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

• 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

• 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

Section 7.0 Mewps and Plant

Section 8.0 Skips & Waste

Section 9.0 - Fire Prevention & Hazardous Materials

Section 10.0 PPE & Noise

Section 11.0 Electricity

Section 12.0 General

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

• What is the general attitude to safety on site?

• Add signature

  Sign

Section 1.0 Management Poster

• Has the management poster been kept up to date?

  Yes

  No

  N/A

• Yes

  No

  N/A

Section 2.0 Permits

• Have all permits been completed correctly with correct controls?

  Yes

  No

  N/A

• Have all hot works permits been closed off correctly?

  Yes

  No

  N/A

Section 3.0 Inductions

• Check Stats Inspection Folder. Have all the inductions been filled in correctly?

  Yes

  No

  N/A

• And uploaded? (large sites only)

  Yes

  No

  N/A

• All the companies mentioned in inductions have been mentioned in the Rams Log?

  Yes

  No

  N/A

Section 4.0 Rams Check

• Pick a random contractor. Can they be seen to be working within their rams?

  Yes

  No

  N/A

• Has a rams review form been done?

  Yes

  No

  N/A

• If there were any discrepancies were they sent back to the contractor to re-submit?

  Yes

  No

  N/A

Section 5.0 Site Tasks

• Are there any outstanding tasks?

  No

  Yes

Section 6.0 MEWP/Plant Inspections

• Are the mewp inspection forms being completed correctly by all operatives using them?

  Yes

  No

  N/A

• Are all the LOLER certificates displayed on the Management Poster incl forklift

  Yes

  No

  N/A

Section 7.0 Weekly Site Audits by Site Manager

• Have the weekly self site audits been done?

  Yes

  No

  N/A

• Have all the remedials been actioned?

  Yes

  No

  N/A

Section 8.0 Site folder checkup - Cons & Stats

• Yes

  No

  N/A

• Check through the folder and list any outstanding or incorrect issues. Use the slider below to score how well the folder has been kept up to date.