Title Page
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State/Site conducted
- Ohio
- Michigan
- Indiana
- Kentucky
- Pennsylvania
- West Virginia
- Maryland
- New York
- Virginia
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Conducted on
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Prime Contractor
- AEP
- AEP Elkhart
- AEP South Bend
- AEP Buchanan
- First Energy
- Mid Ohio
- Columbia Gas
- Bachtel Excavating
- CTL
- Diggers of Ohio
- Enviroserve
- Haas Brothers
- J Miller & Son Excavating
- JF Electric
- JWD
- KCI Technologies
- Kent Power
- MJ Electric
- RT Vernal
- S&ME
- Superior Paving
- T2
- Taylor Telecommunications
- Yoder Drilling
- AAMP
- Thayer
- MP Next
- Klein's Restoration Services, LLC
- Ni Source
- Nipsco
- Russell Tree
- Asplundh
- Verita Telecommunications
- New South
- Brenneman Excavating
- Patriot Locating
- Dawson Geo
- Dominion VA
- Team Fishel
- Pike
- Mastec
- Hypower
- Brock Builders
- Global Oilfields
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General Contractor
- AEP
- AEP Elkhart
- AEP South Bend
- AEP Buchanan
- First Energy
- Mid Ohio
- Columbia Gas
- Bachtel Excavating
- CTL
- Diggers of Ohio
- Enviroserve
- Haas Brothers
- J Miller & Son Excavating
- JF Electric
- JWD
- KCI Technologies
- Kent Power
- MJ Electric
- RT Vernal
- S&ME
- Superior Paving
- T2
- Taylor Telecommunications
- Yoder Drilling
- AAMP
- Thayer
- MP Next
- Klein's Restoration Services, LLC
- Ni Source
- Nipsco
- Russell Tree
- Asplundh
- Verita Telecommunications
- New South
- Brenneman Excavating
- Patriot Locating
- Dawson Geo
- Dominion VA
- Team Fishel
- Pike
- Mastec
- Hypower
- Brock Builders
- Global Oilfields
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Client Satisfaction/Comments
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Client Supervisor
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Personnel First and Last Name
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Truck Number (s)
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Prepared by
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Location
General
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General Notes:
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Pictures of zone. Needs More than 2 Pictures
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JSA is filled out completely and the crew is informed of all possible hazards?
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What Exactly is not filled out on JSA?
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Drinking water available onsite for employees
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Was a break offered to crew members?
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Both employees have ATTSA card with them.
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Both Flagger have valid drivers license or I.D? (this makes ATTSA card valid)
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Did you observe a Near Miss while conducting safety inspection?
PPE
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Pictures Of Both Traffic Technicians in full PPE
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Hard hat.
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Eye protection.
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Class III vest.
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Class E pants.
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Boots with safety toe.
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Whistle.
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Radio on person?
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Night operations?
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Light wand.
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Halo.
Zone Inspection
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All traffic control signs set up.
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Are all signs properly spaced?
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Are the tapers compliant?
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Is there enough roll ahead space between our truck and the work area?
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Are the traffic cones around the work area correctly spaced. (Tangent Area)
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Are paddles being used correctly? Are they out?
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Are the radios being used correctly.
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Are the flaggers in the correct position.
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Does the crew have a full sign package?
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Did the crew take down zone properly?
Equipment
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How many signs/stands are being used?
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How many channelizing devices are being used?
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Are the paddles the correct height?
Pictures of zone if improperly setup
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Improper Zone Pictures
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Corrected Zone Pictures
Arrow Board
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Arrow board in proper working condition.
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Tires in good condition.
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Tow chains in good condition.
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Trailer Light wire in good codition.
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Arrow board in correct position.
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Is the Arrow Board unhooked from the truck?
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Is The Arrow Board setup properly?
Vehicle Inspection
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LL Inspect has been completed
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Vehicle cleanliness is satisfactory.
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Pictures of Truck. Front, Both Sides, Rear and inside of truck
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Current registration or rental agreement.
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Current insurance paperwork present.
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T-80 Flip Book/Binder
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Driver has valid drivers license.
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Driver has DOT medical card if needed.
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Seat belts used when driving & or Properly stored while parked?
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1st Aid kit available and in adequate condition.
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Fire extinguisher present and in good condition.
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Fire extinguisher monthly inspection is up to date.
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Extra Radio & Batteries?
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Are the wheels curbed?
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Is the E-brake on?
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Tablet / condition
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Fuel Card
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Is there another vehicle on site?
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LL Inspect has been completed
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Vehicle cleanliness is satisfactory.
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Pictures of truck. Front, Both Sides, Rear and inside of truck
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Current registration or rental agreement.
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Current insurance paperwork present.
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Driver has valid drivers license.
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Driver has medical card if needed.
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Seat belts used when driving & or Properly stored while parked?
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Are the wheels curbed?
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Is the E-Brake on?
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Tablet/Condition
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Fuel Card
Equipment
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How many signs/stands are left in the truck? (Not being used?)
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How many channelizing devices are left in the truck? (Not being used?)
