Hydrovac Field Audit

• Client

• Project name:

• Conducted on

  Date

• Prepared by

• Location
  Address

Documentation / Work Planning

• Hazard Assessment <br>Properly completed and reviewed by workers

  Yes

  No

  N/A

• Line locates <br>Completed and valid?<br>All parties confirmation obtained?<br>Other parties notified?

  Yes

  No

  N/A

• A clear work plan review

  Yes

  No

  N/A

• Notification completed: Land owner, pipeline

  Yes

  No

  N/A
Construction Package

• Work package complete?<br>Site work, approvals, crossing agreements, site walk throughs.

  Yes

  No

  N/A

• Drawing details and notes reviewed?<br>Drawing notes accurate compared to Site layout ?

  Yes

  No

  N/A

• Site Walk through completed

  Yes

  No

  N/A

• Comments

PPE and Emergency Response

• Safety footwear

  Yes

  No

  N/A

• F.R. Coveralls

  Yes

  No

  N/A

• Hard hat <br>check date issue replace 1 year

  Yes

  No

  N/A

• Hand protection

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Condition of PPE

  Yes

  No

  N/A

• Fire extinguisher <br>Available / certified

  Yes

  No

  N/A

• SDS on site

  Yes

  No

  N/A

• Spill Response Kit<br>Response kit complete?

  Yes

  No

  N/A

• First-Aid Kit and blankets as required?

  Yes

  No

  N/A

• Contractors minimum PPE requirements are met?

  Yes

  No

  N/A

• Emergency Action Plan

  Yes

  No

  N/A

• Environmental concerns?

  Safe

  At Risk

  N/A

• Comments

Traffic management signs

• Proper sign placement<br>Traffic eliminated from work zones

  Yes

  No

  N/A

• Traffic cones and or barricades utilized?

  Yes

  No

  N/A

• Traffic control person certified?

  Yes

  No

  N/A

• Traffic control is effective for site

  Yes

  No

  N/A

• TMP on site

  Yes

  No

  N/A

• STMS and TC on site

  Yes

  No

  N/A

• Comments

Excavation

• Hydrovac equipment inspection completed

  Yes

  No

  N/A

• Services exposed prior to excavation

  Yes

  No

  N/A

• Yes

  No

  N/A

• Spotter in place around live services

  Yes

  No

  N/A

• Pipeline right of way or pipeline no right of way. <br>Controlled zone 30 M<br>Exposed prior - 5 M

  Yes

  No

  N/A

• Shoring / sloping/benching/trench shield

  Yes

  No

  N/A

• Safe entry and exits at 8 meter intervals

  Yes

  No

  N/A

• Spoil pile 1 meter away from excavation.

  Yes

  No

  N/A

• Proper depth achieved?

  Yes

  No

  N/A

• No plant equipment or materials stored at edge of excavation

  Yes

  No

  N/A

• Adequate separation from other services achieved?

  Yes

  No

  N/A

• Excavations left open are inspected prior to entry?

  Yes

  No

  N/A

• Stability of trench walls checked

  Yes

  No

  N/A

• Comments

• Directional drilling

Directional drilling

• Buried facilities exposed prior?

  Yes

  No

  N/A

• Crossing buried facilities at sight hole?

  Yes

  No

  N/A

• Adequate size reamer?<br>The pilot hole is to be reamed 1.5 times larger than the largest outside diameter (OD) of the pipe installed.

  Yes

  No

  N/A

• Weak link to spec.?<br>Conforms to pipe manufactures allowable pull back pressure spec?<br>

  Yes

  No

  N/A

• Double tracer wire required? Used?<br>Type and size as per drawing or spec?

  Yes

  No

  N/A

• Required depth achieved?

  Yes

  No

  N/A

• Pipe free of damage after bore complete?

  Yes

  No

  N/A

• Comments

Hydro Excavation

• Water pressure: max 2000psi(13790 Kpa)<br>Water temp: max 180 F ( 82 C)

  Yes

  No

  N/A

• Noise warning signs placed?

  Yes

  No

  N/A

• PPE Utilized<br>

  Yes

  No

  N/A

• Continuous wand motion

  Yes

  No

  N/A

• Bonding and grounding completed before start up within 1 meter of power line?

  Yes

  No

  N/A

• Public kept away from Hydrovac?

  Yes

  No

  N/A

• Adequate protection of holes

  Yes

  No

  N/A

• Power company orientation

  Yes

  No

  N/A

• Hydrovac slurry disposal at approved site

  Yes

  No

  N/A

• Add media

  Media

• Comments

• Confined space / Restricted space

• Backfill

Backfill

• Trench free from objects?

  Yes

  No

  N/A

• Tracer wire installed no further than 15 cm

  Yes

  No

  N/A

• Proper pipe shading?

  Yes

  No

  N/A

• Back fill follows best practice requirements?

  Yes

  No

  N/A

• Proper tampers used?

  Yes

  No

  N/A

• Add media

  Media

• Comments

Site securement

• Equipment, materials secured and properly barricaded

  Yes

  No

  N/A

• Excavations properly fenced and barricaded?

  Yes

  No

  N/A

• Fenced excavations in close proximity of travelled areas clearly identified and marked with reflective capability for night time?

  Yes

  No

  N/A

• Pipe ends capped?

  Yes

  No

  N/A

• Flashing warning indicators working?

  Yes

  No

  N/A
Action item

• Action item

• Complete by:

  Date

• Assigned to:

• Personal on site

• Accepted by:

  Sign

Audit wrap up discussion

• Select date

  Date