Information
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Document No.
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Job Name / Number
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Conducted on
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Prepared by
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Location
Programs / Information
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Safety Policy & Standard Operating Procedure Manual Onsite & Current
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Utility Contractor Field Binder Available
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First Aid/CPR Cards
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Gas Company Operator Qualification Cards
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Chemical Containers Properly Stored and Labeled
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Hazardous Chemical / Prop 65 Chemical Inventory Current & Available
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All Safety Data Sheets (SDS) Available
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Weekly Toolbox Safety Trainings Held
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Topic Covered:
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Daily Foreman Safety Huddles Held & Reviewed
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Yellow Hard Hat Mentoring Program in Effect
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Documented Daily Inspections Completed (Rough Terrain Forklift, Heavy Equipment, Vehicle/Trailer, etc.,)
Personal Protective Equipment
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Hard Hats
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Eye Protection
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Hearing Protection
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Appropriate Hand Protection
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Respirators Or Dust Masks
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High Visibility Garment (ANSI Class II Or III)
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Foot Protection - Toe Guards
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Other:
Atmospheric Monitors
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All Gas Monitors Properly Calibrated and Available
Housekeeping
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Truck Bed, Tool Bins, Scrape Pipe
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Lay-down Areas Organized, Piling & Stacking Secured
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Adequate Supply Of Trash Receptacles
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Pipe and Fittings (Storage Bins)
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All Pipe Capped - In Trench, On Ground, On Truck
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Other:
Hot Work
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Welding - Gloves/Goggles/Sleeves/Ear Plugs/Fire Ext.
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Heating Iron Calibrated
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Handling Iron - Gloves
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Check Heating Faces
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Flash and Sound Hole Before Hot Work Begins
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Other:
Ladders (Zero Tolerance Item)
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Ladders Inspected And In Good Condition
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Employees Trained On Safe Ladder Use
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Ladders In Use Are Properly Secured
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Extension Ladders Extend 36" Above Landing
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Ladder Weight Rating 300 Lb. - 1A or Greater
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Ladders Not In Use Are Properly Stored
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Other:
Fire Protection
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Fire Extinguishers Certified Within the Last 12 Months
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Fire Extinguishers Inspected Monthly and Tags Signed
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Other:
Hand Tools
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Whip Checks In Use On Pressurized Lines
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Proper Tool In Use For Task, Proper PPE In Use
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Defective Tools Tagged / Removed From Site
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Safety Guards And Devices Installed (Zero Tolerance Item)
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Other:
Equipment
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Operator Trained, Authorized And Or Certified (Certification Proof Readily Available)
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Pre-Inspection Check List Completed
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Maintenance Inspection Current (Annual & 90 Day)
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Required Manuals, Load Charts, With Equipment
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Seatbelt In Use
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Backup Alarm Functioning
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Operating At Safe Speeds
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Wheels Chocked On Mobile Equipment
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Other:
Confined Space (Zero Tolerance Item)
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Employees Trained (Supervisor, Attendant, Entrant)
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Permit For Entry Completed & Posted
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Continuous Air Monitoring Provided
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Adequate Ventilation Provided (Blower/Fan)
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Retrieval System In Place
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Other:
First Aid
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Trained Personnel Available
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Kits/Supplies Available and Fully Stocked
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Designated Medical Provider Identified
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Other:
Power Lines
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Designated Spotter Used
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Adequate Distance Maintained from Power Lines Min. 10' up to 50KV
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Other:
Trenching And Excavation (Zero Tolerance Item)
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Competent Person Designated And Identified
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Annual Permit Posted And Local Cal OSHA Office Notified (Over 5' In Depth)
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Documented Daily Trench/Excavation Inspection Performed
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Proper Protective System In Place (Over 5' In Depth)
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Safe Access / Egress Provided (Ladders With In 25' Or Ramp <30 Deg.)
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Approved Potholing and Verification of Utilities Used
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Other:
Tapping and Stopping
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Gloves/Glasses/Cotton Cover-alls/Ear Plugs
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Fire Extinguisher Out and Ready
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Other:
Site/Public Protection
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Traffic Control In Place
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Anchor Air and Water Hoses Across Traffic
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All Vehicles Parked in Cone Zone
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Hazard Warning Signs In Use
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Other:
Purging
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Ground Wire In Use
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Gloves/Glasses/Sleeves/Ear Plugs/Collar Buttoned
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Ground Wire In Use
Boring
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Insulated Gloves/Boots While Boring
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Insulator on Bore Gun
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Proper Use of Push Pull Hook
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Insulated Gloves Certified (Every 6 Mo.) and Air or Water Tested Prior to Use
Removal of Asphaltic Coal Tar Pipe Wrap
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Eye Protection and Gloves in Use
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Tyvek Cover-alls and Shoe Covers in Use
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1/2 Face Air Purifying Respirator With P100 Cartridge In Use
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Encapsulate In Use
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Six-Mil Plastic Sheeting and Labeled Disposal Bags In Use
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Regulated Area Established With Signage
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Employees Trained as per Cal OSHA Requirements
Heat Illness Prevention (Zero Tolerance Item)
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Employees / Supervision Trained
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New Employees Not Acclimated To Heat Under Additional Supervision
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Cool Clean Drinking Water Supplied
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Disposable Cups Provided w/ Trash Receptacle Nearby
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Shade & Comfortable Seating Provided For Preventative Recovery Breaks (Required at 80 Degrees)
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High Heat Provisions In Place (95 Deg. & Above)
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Other:
Silica Dust Exposure
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Employees Properly Trained
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Competent Person Designated
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Engineering Controls Being Used (Vacuum/Wet Methods)
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Proper Respiratory Protection In-use
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Site Specific Control Plan In Place
Corrective Actions Taken / Inspection Summary
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All "Corrective Action" items are to be corrected at the jobsite within 24 hours. If corrective action is not possible, the item shall be brought to the immediate attention of the Safety Director.
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Project Supervision
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Safety Specialist
