Title Page
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Document No.
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Client / Site
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Conducted on
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Location
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Auditor
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Forman
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Crew
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Equipment
- Vac Truck
- Jet Vac
- Hydro
- Vacuum Truck
- Jetter
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Are crew members wearing the required Personal Protective Gear?
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Is the personal protective gear adequate for the job?
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Are all personnel aware of the characteristics of the material?
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Is Confined Space Entry required for this job?
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Is Permit completed & posted
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Is Gas Detector in place and operable?
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Is Ventilation in place and operable?
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Is full Body Harness properly worn?
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Is Lifeline properly secured to harnes
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Is a Tripod and Winch needed if vertical entry required?
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Is the job setup Safely and Effective?
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Are Barricades in place to keep job site protected?
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Are Tripping/Slipping hazards minimized?
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Is the job site kept free of trash and debris?
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Is the proper equipment being used on the job?
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Does the Forman have the tools to do the job?
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Is the equipment properly maintained?
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Has a Vehicle Inspection Sheet been completed?
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Does any of the equipment need to be written up for repairs?
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Are there any leaking fluids that be attended to?
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Have steps been taken to contain any leaks?
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Does the Operator have a spill kit available?
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Are all percussion being taken to prevent spills or any other Environmental Damages?
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Is the job being properly supervised?
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What can be done to improve our job site performance?
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What was discussed with the crew concerning safety and improving the job performance?