Pro-Safety Utility Damage Prevention Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Pre-Construction Steps

• Site Plan/Field Sketch showing excavation limits or bore path.

  Yes

  No

  N/A

• Excavation OR Horizontal Directional Drilling "PERMIT" APPROVED?

  Yes

  No

  N/A

• Pre-Excavation/Boring meeting with Locator Service, High Priority Utility Owners (Fiber, High Pressure Gas, Water Sewer)?

  Yes

  No

  N/A

• Area White Lined per drawings or plan.

  Yes

  No

  N/A

• Utility Locate Request (CALL Before You Dig 811) sent 3 business days prior.

  Yes

  No

  N/A

• Utility Locate Request Ticket Current Within 10 Days?

  Yes

  No

  N/A

• Private Utilities Located?

  Yes

  No

  N/A

• ALL Utilities Marked Clearly (Not Faded) per Uniform Color Code & Marking Guidelines?

  Yes

  No

  N/A

• Utility Markings Photographed?

  Yes

  No

  N/A

• Site Checked for visible signs of utilities that may have been missed (Pedestals, Risers, Meters, Trench Lines)?

  Yes

  No

  N/A

• Verify service feeds from buildings have been located?

  Yes

  No

  N/A

• Markings added to drawings?

  Yes

  No

  N/A

• Toolbox Talk and/or AHA with all personnel on site?

  Yes

  No

  N/A

• Emergency Action Plan communicated to all personnel?<br>Gas Line Hit = CALL 911-EVACUATE AREA IMMEDIATELY! Then from safe distance call Supervisor AND Gas Company!<br>Electrical Line Hit = Stay in Cab - Ground Workers use shuffle or bunny hop methods to safe area!<br>Phone, Water, Cable, Water, Sewer, etc. = Call Supervisor Immediately!

  Yes

  No

  N/A

Pre Work Photographic or Video Documentation:

• Utility Markings?

  Yes

  No

  N/A

• Pedestals, Risers, Meters, etc?

  Yes

  No

  N/A

• Sidewalks, Driveways, Streets, Curbs for cracks, condition and pre-existing damage?

  Yes

  No

  N/A

• Trees, Shrubs, Flower Beds?

  Yes

  No

  N/A

• Mail boxes, Street Signs, Monuments?

  Yes

  No

  N/A

Traffic Control:

• Traffic Control Plan Developed per industry standard (MUTCD)?

  Yes

  No

  N/A

• Traffic Control Plan Approved by City?

  Yes

  No

  N/A

• Traffic Control Devices installed per plan?

  Yes

  No

  N/A

• Traffic Control Devices adequate?

  Yes

  No

  N/A

• Traffic Control Plan requires Field Modification to accommodate site hazards?

  Yes

  No

  N/A

• Traffic Control DevIces maintained (Clean, Faded, Blown/Drove Over, etc.)?

  Yes

  No

  N/A

• Traffic Control Devices taken down when not needed or project completion (Extended breaks, Done for the Evening)?

  Yes

  No

  N/A

Personal Protective Equipment:

• ANSI Approved High Visibility Outer Clothing Worn and in good condition?

  Yes

  No

  N/A

• ANSI Approved Hardhat Worn Properly (No Ball Caps, Brim Forward) and in Good Condition?

  Yes

  No

  N/A

• ANSI Approved Safety Glasses by ALL Personnel?

  Yes

  No

  N/A

• Minimum Short Sleeved Shirt and Long Trousers Worn?

  Yes

  No

  N/A

• Heavy Duty Work Boots WORN Properly (Laced up) and in GOOD Condition?

  Yes

  No

  N/A

• Appropriate Work Gloves Worn?

  Yes

  No

  N/A

• Proper Lifting procedures followed for manual material handling?

  Yes

  No

  N/A

Equipment Safety:

• ALL equipment and tools inspected prior to use?

  Yes

  No

  N/A

• Owner's Manual for all equipment readily available?

  Yes

  No

  N/A

• Walkover locating equipment calibrated prior to operation?

  Select Yes No Not Applicable

  • Yes
  • No
  • Not Applicable

• Operators have been trained in Safety Features and Procedures?

  Yes

  No

  N/A

• Have the areas around site excavations been cordoned off?

  Yes

  No

  N/A

• Strike alert system operational with ground installed properly?

  Select Yes No Not Applicable

  • Yes
  • No
  • Not Applicable

• Photo of ground properly installed

  Media

• Has a height permit issued as well as a excavation permit?

  Yes

  No

  N/A

• Are the operatives working in pairs around or inside the excavation?

  Safe

  At Risk

  N/A

• Were the utility drawings checked prior to excavations being started? Ask to be shown drawings and comment

  Yes

  No

  N/A

• Does the excavation permit show instructions for scanning the area prior to excavating?

  Yes

  No

  N/A

• Backreaming process visually observed when passing an existing utility?

  Select Yes No Not Applicable

  • Yes
  • No
  • Not Applicable

• Fencing, cones, cover plates installed to protect open pits?

  Yes

  No

  Not Applicable

• Photo documentation of open pit protection

  Media

• All trucks & trailers in compliance with US DOT Requirements?<br>* Pre-trip Inspection<br>* Safety Triangles<br>* Fire Extinguisher<br>* Cargo Securement<br>* Seat Belts worn<br>* No Handheld Phone Use<br>* Clean insides and out

  Yes

  No

  Not Applicable

• Photo of pre trip

  Media

• Photo of safety triangles

  Media

• Photo of fire extinguisher

  Media

• Photo of cargo Securement

  Media

• Any general comments, observations, or concerns about this site?

• What is the general attitude to safety on site?

• Add signature

  Sign

• Have the weekly self site audits been done?

  Yes

  No

  N/A

• Have all the remedials been actioned?

  Yes

  No

  N/A