Information

  • Job Number-Initials-Date

  • Project Name

General Project Informaton

  • Site hours of operation

  • Prepared by

  • Conducted on

  • Weather Conditions

  • Rainfall Amount in last 24 Hours (inches)

  • Location

1. Inspection

  • 1a. Have all disturbed areas requiring temporary or permanent stabilization been stabilized/seeded/mulched/straw/graveled?

  • 1b. Are soil stockpiles and cut/fill slopes adequately stabilized with seeding and/or sediment trapping measures?

  • 1c. Does permanent vegetation provide adequate stabilization?

  • 1d. Have sediment trapping basins/structures/measures been constructed and are maintained?

  • 1e. Are on-site utility trenches, channels and outlets adequately stabilized and maintained?

  • 1f. Do all operational storm sewer inlets/catch basins have adequate inlet protection and are being maintained?

  • 1g. Is perimeter silt fence installed properly and maintained?

  • 1h. Are construction entrances constructed and maintained?

  • 1i. Is dust control required and being provided?

  • 1j. Is soil/mud/spoils being kept off public roadways at intersections with site entrances/access roads?

  • 1k. Are enough spill kits being kept on site and maintained for the amount of equipment on site?

  • 1l. Is a proper means for concrete washout being provided and maintained, such to prevent runoff or percolation into ground water?

  • 1m. Is there dewatering activity onsite today? Are proper practices being followed?

  • 1n. Are adjacent properties and waterways downstream adequately protected from erosion and sediment pollution/runoff?

  • 1o. Have all temporary BMPs/control structures that are no longer required been removed?

2. Corrective Actions

  • 2a. Are corrective actions or maintenance required?

  • 2b. List JMCC supervisor and/or subcontractor supervisor notified of corrective actions/maintenance required.

  • 2c. List corrective actions/maintenance performed.

  • 2d. Add corrective photo's:

Signature

  • I certify under penalty of law, as provided by RSA 485-A:22, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.