Scott kutz HSE

Basic Project Information

• Date Audit Conducted On

  Date
• Location
  Address

• Project Number

• Project or Site Name

• Division (s) working on Project

  Select Tunneling Communications Equipment Highway Crushing Pits and Quarries Pipeline Wind Pipe Services Power Corporate Directional Crossings CFS Michels Stone Foundations AB&J

  • Tunneling
  • Communications
  • Equipment
  • Highway
  • Crushing
  • Pits and Quarries
  • Pipeline
  • Wind
  • Pipe Services
  • Power
  • Corporate
  • Directional Crossings
  • CFS
  • Michels Stone
  • Foundations
  • AB&J

• Description of Work

• Audit Authored by:

• tthis is he

  Yes

  No

  N/A

Additional Project Information

• Michels Management On Site

Personnel

• Name of Manager

• Number of Personnel on Project

• Are Additional Personnel Assisting with this Audit

  Yes

  No

  N/A

• List Personnel Assisting with Audit

Personnel

• Name

• Are Michels Sub Contractors On Site

  Yes

  No

  N/A

• List Michels Sub Contractors Present

Sub Contractors

• Sub Contractor

• Are Contractors that are not Michels Subs On Site

  Yes

  No

  N/A

• List Other Contractors On Site

Contractors

• Contractor

Postings and PPE

• Does the Site have the Required Labor Postings?

  Yes

  No

  Not Applicable

  Not Reviewed

• Postings

  Select EEO Policy State Labor Postings Employment Postings

  • EEO Policy
  • State Labor Postings
  • Employment Postings

• Add media

  Media

• Does the Site have the Required HSE Postings and Plans?

  Yes

  No

  Not Applicable

  Not Reviewed

• Postings

  Select Signed HSE Policy Michels Emergency Response Team Number Hospital Location Site Specific HSE Plan

  • Signed HSE Policy
  • Michels Emergency Response Team Number
  • Hospital Location
  • Site Specific HSE Plan

• Add media

  Media

• PPE Required on Project

  Select Hi Vis Clothing Hard Had Safety Toe Boots Safety Glasses FR Clothing Respirator Hearing Protection

  • Hi Vis Clothing
  • Hard Had
  • Safety Toe Boots
  • Safety Glasses
  • FR Clothing
  • Respirator
  • Hearing Protection

• Are the personnel properly fit tested

  Yes

  No

  No Applicable

  I don't know

• Is appropriate PPE being worn?

  Yes

  No

  No Applicable

  I don't know

Environmental

• Does the Site have someone assigned to manage any spills that might occur?

  Yes

  No

  Not Applicable

  Not Reviewed

• Who is that Person?

• Are there Environmentally Sensitive Features present?

  Yes

  No

  No Applicable

  I don't know

• Select the Sensitive Features

  Select Wetlands Waterways Cultural Other

  • Wetlands
  • Waterways
  • Cultural
  • Other

• Are the features flagged, barricaded or otherwise delineated in the field.

  Yes

  No

  No Applicable

  I don't know

• Are Sensitive Features identified on construction drawings

  Yes

  No

  No Applicable

  I don't know

• Does the project have a Storm Water Pollution Plan (SWPPP) or similar?

  Yes

  No

  Not Applicable

  Not Reviewed

• Are the required inspections Michels Responsibility?

  Yes

  No

  No Applicable

  I don't know

• Are Spill Kits present

  Yes

  No

  Not Applicable

  Not Reviewed

• In all vehicles or at least immediately assessable to all crews

  Yes

  No

  No Applicable

  I don't know

• At all Fueling Stations

  Yes

  No

  No Applicable

  I don't know

Incident Review

• Draw the Incident

  Drawing

• Take Pictures and Annotate Pictures

  Media

• List the Personnel Involved with the Incident

Personnel Involved

• List the Equipment that was involved in the Incident

Equipment Involved

• List any Witnesses

Witnesses

• Provide the Witness Contact Information

Corrective Actions Required

• Does the Project Require Corrective Actions

  Yes

  No

  N/A

• List Corrective Actions Required

Corrective Action

• Date When Corrective Actions should be Accomplished

  Date

• List Personnel Required to Complete Corrective Action

Personnel

Certification

• Date and Time Audit was Completed

  Date

• Signature

  Sign