FMSO Bluestake

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Names of Auditors

• Name(s) of Employees and Supervisor being audited.

Employee Competencies

• Employees can describe when a Bluestake permit is required.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe who to contact to obtain a Bluestake permit.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe what they should do during an excavation if unexpected utility or process lines are discovered.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe how close to known utilities they can excavate with machinery.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe what they should do if they contact a utility line.

  Yes

  No

  N/A

• Completion Date:

Supervisor Competencies

• Supervisors can describe how they trust but verify the following for their employees:

• Employees can describe when a Bluestake permit is required.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe who to contact to obtain a Bluestake permit.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe what they should do during an excavation if unexpected utility or process lines are discovered.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe how close to known utilities they can excavate with machinery.

  Yes

  No

  N/A

• Completion Date:

• Employees can describe what they should do if they contact a utility line.

  Yes

  No

  N/A

• Completion Date:

• Supervisors can relate an experience when they coached, reprimanded or praised employees for Bluestake processes.

  Yes

  No

  N/A

• Completion Date:

Observation of Work Practices

• Is a Bluestake permit obtained prior to performing activities described in the guideline? (Penetration of non-native ground or any wall, floor penetration deeper than 2 inches).

  Yes

  No

  N/A

• Completion Date:

• Does the engineering or other department have a record of known utilities that is up to date?

  Yes

  No

  N/A

• Completion Date:

• Are utilities properly marked prior to the commencement of work?

  Yes

  No

  N/A

• Completion Date:

• Is a Bluestake permit completed properly prior to the commencement of work?

  Yes

  No

  N/A

• Completion Date:

• Auditor(s) Signature

  Sign

• Revision 1.0 iCloud posted document is the controlled copy. 07/03/13