NWMCC MA/NY/CT - LCR Site Safety Inspection

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Traffic Control

• Are cones in use and setup properly?

  Yes

  No

  N/A

• Are signs in use and setup properly?

  Yes

  No

  N/A

• Are manhole guards setup at both the Upstream manhole and Downstream manhole?

  Yes

  No

  N/A

• If required on the site are Details and Flaggers printed?

  Yes

  No

  N/A

Confined Space Equipment

• Are tripods and winches set up at both Upstream manhole and Downstream manhole?

  Yes

  No

  N/A

• Are Gas Detectors set up and working at both Upstream manhole and Downstream manhole?

  Yes

  No

  N/A

• Does each employee have a Personal air meter and is it in working condition?

  Yes

  No

  N/A

• Are Blowers set up and working properly?

  Yes

  No

  N/A

• Are lifelines in proper condition and in place?

  Yes

  No

  N/A

• Are the Harnesses in proper condition and used properly?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Personal(PPE)

• Are all employees wearing Hard Hats?

  Yes

  No

  N/A

• Are all employees wearing Safety Vests or Jacket?

  Yes

  No

  N/A

• Are all employees wearing Steel Toe Boots?

  Yes

  No

  N/A

• Are all employees using proper Hearing Protection?

  Yes

  No

  N/A

• Are all employees wearing proper Tyvex suit for the job site?<br>(Proper Chemical resistance and covering proper extremities)

  Yes

  No

  N/A

• Are all employees using proper Eye Protection for the job site?<br>(goggles or glasses)

  Yes

  No

  N/A

• Are all employees using proper Face Protection?

  Yes

  No

  N/A

• Are all employees using proper Hand Protection?

  Yes

  No

  N/A

• Are all employees using proper Respiratory Protection?

  Yes

  No

  N/A

Vehicle Equipment

• DVIR filled out and accurate?

  Yes

  No

  N/A

• Log Book up to date?

  Yes

  No

  N/A

• Does the Vehicle have a First aid kit?

  Yes

  No

  N/A

• Does the Vehicle have the proper Fire Extinguishers?

  Yes

  No

  N/A

• Does the Vehicle have Reflective Safety triangles

  Yes

  No

  N/A

• Does the Vehicle have Choke blocks?

  Yes

  No

  N/A

• Does the Vehicle have a MSDS Book?

  Yes

  No

  N/A

• Is the Vehicle operating under Standard Operating Procedure?

  Yes

  No

  N/A

• Does the Vehicle have an Eye Wash station?

  Yes

  No

  N/A

• Are the Vehicles Radios working properly?

  Yes

  No

  N/A

• Is the Vehicle's By-Pass working properly?

  Yes

  No

  N/A

• Is the Vehicles By-pass hose working properly?

  Yes

  No

  N/A

Materials

• Is the Resin the proper type for job?

  Yes

  No

  N/A

• Are the chemical buckets clearly and properly labeled?

  Yes

  No

  N/A

Housekeeping

• Was the truck cleaned?

  Yes

  No

  N/A

• Is the equipment maintained?

  Yes

  No

  N/A

• Are the tools in good working order?

  Yes

  No

  N/A

• Are crew members wearing the proper uniforms and look presentable?

  Yes

  No

  N/A