LCREC Crew Visit Form

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

  Select Baldwin Porter Bax Trevor Brown Danny Clema Brandon Farmer Rick Fuller Kennie Jones Doug Langhammer Josh Lukowski Andy McEwen Mark Mobley Bruce Owen Scott Perotti Mike Richards Mike Roberts Luke Richardson Robert Sheperd Ron Stueve Nick Toms John Ulhorn Dan Williams Ben Paul Karston

  • Baldwin Porter
  • Bax Trevor
  • Brown Danny
  • Clema Brandon
  • Farmer Rick
  • Fuller Kennie
  • Jones Doug
  • Langhammer Josh
  • Lukowski Andy
  • McEwen Mark
  • Mobley Bruce
  • Owen Scott
  • Perotti Mike
  • Richards Mike
  • Roberts Luke
  • Richardson Robert
  • Sheperd Ron
  • Stueve Nick
  • Toms John
  • Ulhorn Dan
  • Williams Ben
  • Paul Karston

• Job Briefing Completed?

  Yes

  No

  N/A

PPE

• Hard hats

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Harness?

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Proper Clothing

  Yes

  No

  N/A

• Work Gloves

  Yes

  No

  N/A

• Is chain saw being used?

  Yes

  No

  N/A

• Are chain saw chaps being used?

  Yes

  No

  N/A

Grounding?

• Truck Grounds

  Yes

  No

  N/A

• Personal Protective Grounds

  Yes

  No

  N/A

Hot Line Work

• Rubber gloves

  Yes

  No

  N/A

• Sleeves

  Yes

  No

  N/A

• Adequate Cover UP

  Yes

  No

  N/A

• One Shot

  Yes

  No

  N/A

Traffic Control

• Cones utilized

  Yes

  No

  N/A

• Proper Signage

  Yes

  No

  N/A

• Flagger

  Yes

  No

  N/A

• Safety Vests?

  Yes

  No

  N/A

• Strobe lights Utilized

  Yes

  No

  N/A

Underground

• Is there underground work being preformed?

  Yes

  No

  N/A

• If they are digging more than 4' do they an Entry/exit ladder in place?

  Yes

  No

  N/A

Vehicles

• Wheel chocks

  Yes

  No

  N/A

• Vehicles on site.

  Select 235 237 241 242 245 246 256 257 258 261 262 265 266 267 268 270 271 272 274 275 276 277 278 279 280 282 283 285 286 288 259

  • 235
  • 237
  • 241
  • 242
  • 245
  • 246
  • 256
  • 257
  • 258
  • 261
  • 262
  • 265
  • 266
  • 267
  • 268
  • 270
  • 271
  • 272
  • 274
  • 275
  • 276
  • 277
  • 278
  • 279
  • 280
  • 282
  • 283
  • 285
  • 286
  • 288
  • 259