Manetta Enterprises, Inc.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Competent Person

• Opening Ticket Number

• Permit Number

• Weather

1.0- Workplace

• 1.1.-Code 753 (Mark Outs)

  Yes

  No

  N/A

• 1.2- Inspector

  Yes

  No

  N/A

• 1.3- Competent Person

  Yes

  No

  N/A

2.0- Administrative

• 2.1- Documentation of Job Briefing

  Yes

  No

  N/A

• 2.2- Certification, Certificates of Fitness, & Training Cards

  Yes

  No

  N/A

• 2.3- Air monitor in use, equipment calibrated & current

  Yes

  No

  N/A

• 2.4- Air monitor log on-site

  Yes

  No

  N/A

• 2.5- HASP on-site & Current

  Yes

  No

  N/A

• 2.6- Permits posted & visible

  Yes

  No

  N/A

• 2.7- Complete job package on-site

  Yes

  No

  N/A

• 2.8- Noise Mitigation Plan posted when required

  Yes

  No

  N/A

• 2.9- Con Edison's rule book for MUTCD on-site

  Yes

  No

  N/A

• 2.10- First Aid Kit on-site

  Yes

  No

  N/A

• 2.11- Spill Kit on-site

  Yes

  No

  N/A

• 2.12- Fire extinguisher visible & immediately available on-site

  Yes

  No

  N/A

• 2.13- Complete contact list

  Yes

  No

  N/A

• 2.14- Local hospital information

  Yes

  No

  N/A

• 2.15- Safety Data Sheet on-site (SDS's)

  Yes

  No

  N/A

• 2.16- CEHSP 17.02 Gas Enclosed Space Entry Procedures

  Yes

  No

  N/A

• 2.17- CEHSP 17.01 Electrical Enclosed Entry Procedures

  Yes

  No

  N/A

• 2.18- CEHSP 13.00 Excavation Procedures

  Yes

  No

  N/A

• 2.19- Current RWLB Matrix Post

  Yes

  No

  N/A

• 2.20- HASP Acknowledgement form on-site & signed

  Yes

  No

  N/A

Work Area Protection

• 3.1- Flagger posted with advanced warning signs & flags

  Yes

  No

  N/A

• 3.2- Crash worthy barricades in use, complete & in compliance

  Yes

  No

  N/A

• 3.3- Stanchions & cones connected where required

  Yes

  No

  N/A

• 3.4- MUTCD set-up signs in use when required

  Yes

  No

  N/A

• 3.5- Arrow board operating properly & in use if applicable

  Yes

  No

  N/A

• 3.6- Flag trees in use if required

  Yes

  No

  N/A

• 3.7- Pedestrians provided with a safe & clear travel

  Yes

  No

  N/A

• 3.8- Plates; pinned, ramped, flush, & skid proof where required

  Yes

  No

  N/A

• 3.9 Manhole guardrail in use when work is in progress in such areas

  Yes

  No

  N/A

• 3.10- Slings & chains in good condition

  Yes

  No

  N/A

• 3.11- Rubber electrical gloves dated within expiration date

  Yes

  No

  N/A

• 3.12- Proper PPE in use when required

  Yes

  No

  N/A

• 3.13- Vehicle's engines turned off (idling regulations)

  Yes

  No

  N/A

• 3.14- Seat belts intact & in good condition

  Yes

  No

  N/A

• 3.15- Wheel Chocks in use when truck is in standby

  Yes

  No

  N/A

• 3.16- Hydrants & bus stops clear

  Yes

  No

  N/A

• 3.17- All tools in good shape

  Yes

  No

  N/A

• 3.18- Adequate set-up

  Yes

  No

  N/A

• 3.19- Housekeeping

  Yes

  No

  N/A

4.0 Excavation

• 4.1- Spoils & equipment 2' away from excavation

  Yes

  No

  N/A

• 4.2- Gas monitoring when required

  Yes

  No

  N/A

• 4.3- Ladders used at 4' depth or greater

  Yes

  No

  N/A

• 4.4- Ladders in place for every 25' of lateral travel

  Yes

  No

  N/A

• 4.5- Shoring / Sheeting when required

  Yes

  No

  N/A

• 4.6- Daily Excavation inspection conducted

  Yes

  No

  N/A

Sign off

• On-site Representative

• Auditors Signature