FSSW - CFR 214 Exempt Contractor Checklist - 05182017

Title Page

Contractor: Flatiron - Skanska - Stacy and Witbeck (FSSW)
Conducted on:
Contractor's Designated Competent Employee:

CFR 214 Exempt Contractor Checklist

CONTRACTOR INFORMATION

Contractor: Flatiron - Skanska - Stacy and Witbeck
People in Attendance
People in Attendance
- Jeremiah Roland
- Mario Moreno
- Jose Vorga
- Eduardo Giez
- Juan Carlos Reode
- Eduardo Soluatar
- Jouauy Romuo
- Jason Kossuga
- Richard Penz
- Edgar Q
- Johnny Edwards
- Alberto Lopez
- Andris Moun
- Juan Gonzalez
- Fabian Moreno
- Jose Aguirre
- Erickson Goff
- Fausto Flores
- Juan Sandoval
- Juan Sosedupez
- Roberto Lung
- Shayre Willinghed
- Keith Wesley
- Jeff Robertson
- Sherman Bradshaw
- David Salas
- Rodolfo Hernandez
- Carlos A Olguin
- Miguel Maldonado
- Jose Escalario
- Lucio Confresos Mascorro
- Isaics Gomez
- Jolge Duena
- Terry L. Patton
- Cesar Camacho
- Bary Stevens
- Moe Tahmaseki
- Rudy Marques Mora
- Bart Gray
- Michael Woods
- Raul Castillo
- Jose M Jimenez
- Eusabio Rodriguez
- Carlos Brander
- Julio Jimenez
- Jesus Maldonado
- Carlos Vera Esquivel
- Salvador Ledesma
- Daniel Ramirez
- Pedro Ochoa
- Matt Ashout
- Logitu Faase
- Steve Alonzo
- Guadalupe Montes
- Julio Cesar Carroll
- Mike Ward
- Cyndi Howell
- Lee Duncan
- Jose L Tiscareno
- Chuck Hartman
- Mario Ramirez
- Eosabio Rodriguez
- Ken Milene
- Chris Zawachi
- Frank Taylor
- Wylie Wiles
- Jose Luis Cazares
- Fernando Camacho
- Matt Hicks
- Eduardo Valdivia
- Heracio Ramirez
- Steven Johnson
- Ali Sartok
- Robert Blake
- Jorge D
- Camillo Caronel
- Benjamin Gonzalez
- Jerald Garcia
- Ray
- Juan Lomeli
- Hector Estrada
- Jesus Gonzalez
- Francisco Run
- Mike Bone
- Aymen Salgado
- William Weakley
- Joe T
- Ramon Campos
- Miguel Arzvu
- Ramon Rojas
- Margarito Torres
- Oscar Sanchez
- Jose Lopez
- Greg Murillo
- Auden Mercado
- Miguel Barrera
- Damien Martinez
- Vance Bares
- Jose Hernandez
- Felipe Pedroza
- J.R. Morales
- Laureano Avila
- Jose Felix
- Jose Ochoa
- Woody Ledbetter
- Dean Gabrelcik
- Roman Alaric
- Robert Salgado
- Jesse Machado
- Guadalupe Martinez
- Rogelio Marin
- Joseph Terrazas
- Nate Green
- Howard Davis
- Sergio Lepe
- Manuel Gonzales
- Add Trucker
- Ebrahim Poustchi
- Luis Castillon
- David Kosareﬀ
- William Seleznoﬀ
- Conrad Nava
- Magic Morales
- Agustin Rubio
- Felipe Cano
- Pedro bravo
- Jan Valenzuela
- Ramon Ramirez
- Victor Porras
- Ramon Godinez
- Jaime Felix
- Bill Harris
- Ruben Perez
- Boris Gamero
- Edward Denny
- Victor Arias
- David Magana
- Carlos Coss
- Erick Lopez
- Jonathan Perez
Jeremiah Roland
DL Number: D6884176
License Plate: 9F22452
Equipment Number: 3
Robert Salgado
DL Number: A9692856
License Plate: 98997S1
Equipment #: 01
Jesse Machado
DL Number: D5561546
License Plate: 91429B2
Equipment #: 02
Guadalupe Martinez
DL Number: B3053362
License Plate: 16163Z1
Equipment #: 01
Rogelio Marin
DL Number: D4483152
License Plate: 56279X1
Equipment #: 02
Joseph Terrazas
DL Number: C4571045
License Plate: 91694Y1
Equipment #: 04
Nate Green
DL Number: C2253289
License Plate: 83152X1
Equipment #: 03
Howard Davis
DL Number: N2348041
License Plate: 47925D2
Equipment #: DA6
Sergio Lepe
DL Number: D2528550
License Plate: 25882E2
Equipment #: 56
Manuel Gonzales
DL Number: B4878549
License Plate: 41369Z1
Equipment #: 03
Mario Moreno
DL Number: N7452074
License Plate: 9B04989
Equipment Number: E-364
Jose Vorga
DL Number: A3428893
License Plate: 9F21805
Equipment #: 348
Eduardo Giez
DL Number: A8602035
License Plate: 9F21804
Equipment #: 340
Juan Carlos Reode
DL Number: A5879092
License Plate: ROCHA TK
Equipment #: 1
Eduardo Soluatar
DL Number: A5879092
License Plate: 9F22031
Equipment #: 4
Jouauy Romuo
DL Number: D1269271
License Plate: 9F60676
Equipment #: R2-322
Jason Kossuga
DL Number: D2204933
License Plate: 9F21800
Equipment #: H1
Richard Penz
DL Number: D7317049
License Plate: 9F21803
Equipment #: 2
Edgar Q
DL Number: D1267166
License Plate: 9F44607
Equipment #: 15-349
Johnny Edwards
DL Number: B4520075
License Plate: 9F21799
Equipment #: G5
Alberto Lopez
DL Number: A6810547
License Plate: 9D55139
Equipment #: 414
Andris Moun
DL Number: D3678533
License Plate: 9E46556
Equipment #: 34
Juan Gonzalez
DL Number: A1413635
License Plate: 9D32257
Equipment #: 40
Fabian Moreno
DL Number: D9297416
License Plate: 9F44608
Equipment #: 4
Jose Aguirre
DL Number: B6206422
License Plate: 9D75862
Equipment #: 55
Erickson Goff
DL Number: A4713067
License Plate: 9F21813
Equipment #: 22
Fausto Flores
DL Number: A3469340
License Plate: 9E90162
Equipment #: F4
Juan Sandoval
DL Number: A7870458
License Plate: 9F22218
Equipment #: 01
Juan Sosedupez
DL Number: C1360015
License Plate: 9B92659
Equipment #: 1
Roberto Lung
DL Number: D905008
License Plate: CP91657
Equipment #: 1216
Shayre Willinghed
DL Number: D905008
License Plate: CP91657
Equipment #: 1216
Keith Wesley
DL Number: A3447692
License Plate: 83602WL
Equipment #: 1
David Salas
DL Number: B6364579
License Plate: 9024IJI
Equipment #: 62
Rodolfo Hernandez
DL Number: D3354369
License Plate: 30047WI
Equipment #: 03
Carlos A Olguin
DL Number: N7208419
License Plate: 8D42366
Equipment #: G8
Miguel Maldonado
DL Number: B5804347
License Plate: 7Y45830
Equipment #: 07
Jose Escalario
DL Number: C2152009
License Plate: 92439A2
Equipment #: 06
Lucio Confresos Mascorro
DL Number: A4312636
License Plate: GOFER1
Equipment #: 1
Isaics Gomez
DL Number: A6088253
License Plate: 8Y59925
Equipment #: 413
Jolge Duena
DL Number: V0106314
License Plate: 06941N1
Equipment #: G7
Terry L. Patton
DL Number: R0805982
License Plate: 73248Y1
Equipment #: ABO1
Cesar Camacho
DL Number: D3970626
License Plate: 7C29845
Equipment #: J316
Rudy Marquez Mora
DL Number: N8382324
License Plate: 7S46285
Equipment #: RM111
Bary Stevens
DL Number: C2136688
License Plate: 67238A1
Equipment #: R99
Moe Tahmaseki
DL Number: B6116883
License Plate: 6967IUI
Equipment #: 7IUI
Bart Gray
DL Number: C4996767
License Plate: 7A11111
Equipment #: R95
Michael Woods
DL Number: D2207118
License Plate: 44252B2
Equipment #: A21
Raul Castillo
DL Number: B9516104
License Plate: 26878A2
Equipment #: 003
Jose M Jimenez
DL Number: C6712839
License Plate: 8S93024
Equipment #: (Please Specify)
Eusabio Rodriguez
DL Number: D5029976
License Plate: 65782B2
Equipment #: 04
Carlos Brander
DL Number: D1268989
License Plate: 8D17468
Equipment #: G5
Julio Jimenez
DL Number: A1893053
License Plate: 62671P1
Equipment #: 05
Jesus Maldonado
DL Number: D1433905
License Plate: 8F92669
Equipment #: 06
Carlos Vera Esquivel
DL Number: D9302443
License Plate: 92140A2
Equipment #: G11
Salvador Ledesma
DL Number: C7005998
License Plate: 27142XI
Equipment #: 02
Daniel Ramirez
DL Number: A1397463
License Plate: 70255W1
Equipment #: DRT1
Pedro Ochoa
DL Number: D3819868
License Plate: 22984V1
Equipment #: 372972
Matt Ashout
DL Number: B5467435
License Plate: 61748T1
Equipment #: 48T1
Logitu Faase
DL Number: B9257526
License Plate: 95185G1
Equipment #: 28
Steve Alonzo
DL Number: N4644179
License Plate: 61747T1
Equipment #: 47T1
Guadalupe Montes
DL Number: D4425320
License Plate: 8B76298
Equipment #: 142-4
Julio Cesar Carroll
DL Number: A7547356
License Plate: 98544K1
Equipment #: J28
Mike Ward
DL Number: N8531149
License Plate: 8G52374
Equipment #: 007
Cyndi Howell
DL Number: C1490762
License Plate: 97900M1
Equipment #: A16
Lee Duncan
DL Number: V7038257
License Plate: 21918W1
Equipment #: 54
Jose L Tiscareno
DL Number: C2553484
License Plate: 07150B2
Equipment #: PS91
Chuck Hartman
DL Number: S0969444
License Plate: 85908W1
Equipment #: K484
Mario Ramirez
DL Number: C4927428
License Plate: 8E50892
Equipment #: G3
Eosabio Rodriguez
DL Number: D5029976
License Plate: 65782B2
Equipment #: 04
Ken Milene
DL Number: B7537203
License Plate: 43386B2
Equipment #: Z-2
Chris Zawachi
DL Number: A9082967
License Plate: 34757T1
Equipment #: A1
Frank Taylor
DL Number: C0327382
License Plate: 85492D2
Equipment #: T-604
Wylie Wiles
DL Number: N3340269
License Plate: 05409E1
Equipment #: 02
Jose Luis Cazarez
DL Number: B6364963
License Plate: 26256A2
Equipment #: 04
Fernando Camacho
DL Number: U5103510
License Plate: 13660L1
Equipment #: 01
Matt Hicks
DL Number: D6135394
License Plate: 44252B2
Equipment #: 19
Eduardo Valdivia
DL Number: E2639224
License Plate: 7074621
Equipment #: RSB1
Sherman Bradshaw
DL Number: B9132335
License Plate: 8T21962
Equipment #: SK2
Steven Johnson
DL Number: A6768028
License Plate: 87851D2
Equipment #: 939-510
Ali Sartok
DL Number: D2705157
License Plate: 83155X1
Equipment #: 55X1
Robert Blake
DL Number: N4011581
License Plate: 86423B2
Equipment #: 23B2
Jorge D
DL Number: U0106314
License Plate: 06941N1
Equipment #: G7
Camillo Caronel
DL Number: C1291614
License Plate: 7594598
Equipment #: 24
Benjamin Gonzalez
DL Number: C2583784
License Plate: GOFER1
Equipment #: G1
Jerald Garcia
DL Number: C2310289
License Plate: 0051821
Equipment #: 791
Ray
DL Number: F2512117
License Plate: 83157X1
Equipment #: 57X1
Juan Lomeli
DL Number: D7603872
License Plate: 8V43199
Equipment #: 01
Hector Estrada
DL Number: N7589917
License Plate: 9E33357
Equipment #: 27
Jesus Gonzalez
DL Number: N9526289
License Plate: 9D96981
Equipment #: 501
Francisco Run
DL Number: C5525861
License Plate: 65819V1
Equipment #: 111
Mike Bone
DL Number: A4282043
License Plate: 14798L1
Equipment #: 99
Aymen Salgado
DL Number: D3907482
License Plate: 81332W1
Equipment #: RSB 03
William Weakley
DL Number: N5436683
License Plate: 9F44664
Equipment #: H320
Joe T
DL Number: M0816381
License Plate: 8L15058
Equipment #: 82
Ramon Campos
DL Number: D7218063
License Plate: 69H038H1
Equipment #: 24
Miguel Arzvu
DL Number: C4219184
License Plate: 72000F2
Equipment #: D07
Ramon Rojas
DL Number: N7347425
License Plate: 58870C2
Equipment #: 03
Margarito Torres
DL Number: N8877869
License Plate: 8B91799
Equipment #: 777
Oscar Sanchez
DL Number: F8202687
License Plate: 27379A2
Equipment #: D73
Jose Lopez
DL Number: D1397450
License Plate: 8X79862
Equipment #: D71
Greg Murillo
DL Number: B3605751
License Plate: 08033B2
Equipment #: 211
Auden Mercado
DL Number: D9917887
License Plate: 56787R1
Equipment #: 420
Miguel Barrera
DL Number: Y2521272
License Plate: 7D58541
Equipment #: MT67
Damien Martinez
DL Number: D2025425
License Plate: 08010B2
Equipment #: 911
Vance Bares
DL Number: D7280229
License Plate: 80901H1
Equipment #: 187
Jose Hernandez
DL Number: A6355500
License Plate: 41022C1
Equipment #: 5150
Felipe Pedroza
DL Number: C3136216
License Plate: 8X08856
Equipment #: 26
J.R. Morales
DL Number: B4463133
License Plate: 95186G1
Equipment #: 27
Laureano Avila
DL Number: C2267938
License Plate: 95187G1
Equipment #: 29
Roman Alaric
DL Number: A3635671
License Plate: 8L07538
Equipment #: D84
Heracio Ramirez
DL Number: D9056413
License Plate: 46505N1
Equipment #: 01
Woody Ledbetter
DL Number: A6131593
License Plate: 77912M1
Equipment #: D74
Dean Gabrelcik
DL Number: D6886676
License Plate: 99070J1
Equipment #: BE100
Jose Ochoa
DL Number: A9047307
License Plate: 9E05165
Equipment #: 01
Jose Felix
DL Number: B5875596
License Plate: 8E5092
Equipment #: G3
Ebrahim Poustchi
DL Number: C5305602
License Plate: 83841X1
Equipment #: 41X1
Felipe Cano
DL Number: C4258076
License Plate: 65817V1
Equipment #: 107
Luis Castillon
DL Number: A4032178
License Plate: 84609S1
Equipment #: B1
David Kosareﬀ
DL Number: N3671055
License Plate: 74185N1
Equipment #: 02
William Seleznoﬀ
DL Number: R0292321
License Plate: 13949D2
Equipment #: 03
Conrad Nava
DL Number: U5011949
License Plate: 63131P1
Equipment #: 01
Magic Morales
DL Number: B4463133
License Plate: 95186G1
Equipment #: 27
Agustin Rubio
DL Number: C3859833
License Plate: 7439Y1
Equipment #: 109
Pedro Bravo
DL Number: C4950341
License Plate: 27398W1
Equipment #: B8
Jan Valenzuela
DL Number: D4755478
License Plate: 8D17468
Equipment #: G5
Company
- Granite Construction
- FSSW
- Loretta Trucking
- Gaspar
- Kelly Trucking
- Burns Trucking
- Other
Please Specify:
Type of Equipment
- Bottom Dump
- Booster
- Super 10
- 18 Wheeler
- Flatbed
- Other
Please Specify:
Type of Delivery
- Class 2 Base
- 1/4 ton Rip Rap
- Steel Plates
- 40' Beams
- Dirt Fill
- 3/4" Rock
- Other
Please Specify:
Are there any errors in the above information?
Please Specify:
Verify above information and sign below
Ramon Ramirez
DL Number: C1100380
License Plate: 92439A2
Equipment #: 06
Boris Gamero
DL Number: D9039164
License Plate: 64837P1
Equipment #: 04
Ruben Perez
DL Number: U1162283
License Plate: 88079A2
Equipment #: C03
Ramon Ramirez
DL Number: C1100380
License Plate: 92439A2
Equipment #: 06
Bill Harris
DL Number: 173156481
License Plate: 88147A2
Equipment #: 484
Ramon Godinez
DL Number: C3230598
License Plate: 46643N1
Equipment #: 50
Victor Porras
DL Number: D1265689
License Plate: 76457F2
Equipment #: 06
Jaime Felix
DL Number: D7208646
License Plate: 64789A1
Equipment #: 403
Jonathan Perez
DL Number: F4465690
License Plate: 6N11752
Equipment #: C04
Erick Lopez
DL Number: F4972224
License Plate: 92102D2
Equipment #: C01
Carlos Coss
DL Number: D6824111
License Plate: 67867Z1
Equipment #: 54
David Magana
DL Number: C4257884
License Plate: 11941R1
Equipment #: G6
Victor Arias
DL Number: D3903075
License Plate: 25094E2
Equipment #: 01
Edward Denny
DL Number: M0384249
License Plate: 67346C2
Equipment #: Fe 17
Name:
Company
- Granite Construction
- FSSW
- Loretta Trucking
- Gaspar
- Kelly Trucking
- Burns Trucking
- Other
Please Specify:
DL Number:
License Plate:
Equipment Number:
Type of Equipment
- Bottom Dump
- Booster
- Super 10
- 18 Wheeler
- Flatbed
- Other
Please Specify:
Type of Delivery
- Class 2 Base
- 1/4 ton Rip Rap
- Steel Plates
- 40' Beams
- Dirt Fill
- 3/4" Rock
- Other
Please Specify:
Verify above information and sign below

PRIOR TO ENTERING THE ROW

Provided employees with Job Briefing
Contractor's Designated Competent Employee has answered general questions

RWP Procedure

Reviewed Key terms and safety measures
Discussed clearing and stopping procedures
Reviewed general jobsite requirements
Lookout/Watchman
White Board / Air horn and whistle
Form B
Please Specify:
Track and Time
Right to Challenge

PROCEDURES

Delivery of materials locations and safe clearing procedures
Truck Driver Failed to Comply
(REMOVED FROM - NCTD Railroad Right of Way).
Specify Trucker who Failed to comply
- Jeremiah Roland
- Mario Moreno
- Jose Vorga
- Eduardo Giez
- Juan Carlos Reode
- Eduardo Soluatar
- Jouauy Romuo
- Jason Kossuga
- Richard Penz
- Edgar Q
- Johnny Edwards
- Alberto Lopez
- Andris Moun
- Juan Gonzalez
- Fabian Moreno
- Jose Aguirre
- Erickson Goff
- Fausto Flores
- Juan Sandoval
- Juan Sosedupez
- Roberto Lung
- Shayre Willinghed
- Keith Wesley
- Jeff Robertson
- Sherman Bradshaw
- David Salas
- Rodolfo Hernandez
- Carlos A Olguin
- Miguel Maldonado
- Jose Escalario
- Lucio Confresos Mascorro
- Isaics Gomez
- Jolge Duena
- Terry L. Patton
- Cesar Camacho
- Bary Stevens
- Moe Tahmaseki
- Rudy Marques Mora
- Bart Gray
- Michael Woods
- Raul Castillo
- Jose M Jimenez
- Eusabio Rodriguez
- Carlos Brander
- Julio Jimenez
- Jesus Maldonado
- Carlos Vera Esquivel
- Salvador Ledesma
- Daniel Ramirez
- Pedro Ochoa
- Matt Ashout
- Logitu Faase
- Steve Alonzo
- Guadalupe Montes
- Julio Cesar Carroll
- Mike Ward
- Cyndi Howell
- Lee Duncan
- Jose L Tiscareno
- Chuck Hartman
- Mario Ramirez
- Eosabio Rodriguez
- Ken Milene
- Chris Zawachi
- Frank Taylor
- Wylie Wiles
- Jose Luis Cazares
- Fernando Camacho
- Matt Hicks
- Eduardo Valdivia
- Heracio Ramirez
- Steven Johnson
- Ali Sartok
- Robert Blake
- Jorge D
- Camillo Caronel
- Benjamin Gonzalez
- Jerald Garcia
- Ray
- Juan Lomeli
- Hector Estrada
- Jesus Gonzalez
- Francisco Run
- Mike Bone
- Aymen Salgado
- William Weakley
- Joe T
- Ramon Campos
- Miguel Arzvu
- Ramon Rojas
- Margarito Torres
- Oscar Sanchez
- Jose Lopez
- Greg Murillo
- Auden Mercado
- Miguel Barrera
- Damien Martinez
- Vance Bares
- Jose Hernandez
- Felipe Pedroza
- J.R. Morales
- Laureano Avila
- Jose Felix
- Jose Ochoa
- Woody Ledbetter
- Dean Gabrelcik
- Roman Alaric
- Robert Salgado
- Jesse Machado
- Guadalupe Martinez
- Rogelio Marin
- Joseph Terrazas
- Nate Green
- Howard Davis
- Sergio Lepe
- Manuel Gonzales
- Add Trucker
- Ebrahim Poustchi
- Luis Castillon
- David Kosareﬀ
- William Seleznoﬀ
- Conrad Nava
- Magic Morales
- Agustin Rubio
- Felipe Cano
- Pedro bravo
- Jan Valenzuela
- Ramon Ramirez
- Victor Porras
- Ramon Godinez
- Jaime Felix
- Bill Harris
- Ruben Perez
- Boris Gamero
- Edward Denny
- Victor Arias
- David Magana
- Carlos Coss
- Erick Lopez
- Jonathan Perez
If Other: Please Specify
Mileposts:
Please Specify Mileposts: