NextEdge Wireline Safety Audit Form

Scope of Work

B. Are there applicable safety signs posted?

C. Is there a competent person on site?

D. Is there more than one person (minimum of 2) on site certified in First Aid/CPR/BBP/AED

I. Is the proper equipment to complete the task on the jobsite?

J. Are daily tailgate meetings held to review the scope of work and any safety concerns?

L. Is there a stop work authority procedure in place for personnel to report and correct identified hazards without fear of repercussions?

Has a Vehicle and or Equipment Inspection been conducted prior to use?

A. Are the housekeeping responsibilities met and maintained?

B. Are the materials stored properly and orderly?

C. Are measures taken to prevent access by unauthorized personnel to the site?

D. Are areas barricaded as required?<br>

E. Is adequate drinking water available for all members of the crew?

F. Are chemical, flammable and combustible liquids stored properly? (i.e. no plastic gas cans)

G. Are fire extinguishers of the appropriate size and type available, and with current inspection tags?

E. Are employees dressed in appropriate work clothing?

D. Are employees wearing appropriate gloves when required?

A. Are employees wearing head and or face protection? Hardhats Helmets

B. Are employees wearing proper footwear?

C. Is approved eye protection being used?<br>

F. Are employees wearing appropriate hearing protection when required?

G. Are employees wearing appropriate high-visibility clothing when required?

A. Do personnel exposed to falls have documented training?

B. Is fall protection equipment being inspected daily?

C. Is the proper fall protection equipment on the jobsite to perform the scope of work?

F. Are personnel utilizing 100% tie-off practices?

Are portable ladders being used appropriately?

If using a bucket truck are wheels chocked?

A. Do personnel exposed to electrical hazards have documented training?

B. Based on the scope of work, are the personnel trained on the Lockout/Tagoutprocedures?

E. Are extension cords in good condition?

F. Are the correct length and gauge of extension cords being utilized?

G. If necessary, has the power company been notified?<br>

H. Is there a documented procedure for site-specific electrical hazards that relates to the scope of work?

A. Has a competent person been identified?

B. Has both private and public 811 (utility avoidance) been contacted prior to construction?

C. Have utilities (public and private) been marked?

D. During drilled shaft operations are grounding protection systems in place?

F. Are all open excavations properly barricaded overnight?

G. Have personnel in the trench been properly protected from cave-in?

H. If personnel are in the trench is there proper entry and egress?

I. Have spoils been placed at a minimum of two feet from the excavation edge?

A. Is back-up alarm working properly?

B. Is roll-over protection installed and in good condition?

C. Are safety interlocks operational?

D. Are hazard lights working properly?

E. Are buckets and booms free of cracks and defects?

F. Are personnel clear of the danger area or working radius?

G. Have all the daily inspections required in the operator's manual been performed?

H. Have all operators been properly trained on safe use and operation of the unit being used?

A. Are all tools in good condition?

B. Are electrical tools properly grounded or double insulated?

C. Are proper guards in place?

D. Are all tools being used for intended purpose of the manufacturer?

A. Is CDL valid for equipment being used?<br>

B. Do drivers have DOT Medical Card (greater than 10,001 lbs GVW)?

C. Are drivers Electronic Logging Devices (ELD) current?

D. Are Daily Vehicle Inspection Reports (DVIR) current?

E. Is vehicle labeled per DOT requirements?

F. Are emergency reflectors in the vehicle?

G. Is vehicle interior / exterior maintained properly?

H. Is there any interior or exterior damage?

I. Is the windshield in good condition?

J. Are tires in good condition?

K. Are fire extinguisher(s) of appropriate size and rating readily available and equipped with a current monthly inspection tag?

L. Is the fire extinguisher location identified?

M. Is a DOT compliant first aid kit located on the vehicle?

N. Are all state & federal inspection stickers current?

O. Is the insurance and registration certificate current and readily available?

P. Are all exterior lights in operational condition? (truck and trailer)

Q. Are trailer breakaway harnesses properly functioning?

R. Are trailer safety chains properly installed?

S. Is material secured in accordance with DOT regulations?

T. Are all fuel containers used properly?

Overall Impression

Necessary to follow up with written documentation?

If any deficiencies were they corrected immediately?

Was this report was reviewed with supervisor and crew?

Compliance Completed By