MASTER NWMCC- TV inspection

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Equipment worthiness

Cab/Chassis/Generator

• Are fluid levels proper, and are belts/hoses in good condition?

  Yes

  No

  N/A

• Are the tires in good condition?

  Yes

  No

  N/A

• Are there any noticeable leaks from under truck or generator?

  Yes

  No

  N/A

• Is the roof of the truck free of leaks?

  Yes

  No

  N/A

• Is the condition of the box in proper working condition?( any damage to air conditioner ect )?

  Yes

  No

  N/A

• Is the truck clean inside and out?

  Yes

  No

  N/A

TV studio

• Are all screws tight on the crawler (can the motor be wiggled at all?)

  Yes

  No

  N/A

• Are there any missing electric outlet covers, is there a cover for the Circuit breaker panel, Anything leaning against circuit breaker panel?

  Yes

  No

  N/A

• Does operator have two working cameras and has the spare been tested within a week?

  Yes

  No

  N/A

• Is the picture quality acceptable (live video as well as recorded video), microphone works?

  Yes

  No

  N/A

• Has the rootsaw been lubricated, and is able to spin freely by hand?

  Yes

  No

  N/A

• Does operator have company mandated tools?

  Yes

  No

  N/A

• Has the operator checked if the footage counter is accurate?

  Yes

  No

  N/A

Job site setup

• Does driver know height of vehicle/any overhead obstructions

  Yes

  No

  N/A

• Is there proper traffic control, cones being used, manhole cage being used?

  Yes

  No

  N/A

• Are arrow boards being used?

  Yes

  No

  N/A

• Are wheel chocks being used?

  Yes

  No

  N/A

• Is a top roller being used?

  Yes

  No

  N/A

• Has the operator made every attempt at staying away from manholes located in the center of an intersection?

  Yes

  No

  N/A

• Is the truck equipped with speed dry or pads?

  Yes

  No

  N/A

Productivity and safety

• Are both gas meters calibrated within the 30 day calibration cycle?

  Yes

  No

  N/A

• Are confined space permits, tripod and winch being used along with calibrated gas meters?

  Yes

  No

  N/A

• Are operators wearing proper ppe for the job they are on?

  Yes

  No

  N/A

• Is the generator being started with the breaker off to allow time to build up proper voltage? And is the operator turning off the breaker prior to shutting down at the end of the day?

  Yes

  No

  N/A

• Does the truck have proper safety equipment? Fire extinguisher, First Aid Kit, Eye Wash Station, wheel chocks etc.?

  Yes

  No

  N/A

• Is the operator crawling at less than 30 feet per a minute down the pipe (pacp requirement).

  Yes

  No

  N/A

• Are all observations being made while going down the pipe?

  Yes

  No

  N/A

Road worthiness

• Is all of the paperwork up to date? ( Ex: registration, insurance card, IFTA, HUT)

  Yes

  No

  N/A

• Does the driver have his driver's license and medical card?

  Yes

  No

  N/A

• Does the driver have his current DVIR and previous day's DVIR?

  Yes

  No

  N/A

• Are the tires and rims in good condition? (Ex: cracks, treads, bolts tight)

  Yes

  No

  N/A

• Is the driver's log book present and up to date?

  Yes

  No

  N/A

• Is the load secured? (Ex: tubes, hoses)

  Yes

  No

  N/A

• Are the right side and backup cameras operational?

  Yes

  No

  N/A

• Were all fluids checked and topped off if needed?

  Yes

  No

  N/A

• Are the mirrors in working order and are clean.

  Yes

  No

  N/A