NWMCC MA/NY/CT - Job Site Safety Inspection

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Traffic Control

• Are traffic cones in use and placed properly?

  Good Set up

  Average Set up

  Poor Set up

  No Cones/Devices Out

  N/A

• Are cone bars in use and placed properly?

  Yes

  No

  Not Required

  n/a

• Have the proper roads signs been put out?

  Yes

  No

  It is not required

• Is all of the crew wearing the proper ANZI class Hi Viz Garments?

  Select Yes. Class 3 (Highway) *Sleeves Yes. Class 2 (Residential) *No Sleeves No. One or More is Missing Not Required

  • Yes. Class 3 (Highway) *Sleeves
  • Yes. Class 2 (Residential) *No Sleeves
  • No. One or More is Missing
  • Not Required

• Is the manhole guard set up and properly placed on the unoccupied manhole?

  Yes

  No, It was not required

  No

• Is the manhole guard missing Confine Space warning signs?

  Yes

  No

  N/A

• Are the appropriate amount of flaggers/ police officers on site?

  Select Yes No. Was ordered but not filled No No Detail was required

  • Yes
  • No. Was ordered but not filled
  • No
  • No Detail was required

Confined Space Entry

• Is the Confined Space Permit filled out completely and visible?

  Yes

  No

  N/A

• Is the gas detector set up above the space being accessed?

  Select Yes, it is contentiously monitoring No, it was tested before entry No, was not used at all n/a

  • Yes, it is contentiously monitoring
  • No, it was tested before entry
  • No, was not used at all
  • n/a

• Has the workers air meters gone in for calibration (once every 30 days)?

  Yes

  No

  N/A

• Do the air meters serial numbers match what is assigned in Safety Suite?

  Yes

  No

• Is the tripod & winch in working condition and properly set up above the space being accessed?

  Select Yes, Good Condition and Set up Yes, Set up but in Bad Condition No, It was not set up n/a

  • Yes, Good Condition and Set up
  • Yes, Set up but in Bad Condition
  • No, It was not set up
  • n/a

• Is the blower set up and working properly?

  Yes

  No

  Not Required

  n/a

• Is the Harness being used in proper condition?

  Good Condition

  Fair Condition

  Poor Condition

  Out of Service

  N/A

• Is the Entrant wearing a personal air monitor?

  Yes

  No

  N/A

• Is the Crew following Proper Confined Space Entry procedures?

  Yes

  No

  N/A

• What Two forms of commutation are they using ?

  Verbal & Visual

  Radio & Visual

  No Communication

  N/A

PPE

• Are all crew members using the proper PPE (Safety Toe Boots, Hard Hats, Safety Vests, and Safety Glasses if required) ?

  Yes

  No

  N/A

• Are all of the Hard Hats in proper condition and being worn properly?

  Yes

  No

  N/A

• Are any of the Hi Viz garments to dirty, faded, or torn up to be effective?

  Yes

  No

  N/A

• Is the crew using ear plugs when Necessary?

  Yes

  No

  N/A

• Is the crew using the proper Tyvek chemical suit (Yellow or White) for the job?

  Yes

  No

  N/A

• Is the crew using the proper eye protection(Safety glasses of Safety goggles) when Necessary?

  Yes

  No

  N/A

• Are the appropriate gloves being used with the work they are doing?

  Yes

  No

  N/A

• Is the proper respiratory protection being used?

  Yes

  No

  N/A

• Are the workers wearing respirators clean shaven?

  Yes

  No

  N/A

Vehicle Equipment

• Do all crews members have they're tablets with them?

  Yes

  No

  N/A

• Have they been using them daily and kept they're logs up to date?

  Yes

  No

  N/A

• Does the vehicle have a proper First Aid kit, Fire Extinguisher, and Triangles?

  Yes

  No

  N/A

• Is the Fire Extinguisher Secure?

  Yes

  No

  N/A

• Are the Chock Blocks in use?

  Select Yes No, the Vehclie is not parked at an incline/decline No, the Vehicle does not have any

  • Yes
  • No, the Vehclie is not parked at an incline/decline
  • No, the Vehicle does not have any

• Is the eye wash station stocked?

  Yes

  No

  N/A

• Are radios in proper working condition?

  Yes

  No

  No, Ones need to be ordered

  N/A

• Is the By-Pass working properly?

  Yes

  No

  N/A

• Is the By-Pass hose in proper working condition?

  Yes

  No

  N/A

• Are there any other notable issues with Equipment? (Please add in Notes)

  Yes

  No

  N/A

Materials

• Is the proper resin being used?

  Yes

  No

  N/A

• Are chemical buckets properly labeled?

  Yes

  No

  N/A

• Does the vehicle have a SDS book?

  Yes

  No, It is a JC/TV truck

  No, it does not and Needs one

• Is the material being handled with the proper PPE?

  Yes

  No

  N/A

Housekeeping

• Is the outside of the truck clean?

  Yes

  No

  N/A

• Is the inside of the truck clean?

  Yes

  No

  N/A

• Is the crew taking care of issued tools/equipment?

  Yes

  No

  N/A

• Do all crew members have the required tool sets with them?

  Yes

  No

  N/A

• Is the Truck missing equipment?

  Yes

  No

  N/A

• Are crew members wearing NWMCC apperal?

  Yes

  No

  N/A

• Are Crew members presentable & being respectful to customers/detail/public?

  Yes

  No

  N/A