Pre-Job Task Inspection

• Conducted on

  Date

• Prepared by

• Truck#

• Location
  Address

• WO#

• Employees Present

• Supervisor

Arrival Vehicle Placement

• Road

• Driveway

• Parking Lot

• Other

Job Description

• Main

• Service

• Steel

• Plastic

• Repair Leak

• Cut Line

• Replace

• Abandon

• Relocate

• Install

• Other

Traffic Control

• Cones

• Road Signs

• Flag Man

• Other

Site Inspection Working Surface

• Grass

• Dirt

• Cement/Asphalt

• Gravel

• Wet/Damp

• Dry

• Slope

• Uneven Ground

• Snow/Ice

• Oily/Greasy

• Other

Potential Job Hazards Present

• Underground Utilities

• Escaping Gas

• Overhead Hazards

• Confined Space

• Excavation/Trenching

• Excavation Depth

• Work Zone

• Oxygen Deficiency

• Release of Gas

• Wet/Slippery

• Traffic

• Public

• Animals/Insects

• Railroad Tracks

• Ditch

• Intersection

• School Zone

• Chemicals

• Asbestos

• Climbing

• Line Pressure/Test Pressure

• Spoil Bank

• Cave-In

• Surface Stability

• Weather Condition

• Tool Use (Strains)

• Hand & Power Tools

• Communication

• Welding

• Shoring

• Lockout/Tagout

• Other

• Other Potential Hazards/AOCs Associated With Task

• Action Plan for Hazards/AOCs Associated With Task

PPE Required for Task

• Hard Hat

• Gloves

• Safety Glasses/Safety Goggles

• Face Shield

• Reflective Vests

• Nomex Suits (Flash Suits)

• Safety Harness/Lanyard

• Respiratory Equipment

• RKI monitors

• CGI

• Fire Extinguisher

• Shoring Equipment

• Foot Guards

• Ladder

• Knee Pads

• Assist Tool

• Bug Repellent

• MSDS

• Pressure Guages

• Long Sleeve Shirts (FR/Cotton)

• Lock Out/Tag Out Equipment

• First Aid Kit

• AED

• Emergency Numbers

• 811 Ticket #

• Other

Signatures

• Crew Leader

  Sign

• Employee Present

  Sign

• Employee Present

  Sign

• Employee Present

  Sign

• Employee Present

  Sign

• Employee Present

  Sign

• Employee Present

  Sign

• Employee Present

  Sign