PRSI Job Site Safety - Pulv

• Customer & Job Number

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel & Equipment

On site Job Contact

• Name:

  Blank

• Phone #:

  Blank

Traffic Control

• Pre- Warning signs in place?

  Safe

  At Risk

  N/A

• Proper Flaggers in place

  Safe

  At Risk

  N/A

• Are Hazards being controlled, Pedestrian and Traffic?

  Yes

  No

  N/A

• Is Traffic being controlled and protected thru our work zone?

  Safe

  At Risk

  N/A

• Are the Cones/Delineators clean and in good shape?<br>

  Safe

  At Risk

  N/A

• Are we being Protected by the Traffic control?

  Yes

  No

  N/A

Underground Utilities

• Do we have n active USA #

  Yes

  No

  N/A

• Job walk completed

  Safe

  At Risk

  N/A

• Utilities marked/located<br>

  Safe

  At Risk

  N/A

• Pothole Plan Reviewed

  Yes

  No

  N/A

• Utility marks refreshed

  Safe

  At Risk

  N/A

• Any high hazard utility on site? Coordination with utility owner?

  Safe

  At Risk

  N/A

• Are we protecting all utilities?

  Yes

  No

  N/A

Vehicular Safety

• All vehicles parked in a safe/designated area?

  Yes

  No

  N/A

• Are all vehicles coned off?

  Yes

  No

  N/A

• Fire Extinguishers present and marked off?

  Yes

  No

  N/A

• Beacons in use?

  Safe

  At Risk

  N/A

• Drive Cam camera installed and green light?

  Yes

  No

  N/A

• Are truck beds free of clutter and oil containers labeled?

  Yes

  No

  N/A

• Are trucks clean on inside, free of trash?

  Yes

  No

  N/A

• License plates and tags current?

  Yes

  No

  N/A

PRSI Trailers

• Trailers coned off?

  Safe

  At Risk

  N/A

• Decking free of debri and wood in good shape?

  Safe

  At Risk

  N/A

• Tires in good condition and wearing evenly?

  Safe

  At Risk

  N/A

PPE

• All P.P.E being used- hardhats, glasses, gloves, ear protection?

  Safe

  At Risk

  N/A

• Safety Boots

  Safe

  At Risk

  N/A

• Water / Coolers Clean

  Safe

  At Risk

  N/A

• Vendors Compliant and wearing proper PPE while outside vehicles?

  Safe

  At Risk

  N/A

• High Illness policy being followed?

  Safe

  At Risk

  N/A

Program Applications

• Tailgate Meetings attended by crew?

  Yes

  No

  N/A

• Is Foreman in control of his job site?

  Yes

  No

  N/A

• Are Job Hazards recognized and pointed out to the crew?

  Safe

  At Risk

  N/A

Machine Safety

• Is equipment being safely operated?

  Safe

  At Risk

  N/A

• Maintenance & Free of any oil leaks?

  Safe

  At Risk

  N/A

• Safe Operator Station/Seat Belts being used?

  Safe

  At Risk

  N/A

• Fire Extinguisher current and checked off Monthly?

  Safe

  At Risk

  N/A

• Back Up Alarm working and loud enough?

  Safe

  At Risk

  N/A

• Beacons working properly?

  Safe

  At Risk

  N/A

• Parking / Staging Location Approved and kept clean?

  Safe

  At Risk

  N/A

• Machine locked at end of shift

  Safe

  At Risk

  N/A

Unsafe Practices

• Unguarded Machinery

  Safe

  At Risk

  N/A

• Not Using Safety Locks

  Safe

  At Risk

  N/A

Vehicles/Equipment Present

• Pickup/Service Trucks

  Yes

  No

  N/A

• Water Trucks

  Yes

  No

  N/A

• Spreader

  Safe

  At Risk

  N/A

• Compactor

  Safe

  At Risk

  N/A

• Pulverizer

  Safe

  At Risk

  N/A

• Cement/Lime Trucks

  Safe

  At Risk

  N/A

• Oil Tanker

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Comments

• Any Jobsites photos

  Safe

  At Risk

  N/A