Hallen Construction

• Document No.

• Contract No.

• Customer/Owner - Crew Leader

• Conducted on

  Date

• Prepared by

• Location
  Address

Personal Protective Equipment

• HARD HATS?

  Yes

  No

  N/A

• VESTS?

  Yes

  No

  N/A

• EYE PROTECTION?

  Yes

  No

  N/A

• APPROPRIATE FOOTWEAR/FOOT PROTECTION?

  Yes

  No

  N/A

• HEARING PROTECTION?

  Yes

  No

  N/A

• HAND PROTECTION?

  Yes

  No

  N/A

• F R CLOTHING?

  Yes

  No

  N/A

• RESPIRATORY PROTECTION?

  Yes

  No

  N/A

• CPC CLOTHING?

  Yes

  No

  N/A

• COMMENTS ON PERSONAL PROTECTIVE EQUIPMENT

Work Area Protection and Traffic Control

• TRAFFIC DELINEATED PROPERLY?

  EXCELLENT

  GOOD

  FAIR

  POOR

  N/A

• MATERIAL AND DEBRIS PROTECTED?

  EXCELLENT

  GOOD

  FAIR

  POOR

  N/A

• TRAFFIC CONTROL SIGNS PRESENT AND IN GOOD CONDITION?

  EXCELLENT

  GOOD

  FAIR

  POOR

  N/A

• SIDEWALKS/CROSSINGS CLEAR?

  EXCELLENT

  GOOD

  FAIR

  POOR

  N/A

• TRENCHES PLATED, SPIKED & NON-SKID SURFACE PRESENT?

  EXCELLENT

  GOOD

  FAIR

  POOR

  N/A

• WATERWAYS OPEN/CURB BOARDS PRESENT?

  EXCELLENT

  GOOD

  FAIR

  POOR

  N/A

• FLAGMAN/ARROW BOARD PRESENT?

  EXCELLENT

  GOOD

  FAIR

  POOR

  N/A

• STREET SIGNS IN PLACE/SUPPORTED?

  EXCELLENT

  GOOD

  FAIR

  POOR

  N/A

• COMMENTS ON W.A.P.

General and Administrative Safety

• JOB BRIEFING/TRENCHING LOG COMPLETED?

  Yes

  No

  N/A

• H.A.S.P. ONSITE/CURRENT?

  Yes

  No

  N/A

• PROPER PERMITS & REQUIRED PAPERWORK ONSITE?

  Yes

  No

  N/A

• NOISE MITIGATION PLAN POSTED?

  Yes

  No

  N/A

• 1ST AID/BBP KITS PRESENT?

  Yes

  No

  N/A

• FIRE EXTINGUISHER PRESENT/INSPECTION CURRENT?

  Yes

  No

  N/A

• SPILL KITS AVAILABLE?

  Yes

  No

  N/A

• COMMENTS ON GENERAL & ADMINISTRATIVE SAFETY

Trenching and Excavation

• COMPETENT PERSON ONSITE?

  Yes

  No

  N/A

• PROTECTIVE SYSTEM IN PLACE?

  Yes

  No

  N/A

• LADDER(S) PRESENT/PLACED PROPERLY/GOOD CONDITION?

  Yes

  No

  N/A

• SPOIL BANK CORRECT DISTANCE FROM TRENCH

  Yes

  No

  N/A

• CGI PRESENT/CALIBRATED

  Yes

  No

  N/A

• COMMENTS ON TRENCHING AND EXCAVATION

Material, Tools and Equipment

• EQUIPMENT PLACED PROPERLY?

  Yes

  No

  N/A

• SAFETIES PRESENT AND FUNCTIONING?

  Yes

  No

  N/A

• PNEUMATIC HOSES IN GOOD CONDITION/SECURED?

  Yes

  No

  N/A

• SLINGS AND RIGGING USED PROPERLY/INSPECTED?

  Yes

  No

  N/A

• VEHICLES CHOCKED?

  Yes

  No

  N/A

• ADDITIONAL VEHICLE AND EQUIPMENT COMMENTS

Summary

• ADDITIONAL AUDIT COMMENTS