Kyle Gray
  • Kenny Massioni
  • Michael Stewart
  • Chris O'hara
  • Daniel Horton
  • Ervin Barnes
  • Ryan Rupert
  • Paul Golden
  • Allen Reeder
  • Ray Carroll
  • Michael Stewart
  • David Wade
  • Mark Gray Jr.
  • Kretiene Fokou
  • Kevin Richardson
  • Gerson Vargas

• Superintendent/ Contract Lead

  Select Billy Jackson Paul Hapbell Billy Cole Chris Forgue Antuan McQuaige Sam Shojaei Jack Brown Nick Howell Corey Coil Antonio Forte Nigel Reeder Paul Golden Chris Millan Joe Johnson

  • Billy Jackson
  • Paul Hapbell
  • Billy Cole
  • Chris Forgue
  • Antuan McQuaige
  • Sam Shojaei
  • Jack Brown
  • Nick Howell
  • Corey Coil
  • Antonio Forte
  • Nigel Reeder
  • Paul Golden
  • Chris Millan
  • Joe Johnson

• Jobsite name/number

• Location
  Address

• Tasks being performed during audit?

• Do operations require a compentent person on site?

  Yes

  No

  N/A

• Weather Conditions?

• Inspection completed by:

SITE & PUBLIC PROTECTION

• Is traffic control required?

  Yes

  No

  N/A

• Has the appropriate traffic control measures been set up correctly?

  Safe

  Needs Improvement

  Unsafe

• Is pedestrian traffic//signage/ barricades properly set-up? Are sign stand legs extended

  Safe

  Needs Improvement

  Unsafe

• Is there adequate lighting for worker being done?

  Yes

  No

  N/A

• Are all traffic control devices free from damage and or wear and tear that makes it defective?

  Yes

  No

  N/A

• Is the Zone of Protection established and set up correctly?

  Yes

  No

  N/A

GENERAL

• Is the Job briefing form completed, signed, and the 4 Key Questions done well?

  Yes

  Needs Improvement

  No

• What opportunities were noted?

• Miss Utility ticket available and current?

  Yes

  No

  N/A

• Is status confirmed clear?

  Yes

  No

  N/A

• How was status confirmed clear?

  MISS Utility App/Online

  Hard copy of ticket status

• Are COVID-19 Protocols being adhered to with crew members not showing up to work with Flu-like symptoms, Social Distancing being practiced as appropriate, Masks being used as needed, and hand washing/ sanitizing supplies readily available?

  Yes

  No

  N/A

• Did you observe anyone with flu-like/Covid-19 symptoms? If yes, have the individual leave the site and contact Joy COVID-19 Hotline @301-699-2390

  Yes

  No

• Stretch and Flex completed before starting work?

  Yes

  No

  Not Observed

• Does the crew know what the 2 minute educational video was about?

  Compliant

  Non-Compliant

JOB SITE HOUSEKEEPING

• Are Pathways free from obstructions, and free from slips/ trips and fall hazards?

  Yes

  No

  N/A

• Are designated storage locations identified and maintained to minimize housekeeping hazards?

  Compliant

  Non- Compliant

  N/A

• Is the work area being maintained throughout the day and being kept free from slips/ Trips & Fall hazards?

  Yes

  Needs Improvement

  No

• Are hazardous materials present?

  Yes

  No

  N/A

• Are hazardous materials being handled per HAZCOM standards?

  Compliant

  Non-Compliant

• Is the Hazcom program communicated and understood by workers?

  Compliant

  Non-Compliant

• Is there at least 1 person trained in CPR/ First Aid available onsite?

  Yes

  No

  N/A

• Adequate First Aid/ CPR supplies available?

  Compliant

  Non-Compliant

• Is there adequate bathroom facilities available if applicable?

  Yes

  No

  N/A

• Do workers have sufficient potable water?

  Yes

  No

  N/A

Environmental

• Are respiratory hazards present?

  Yes

  No

  N/A

• Are all airborne Hazards identified and are they being either eliminated/ substituted or controlled?

  Yes

  No

  N/A

• Is Silica Dust being generated?

  Yes

  No

  N/A

• Are tasks being done under Table 1 for Silica Dust?

  Compliant

  Non- Compliant

  N/A

• All other Dust Control(s) in Place including voluntary dust masks when appropriate?

  Compliant

  Non-Compliant

UTILITY SPECIFIC

• Is the proposed area of work delineated with white marker paint?

  Yes

  No

  N/A

• Are all underground utilities located and marked with in the proposed area of work?

  Yes

  No

  N/A

• Have drawing(s) been reviewed today to compare drawings to marks?

  Yes

  No

  N/A

• Are all known utilities in the work area being exposed by hand and protected from damage?

  Yes

  No

  N/A

• Are overhead hazards present?

  Yes

  No

  N/A

• Are overhead hazards identified and controlled?

  Yes

  No

  N/A

Trenching and Excavation

• Is Excavation work being done?

  Yes

  No

  N/A

• Are trenching operations being performed?

  Yes

  No

  N/A

• Is there an appropriate means of access and egress?

  Compliant

  Non- Compliant

  N/A

• Are all materials/tools/ and spoils kept at least 2 ft from edge of the trench?

  Compliant

  Non-Compliant

• Are Ladders in use?

  Yes

  No

  N/A

• Are ladders free from damage and excessive wear and tear?

  Compliant

  Non- Compliant

  N/A

• Does ladder extend a minimum of 36" from landing?

  Yes

  No

  N/A

• Are the ladders being properly positioned and located?

  Compliant

  Non- Compliant

  N/A

• Is the trench 4 ft 10 inches or greater?

  Yes

  No

  N/A

• What protective system is being utilized for the work at hand?

  Select Timber Shoring Hydraulic shoring Sloping/ Angle of Repose Trench shield/ Trench Box Protective system being installed Protective system not required

  • Timber Shoring
  • Hydraulic shoring
  • Sloping/ Angle of Repose
  • Trench shield/ Trench Box
  • Protective system being installed
  • Protective system not required

• Is the protective system adequate for the work being done?

  Compliant

  Non-Compliant

• Is the tabulated data sheet available on site?

  Yes

  No

  N/A

• Is the ladder located within 25 feet of where the workers are located and within the protected area?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT (PPE)

• Is all company required Personal Protective Equipment being used including Eye Protection, Foot protection, Hand Protection,(Cut 4,Puncture 3 rating) High Visibility Safety Vest while on an active job site?

  Yes

  No

  N/A

• Is additional PPE Required?

  Yes

  No

  N/A

• What additional PPE is required?

  Select Face Shield Metatarsal Foot Guards Cut Resistant Gloves Leather Gloves Chaps(leather or synthetic) Extra Hearing Protection Dust Mask Respirator FR Clothing Chin Guards Fall protection Fire Blanket

  • Face Shield
  • Metatarsal Foot Guards
  • Cut Resistant Gloves
  • Leather Gloves
  • Chaps(leather or synthetic)
  • Extra Hearing Protection
  • Dust Mask
  • Respirator
  • FR Clothing
  • Chin Guards
  • Fall protection
  • Fire Blanket

• Is additional PPE that is required adequate and in good condition?

  Pass

  Fail

  N/A

• Is FR Clothing required

  Yes

  No

  N/A

• Is FR clothing worn, in good condition and shirts tucked in?

  Compliant

  Non- Compliant

  N/A

• Are Dielectric Gloves and Blankets required?

  Yes

  No

  N/A

• Dielectric gloves/blankets on site and in good condition?

  Yes

  No

  Not Observed

• Have gloves/blankets been certified in the last 6 months?

  Compliant

  Non-Compliant

HAND AND POWER TOOLS?

• Are small hand tools being used?

  Yes

  No

  N/A

• Are tools that are being used free of any defects or excess wear and tear?

  Compliant

  Non-Compliant

• Proper tool(s) being used for the task at hand?

  Compliant

  Non-Compliant

• Handle(s) free of cracks and attached to tool properly?

  Yes

  No

  N/A

• Are wire strippers available and used in lieu of knife?

  Yes

  No

  N/A

• Are power tools being used?

  Yes

  No

  N/A

• Are extension cords in good condition and free from cuts or broken ground prongs?

  Yes

  No

  N/A

• Are power tools in good working condition and being used per manufactures recommendations?

  Safe

  At Risk

  N/A

• Guard(s) in place and used correctly?

  Safe

  At Risk

  N/A

• Are portable generators being used?

  Yes

  No

  N/A

• Portable Generator(s) in good operating condition?

  Yes

  No

  N/A

• Are portable generators being allowed to cool down before refueling?

  Yes

  No

  Not Observed

• Are air compressors being used?

  Yes

  No

  N/A

• Air Compressors & Hoses in good working condition?

  Safe

  At Risk

  N/A

• Are whip checks attached and in good condition?

  Safe

  At Risk

  N/A

VEHICLES & MOTORIZED EQUIPMENT

• Has the vehicle's Pre-trip inspection been completed and documented in the WhipAround App per company policy?

  Yes

  No

  Not Observed

• Are wheel chocks in place and set appropriately?

  Compliant

  Non-Compliant

• Is the vehicle registration and insurance card on the truck?

  Yes

  No

  Not Observed

• Is vehicle housekeeping in good order?

  Compliant

  Non-Compliant

• Are loads properly secured and organized?

  Compliant

  Non-Compliant

• Are Fuel Supplies stored and protected from accidental spillage?

  Compliant

  Non-Compliant

  N/A

• Are fire extinguishers available on work vehicles, fully charged and inspected?

  Compliant

  Non-Compliant

• Was the tow hitch inspected and in good working condition?

  Yes

  No

  Not Observed

• Are operators certified and have valid card that is current and in possession or readily accessible.

  Yes

  No

  Not Observed

FIRE PREVENTION & PROTECTION

• Is Hot work being done?

  Yes

  No

  N/A

• Is all required fire protection ppe being utilized and adequate for operations.

  Safe

  At Risk

  N/A

• What additional PPE is required?

  Select Face Shield Metatarsal Foot Guards Cut Resistant Gloves Leather Gloves Chaps(leather or synthetic) Extra Hearing Protection Dust Mask Respirator FR Clothing Chin Guards Fall protection Fire Blanket

  • Face Shield
  • Metatarsal Foot Guards
  • Cut Resistant Gloves
  • Leather Gloves
  • Chaps(leather or synthetic)
  • Extra Hearing Protection
  • Dust Mask
  • Respirator
  • FR Clothing
  • Chin Guards
  • Fall protection
  • Fire Blanket

• Adequate number and type of fire extinguisher(s) available and within close distance from operations being done.

  Safe

  At Risk

  N/A

• Is the area clear and free from known flammable materials prior to hot work being done.

  Safe

  At Risk

  N/A

• Is the equipment that requires refueling allowed to cool down before refueling?

  Safe

  At Risk

  N/A

RIGGING

• Is Rigging Required?

  Yes

  No

  N/A

• All rigging & lifting equipment Inspected prior to use & in good condition?

  Safe

  At Risk

  N/A

• What opportunites were noted or corrective measures taken?

• Load(s) being properly rigged & hoisted?

  Yes

  No

  Not Observed

• Is the appropriate tag line being utilized to control hoisted loads?

  Yes

  No

  Not Observed

• Is rigging equipment being stored properly when not in use?

  Yes

  No

  Not Observed

Confined Spaces

• Are permit required confined space protocols required?

  Yes

  No

  N/A

• Has confined space been tested prior to entry?

  Yes

  No

  N/A

• Is forced air ventilation set up and working correctly.

  Yes

  No

  N/A

• Are 4-way gas monitors/ GMI's calibrated, inspected, and in good operating condition?

  Safe

  At Risk

  N/A

• Are employees properly trained for confined space entry?

  Safe

  At Risk

  N/A

• Is confined space permit filled out?

  Compliant

  Non- Compliant

  N/A

• Is specialized equipment being used per manufacture recommendations. I.e. manhole barricade/tripod/, blower, retractable life line?

  Safe

  At Risk

  N/A

Wins

• undefined

Opportunities

• undefined

• On Site Supervisor

  Sign

• Inspector

  Sign