NWMCC MA/NY/CT - Manhole Rehab Inspection

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Equipment Worthiness

• Are all the air tanks on the truck being drained daily?

  Yes

  No

  N/A

• Is the mixer Hopper and Cone clean?

  Yes

  No

  N/A

• Is the equipment clean? (Ex: interior and exterior)

  Yes

  No

  N/A

• Is the oil at normal operating level in the rear assist air compressor crankcase?

  Yes

  No

  N/A

• Is the cement gun in good working condition ?

  Yes

  No

  N/A

• Is the cement hose in good working condition ?

  Yes

  No

  N/A

• Are the air lines in good condition ?

  Yes

  No

  N/A

• Is the grout system working properly ?( Ex: grout pump or gun leaking)

  Yes

  No

  N/A

• Are the grout tanks in good condition?

  Yes

  No

  N/A

• Are the plugs in good condition? (Ex: not leaking or have bubbles)

  Yes

  No

  N/A

Jobsite Setup

• Does the driver have a plan for the day? Has he reviewed maps prior so he has his day set up?

  Yes

  No

  N/A

• Did the operator properly set up the job site? Are the following being used? Road hose, ramps, flaggers, wheel chocks, cones and manhole cage?

  Yes

  No

  N/A

• Is the driver aware of any overhead obstructions on the site?

  Yes

  No

  N/A

• Does the operator know proper procedure if something goes wrong with the truck? Both while driving or during operation?

  Yes

  No

  N/A

• Is the truck equipped with absorbent pads/speedi-dry?

  Yes

  No

  N/A

• Is the confined space permit filled out?

  Yes

  No

  N/A

Productivity/Safety

• Is there a spare nozzle on the truck?

  Yes

  No

  N/A

• Is the tripod/winch in good working condition without defects?

  Yes

  No

  N/A

• Do the safety lights work on the truck?

  Yes

  No

  N/A

• is there a spare cement hose/air lines/cement gun/Pressure washer hose?

  Yes

  No

  N/A

• Are the air holes on the cement gun the proper size?

  Yes

  No

  N/A

• Is there a spare cement cone?

  Yes

  No

  N/A

• Is there an eye wash station on the truck?

  Yes

  No

  N/A

• Does the truck have proper safety equipment? (Ex: fire extinguisher, three triangles, med kit, wheel chocks, Spill Kit)

  Yes

  No

  N/A

• Does the truck have all of the proper PPE for what the employee is doing?

  Yes

  No

  N/A

• Is the Tripod, Winch, and Harness all in good condition?

  Yes

  No

  N/A

• Does the air meter need to be calibrated?

  Yes

  No

  N/A

• Is the AV100 and AP separated?

  Yes

  No

  N/A

• Is the employee wearing the proper Respiratory cartridge for the corresponding application?

  Yes

  No

  N/A

Road Worthiness

• Is all the paperwork up to date? ( Ex: registration, insurance card, IFTA, HUT)

  Yes

  No

  N/A

• Is the trailer properly attached to the truck?

  Yes

  No

  N/A

• Do the trailer wheels lock when you pull the pin?

  Yes

  No

  N/A

• Do the trailer breaks work properly and do all lights work?

  Yes

  No

  N/A

• Does the battery charge when the lights are on (if not most likely trailer has no brakes)?

  Yes

  No

  N/A

• Does the driver have his driver's license and medical card?

  Yes

  No

  N/A

• Does the driver have his current DVIR and previous day's DVIR?

  Yes

  No

  N/A

• Is the driver's log book present and up to date?

  Yes

  No

  N/A

• Are the tires and rims in good condition? (Ex: cracks, treads, bolts tight)

  Yes

  No

  N/A

• Is the load secured?

  Yes

  No

  N/A

• Were all fluids checked and topped off if needed?

  Yes

  No

  N/A

• Are the mirrors in working order and are clean.

  Yes

  No

  N/A