Field Survey Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Driving Observation: Does Driver...

• a. And all occupants wear seatbelts?

  Yes

  No

  N/A

• b. Obey posted speed limits?

  Yes

  No

  N/A

• c. Maintain adequate following distance?

  Yes

  No

  N/A

• d. Slow down gradually when approaching red lights and stop signs?

  Yes

  No

  N/A

• e. Make a full stop at all stop signs?

  Yes

  No

  N/A

• f. Drive with caution in congested/construction zones?

  Yes

  No

  N/A

• g. Avoid excessive and unnecessary lane changes?

  Yes

  No

  N/A

• h. Blend smoothly with merging traffic?

  Yes

  No

  N/A

• i. Have loads secured properly?

  Yes

  No

  N/A

• j. Maintain proper speeds for conditions (i.e. rain, pulling trailer/load)

  Yes

  No

  N/A

• k. Have trailer properly hooked up and tail lights operational?

  Yes

  No

  N/A

• l. Utilize strobe lights upon entering/leaving worksite?

  Yes

  No

  N/A

• Notes:

  Yes

  No

  N/A

2. Boating Operations: Does operator/crew:

• a. Wear approved Life Vests at all times?

  Yes

  No

  N/A

• b. Have Boat Inspection/Orientation filled out and on hand?

  Yes

  No

  N/A

• c. Have all safety equipment on board?

  Yes

  No

  N/A

• d. Operate boat safely and consistent with policies?

  Yes

  No

  N/A

• e. Have current registration sticker and registration?

  Yes

  No

  N/A

• f. Water or fluids on board?

  Yes

  No

  N/A

• g. Load/Unload boat safely?

  Yes

  No

  N/A

• h. Maintain attention to the surrounding and to FDOT Employees?

  Yes

  No

  N/A

3. If Flagging Operation Observed: Does Crew...

• a. Maintain attention to oncoming traffic at all times?

  Yes

  No

  N/A

• b. Utilize strobe lights on vehicle?

  Yes

  No

  N/A

• c. Use proper lifting techniques for loading/unloading?

  Yes

  No

  N/A

• d. Set up/pick up flagging operation in proper sequence?

  Yes

  No

  N/A

• e. Have proper and valid certifications?

  Yes

  No

  N/A

• f. Place temporary traffic control devices at proper spacing and according to specifications?

  Yes

  No

  N/A

• g. Position flaggers properly?

  Yes

  No

  N/A

• h. Stay behind positive protection when outside of vehicle and idle?

  Yes

  No

  N/A

• i. Park vehicle behind position protection or as far from travel as possible?

  Yes

  No

  N/A

• j. Utilize light towers for night flagging?

  Yes

  No

  N/A

• k. Utilize reflective stop/slow for night flagging?

  Yes

  No

  N/A

• l. Flag traffic correctly and efficiently?

  Yes

  No

  N/A

• m. Have traffic properly and safely controlled?

  Yes

  No

  N/A

• Notes:

  Yes

  No

  N/A

4. If Lane Closure Operations Observed, Does Crew...

• a. Maintain attention to oncoming traffic at all times?

  Yes

  No

  N/A

• b. Utilize strobe lights on vehicle?

  Yes

  No

  N/A

• c. Utilize proper lifting techniques for loading/unloading?

  Yes

  No

  N/A

• d. Set up/pick up lane closure operations in proper sequence?

  Yes

  No

  N/A

• e. Place Temporary Traffic Control Devices at proper spacing and according to specifications?

  Yes

  No

  N/A

• f. Stay behind positive protection when outside of vehicle and idle?

  Yes

  No

  N/A

• g. Park vehicle behind positive protection or as far from travel lane as possible?

  Yes

  No

  N/A

• h. Maintain cones upright?

  Yes

  No

  N/A

• Notes:

  Yes

  No

  N/A

5. If Light/Flag Service Operation Observed: Does Crew...

• a. Maintain attention to oncoming traffic at all times?

  Yes

  No

  N/A

• b. Utilize strobe lights on vehicles?

  Yes

  No

  N/A

• c. Utilize proper lifting techniques for loading/unloading?

  Yes

  No

  N/A

• d. Perform service behind positive protection?

  Yes

  No

  N/A

• e. Remove device away from travel lane before servicing?

  Yes

  No

  N/A

• f. Utilize fall protection plan and CAZ when servicing lights accessible from the working surface of a bridge for lights on a leading edge?

  Yes

  No

  N/A

• g. Use ladders safely and according to safety policy?

  Yes

  No

  N/A

• h. Remove signs from the wall before servicing when located on a leading edge?

  Yes

  No

  N/A

• i. Utilize PPE fall protection when servicing lights/flags on signs located on a leading edge?

  Yes

  No

  N/A

• j. Park vehicle behind positive protection or as far from travel lane as possible?

  Yes

  No

  N/A

• Notes:

  Yes

  No

  N/A

6. If Delivery/Pickup Operation is Observed, Does Crew...

• a. Have load properly secured?

  Yes

  No

  N/A

• b. Maintain attention to oncoming traffic at all times?

  Yes

  No

  N/A

• c. Utilize strobe lights on vehicles?

  Yes

  No

  N/A

• d. Use proper lifting techniques?

  Yes

  No

  N/A

• e. Deliver/pick up proper equipment?

  Yes

  No

  N/A

• f. Unload/load behind positive protection or a far from the travel lane as possible?

  Yes

  No

  N/A

• g. Have trailer properly hooked up to vehicle?

  Yes

  No

  N/A

• Notes:

  Yes

  No

  N/A

7. If Sign Installation/Removal is Observed: Does Crew...

• a. Maintain attention to oncoming traffic at all times?

  Yes

  No

  N/A

• b. Utilize strobe lights on vehicles?

  Yes

  No

  N/A

• c. Utilize proper lifting techniques for loading/unloading?

  Yes

  No

  N/A

• d. Install sign to proper FDOT offset from travel lane?

  Yes

  No

  N/A

• e. Install sign according to plans and specifications?

  Yes

  No

  N/A

• f. Pay attention to utility locates during installation?

  Yes

  No

  N/A

• g. Excavate in a safe manner?

  Yes

  No

  N/A

• h. Utilize PPE fall protection when installing signs on a leading edge?

  Yes

  No

  N/A

• i. Park or work behind positive protection or as far from travel lane as possible?

  Yes

  No

  N/A

• Notes:

  Yes

  No

  N/A

8. If Installation/Repair or Removal of Attenuator is Observed, Does Crew...

• a. Maintain attention to oncoming traffic at all times?

  Yes

  No

  N/A

• b. Utilize strobe lights on vehicle?

  Yes

  No

  N/A

• c. Utilize proper lifting techniques for loading/unloading?

  Yes

  No

  N/A

• d. Properly secure load?

  Yes

  No

  N/A

• e. Utilize proper hoisting techniques?

  Yes

  No

  N/A

• f. Utilize power tools with frayed or cut cords?

  Yes

  No

  N/A

• g. Wear proper eye protection when drilling holes or grinding or cutting bolts?

  Yes

  No

  N/A

• h. Utilize proper nuts/bolts/epoxy?

  Yes

  No

  N/A

• i. Park truck and/or trailer between them and oncoming traffic?

  Yes

  No

  N/A

• j. Maintain sage distance from objects that are hoisted?

  Yes

  No

  N/A

• k. Utilizes additional safety measures (i.e. TMA, lane closure) if worksite is unsafe distance from travel lanes?

  Yes

  No

  N/A

• l. Utilize proper respirator protection during drilling concrete if appropriate?

  Yes

  No

  N/A

• Notes:

  Yes

  No

  N/A

General Comments

• Comments:

  Yes

  No

  N/A