JBMDL Site Supervisor Inspection Form

• Facility Number:

• Work Order Number:

• Work Order Completion Date:

  Date

• Supervisor:

• Personnel:

• Inspection Conducted On:

  Date

• This Reports Covers the Following Inspection:

  Select Preventive Maintenance Service Order Collection Work Order

  • Preventive Maintenance
  • Service Order
  • Collection Work Order

Completed Work Order Inspection

• Quality (Workmanship)

  Select Very Satisfied Satisfied Dissatisfied

  • Very Satisfied
  • Satisfied
  • Dissatisfied

• Was the job completed in an efficient and timely manner?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Was the job site cleaned and restored to its original condition?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Was additional work found and reported correctly?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Was paperwork completed accurately with sufficient detail?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Was the customer notified the work was completed?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Was the job previously inspected during the "In-Progress" phase?

  Select Yes No N/A

  • Yes
  • No
  • N/A

In Progress Work Order Inspection

• Quality (In-Progress Workmanship)

  Select Meets Standards Needs Improvements Unacceptable

  • Meets Standards
  • Needs Improvements
  • Unacceptable

• Are all the employees wearing proper PPE?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the Task Assessment filled out correctly?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are the employees L&E's up to date?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is a permit required and present on job?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If a permit is required what type was obtained?

  Select Confined Space Entry Dig Permit Hot Work Permit

  • Confined Space Entry
  • Dig Permit
  • Hot Work Permit

• Is the JSA being followed and/or are tasks assessed properly?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is special safety equipment required?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If safety equipment is required what type was used?

  Select LOTO Fall Protection

  • LOTO
  • Fall Protection

• Is this job a multifunction team requirement?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are the correct tools being utilized and in the proper manner?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Comments:

• Add media

  Media

• Add signature

  Sign