Safety Inspection - Horizontal Boring

• Date

  Date

• Site Name

• Contractor

• Carrier

• Location
  Address

• Can The Site Safety Observation Be Performed? Crew present/work being performed?

  Present

  Not Present

• Crewmembers On Site

Safety Paperwork

• JSA Is Thorough and Complete?

  Good

  Fair

  Poor

• Crew Taking Appropriate Hazard Mitigation Steps Identified In JSA?

  Pass

  Fail

PPE

• Hard Hats

  Safe

  At Risk

  N/A

• High Vis

  Safe

  At Risk

  N/A

• Safety Glasses

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

• Work Attire

  Safe

  At Risk

  N/A

Equipment

• First Aid Kit Readily Accessible?

  Compliant

  Non-Compliant

  N/A

• First Aid Kit Fully Stocked?

  Compliant

  Non-Compliant

  N/A

• Fire Extinguisher Readily Accessible?

  Compliant

  Non-Compliant

  N/A

• Fire Extinguisher Inspected?

  Compliant

  Non-Compliant

  N/A

• GFCI Utilized?

  Compliant

  Non-Compliant

  N/A

• Extension Cords Are Free From Trip Hazards or Properly Marked?

  Good

  Fair

  Poor

  N/A

• Have underground Utilities been located?

  Pass

  Fail

• Is Bore Rig/Vac Truck set up in a safe location? (Traffic control, level ground, etc.)

  Safe

  At Risk

  N/A

• Does Bore Rig/Vac Truck appear to be in good condition?

  Good

  Fair

  Poor

  N/A

• Are controls functioning properly?

  Safe

  At Risk

  N/A

• Are there any fluid leaks?

  Safe

  At Risk

  N/A

• Has the Strike Alert sensor been deployed?

  Compliant

  Non-Compliant

  N/A

• Site/Job Specific PPE Available and in use?

  Safe

  At Risk

  N/A

Site

• Adequate Warmth or Shade Accessible?

  Compliant

  Non-Compliant

  N/A

• Water Available For Entire Crew?

  Compliant

  Non-Compliant

  N/A

• Traffic Cones or Barricades Used When Necessary?

  Compliant

  Non-Compliant

  N/A

• Appropriate Cert Cards Avaliable? EX: Authoroized/Competent Climber, Rigging, First-Aid/CPR, RF, Crane, Aerial Lift, etc.

  Good

  Fair

  Poor

• Housekeeping, Site Free From Excessive Debris/Trash?

  Good

  Fair

  Poor

Signatures

• Inspector

  Sign