Pre-Mobilization Inspection (Ground Improvement - Structural Support)

• Conducted on

  Date

• Project name/number

• Location
  Address

• Prepared by

Utilities

• Were both inside and outside perimeter of job site inspected for utilities?

  Yes

  No

  N/A

• Is the job site clear of utilities?

  Yes

  No

  N/A

• Location

  Select Inside perimeter Outside perimeter Both

  • Inside perimeter
  • Outside perimeter
  • Both

• Source

  Select Overhead Underground Both

  • Overhead
  • Underground
  • Both

• Type

  Select Cable Electrical Fiber optic Gas Phone Sewer/Storm drain Water Other

  • Cable
  • Electrical
  • Fiber optic
  • Gas
  • Phone
  • Sewer/Storm drain
  • Water
  • Other

General Work Area(s)

• Is the job site fenced?

  Yes

  No

  N/A

• Is the job site clear of installation conflicts?

  Yes

  No

  N/A

• Type

  Select Existing building(s) Existing footer(s) Fences Overhang(s) Trees Utilities Other

  • Existing building(s)
  • Existing footer(s)
  • Fences
  • Overhang(s)
  • Trees
  • Utilities
  • Other

• Is the job site free of access restrictions?

  Yes

  No

  N/A

• Issue

  Select Gate size Lot size Metered parking Permits Ramps Subcontractors Other

  • Gate size
  • Lot size
  • Metered parking
  • Permits
  • Ramps
  • Subcontractors
  • Other

• Is there a lay down area for equipment?

  Yes

  No

  N/A

• Is the lay down area level?

  Yes

  No

  N/A

• Is the lay down area stable?

  Yes

  No

  N/A

• Is there a water source available?

  Yes

  No

  N/A

• Type

  Select 3/4" 2" Water truck Other

  • 3/4"
  • 2"
  • Water truck
  • Other

• Are there toilets on site?

  Yes

  No

  N/A

• Is there designated parking for employees?

  Yes

  No

  N/A

• Location

  Select Off site On site Other

  • Off site
  • On site
  • Other

Working Platform

• Is there a level working grade?

  Yes

  No

  N/A

• Recommended improvements

  Select Compact Grade Roll Other

  • Compact
  • Grade
  • Roll
  • Other

• Is there a stable working grade?

  Yes

  No

  N/A

• Recommended improvements

  Select Crane mats Demuck Road plates Rock Other

  • Crane mats
  • Demuck
  • Road plates
  • Rock
  • Other

• Is there evidence that the working platform has been disturbed?

  Y

  N

• Evidence

  Select Fuel/Storage tank Utility removal Other

  • Fuel/Storage tank
  • Utility removal
  • Other

• What was the abatement?

  Select Compacted Road plates Rock Other

  • Compacted
  • Road plates
  • Rock
  • Other

• Are there other factors causing the platform to be pliable?

  Y

  N

• Type

  Select Beach/Sugar sand Water intrusion Other

  • Beach/Sugar sand
  • Water intrusion
  • Other

• Recommended improvements

  Select Crane mats Road plates Rock Other

  • Crane mats
  • Road plates
  • Rock
  • Other

• Were soil borings reviewed?

  Yes

  No

  N/A

• Is the inspection in line with the report?

  Yes

  No

  N/A

• Was a visual inspection of the platform sufficient?

  Yes

  No

  N/A

• Testing performed

  Select Ground penetrometer Load test Proof rolling Running heavy equipment Test pit Other

  • Ground penetrometer
  • Load test
  • Proof rolling
  • Running heavy equipment
  • Test pit
  • Other

• What technique is being performed?

  Select Ground improvement Structural support

  • Ground improvement
  • Structural support

• What equipment is going to be on site?

  Select Aerial Lift Batch plant Back hoe Crane Concrete/Grout pump Drill/Drill rig Excavator Silos Other

  • Aerial Lift
  • Batch plant
  • Back hoe
  • Crane
  • Concrete/Grout pump
  • Drill/Drill rig
  • Excavator
  • Silos
  • Other

Approval

• I approve mobilization to this job site.

  Yes

  No

  N/A

• List improvements needed for mobilization

• Signature

  Sign