Title Page

  • Site conducted

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Equipment Worthiness

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

  • Is the mixer Hopper and Cone clean?

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

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

  • Is the cement gun in good working condition ?

  • Is the cement hose in good working condition ?

  • Are the air lines in good condition ?

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

  • Are the grout tanks in good condition?

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

Jobsite Setup

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

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

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

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

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

  • Is the confined space permit filled out?

Productivity/Safety

  • Is there a spare nozzle on the truck?

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

  • Do the safety lights work on the truck?

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

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

  • Is there a spare cement cone?

  • Is there an eye wash station on the truck?

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

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

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

  • Does the air meter need to be calibrated?

  • Is the AV100 and AP separated?

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

Road Worthiness

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

  • Is the trailer properly attached to the truck?

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

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

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

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

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

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

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

  • Is the load secured?

  • Were all fluids checked and topped off if needed?

  • Are the mirrors in working order and are clean.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.