Title Page
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Site conducted
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Traffic Control
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Are traffic cones in use and placed properly?
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Are the proper signs in use and placed properly?
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Is the manhole guard set up and properly placed at the up stream manhole?
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Is the manhole guard set up and properly placed at the down stream manhole?
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Are flaggers or a Detail present on the job site if required?
Confined Space Equipment
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Has the workers air meter gone in for calibration (once every 30 days)?
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Is the tripod and winch properly set up at the up stream manhole?
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Is the tripod and winch properly set up at the down stream manhole?
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Is the gas detector set up and properly working at the up stream manhole?
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Is the gas detector set up and properly working at the down stream manhole?
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Is the blower set up and working properly?
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Are lifelines properly set up and in use if required?
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Are the harnesses in proper condition?
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Is the Confined Space Permit filled out completely and visible?
PPE
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Are all crew members using proper steel toe boats?
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Are hard hats in use?
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Are safety vest in use?
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Is the crew using ear protection and is the the proper type for the job?
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Is the crew using the proper Tyvek chemical suit (Yellow or White) for the job?
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Is the crew using the proper eye protection(Safety glasses of Safety goggles)?
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Is the crew using face shield if required?
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Is the proper hand protection being used?
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Is the proper respiratory protection being used?
Vehicle Equipment
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IS the DVIR fill out and accurate?
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Is the log book filled out and up to date?
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Does the vehicle have a proper First Aid kit?
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Does the vehicle have the proper Fire Extinguishers?
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Does the vehicle have Triangles?
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Does the vehicle have Chock Blocks?
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Does the vehicle have a MSDS book?
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Is the crew following standard operating procedure for the vehicle?
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Is the eye wash station stocked?
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Are radios in proper working condition?
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Is the By-Pass working properly?
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Is the By-Pass hose in proper working condition?
Materials
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Is the proper resin being used?
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Are chemical buckets properly labeled?
Housekeeping
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Is the truck clean?
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Is the equipment maintained?
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Are all tools in good working condition?
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Are crew members wearing the proper uniforms and look presentable?