K&W Underground Site Inspection Report

• AREA Task Conducted -

• Conducted on

  Date

Area Supervisor:-

Lead Inspector:-

Other members of the inspection team?

• Another auditor

• Is there a valid Locate ticket in place for work location

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• What Services are have been identified?

  Select Electrical Cables (11kV or Higher) Communications / Fibre Optic / Telephone Gas Pipes Electrical Cables (less than 11kV) Air / Water Pipes Fuel / Oil Sewer / Drains

  • Electrical Cables (11kV or Higher)
  • Communications / Fibre Optic / Telephone
  • Gas Pipes
  • Electrical Cables (less than 11kV)
  • Air / Water Pipes
  • Fuel / Oil
  • Sewer / Drains

• Have the services locations and their depth or height (as applicable) also been identified on plans and drawings ?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• Types of Assets and Limits of Underground Approach

  

• Table of Safe Approach distances

  

• Take a photo of the service locations marked on the ground.

  Media

• Are we maintaining the required approach distance to the services

  Yes

  No

  N/A

• Have all redundant Services been marked?

  Yes

  No

  N/A

• Have all associated nearby pits been opened, and checked to identify services?

  Yes

  No

  N/A

• Has an emergency evacuation/rescue plan been developed and in place if the trench is deeper than 5 feet?

  Yes

  No

  N/A

• If the trench is deeper than 5 feet deep is it battered, benched or shored or inspected by a competent person?

  Yes

  No

  N/A

• Has suitable barricading been identified and established?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• What type of barricading has been erected?

  Select Water filled Jersey Concrete Windrow Steel Permitier fencs Crowd Control Flagging Other

  • Water filled Jersey
  • Concrete
  • Windrow
  • Steel Permitier fencs
  • Crowd Control
  • Flagging
  • Other

• Are there vehicles operating in the area?

  Yes

  No

  N/A

• Have barriers been established to prevent vehicles form entering the work zone?

  Yes

  No

  N/A

• Are there controls and measures in place to prevent vehicle fumes from entering the work area?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• Is warning signage displayed in prominent locations?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• Is the barricading and signage in good condition?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• Take a photo

  Media

• For trenches deeper than 5 feet, is there a means of access/egress every 25 feet?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• Are the trench spoils at least 2 feet away from the trench?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• If spotters are used are they positioned in safe location

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable

• Is the trench/es inspected by a competent person prior to commencing work or after an adverse weather event?

  Compliant

  Unacceptable

  Needs Improvement

  Not Applicable
Action required?

• Action

• Allocated to

• Action due

  Date

• Lead Inspector to sign

  Sign

• Other members of the inspection team to sign:

  Sign

• Yes

  No

  N/A