Signal / Traffic Safety Audit

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Job number

• Has the driver done a pre trip inspection on his truck and trailer before using them today?

  Yes

  No

  N/A

Who is the foreman on this job

• Date and Time audit began

  Date

• Has the Daily Huddle / Pre Task been done

  Yes

  No

  N/A

• Was the daily Huddle signed by everyone on the job?

  Yes

  No

  N/A

JSA MUST BE DONE FOR EACH JOB! However, if the job description has not changed, and if no new crew member comes on the job, you can use the JSA until the job is complete. Every crew member working on the job has to sign the JSA. And a new JSA must be done when the job description changes.

• Has the foreman completed the (JSA) prior to starting the job?

  Yes

  No

  N/A

• Are all trucks, and trailer loaded safely? This means NO material is loaded higher than the work bins, and NO risk of material coming off the truck.

  Yes

  No

  N/A

• Is the lane closure set up properly, signs, cones, tapper etc.?

  Yes

  No

  N/A

• Was the crew cutting? If so were they wet cutting?

  Yes

  No

  N/A

EXTERIOR LIGHTING

• High and Low Beams Operational

  Yes

  No

  N/A

• Has the equipment been inspected prior to using it?

  Yes

  No

  N/A

• Clearance, Reflectors Operational

  Yes

  No

  N/A

• Left and Right Tail Lights Operational

  Yes

  No

  N/A

• Left and Right Front Indicators Operational

  Yes

  No

  N/A

• Left and Right Rear Turn Indicators Operational

  Yes

  No

  N/A

• Left and Right Break Lights Operational

  Yes

  No

  N/A

• License Plate Lights Operational

  Yes

  No

  N/A

• Rear Reverse Light Operational

  Yes

  No

  N/A

• Audible Reverse Alarm Operational

  Yes

  No

  N/A

EXTERIOR BODY AND GLASS (Take Photos of any noted damage)

• Windshield Free of Cracks and Chips

  Yes

  No

  N/A

• Left Mirrors adjustable and Free of Damage

  Yes

  No

  N/A

• Left Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• License Plate in Position, Clean, Free of Damage

  Yes

  No

  N/A

• Right Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Right Mirror Adjustable and Free of Damage

  Yes

  No

  N/A

TIRES

• Are wheels chocked properly

  Yes

  No

  N/A

• Is proper pads under outriggers

  Yes

  No

  N/A

• Front Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Front Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

INTERIOR

• Is state inspection on drivers vent window current

  Yes

  No

  N/A

• Is Dielectric testing current

  Yes

  No

  N/A

• Pre Trip inspection book visible, and easy access to it

  Yes

  No

  N/A

• Windshield Wipers Functioning Properly

  Yes

  No

  N/A

• Driver Seat Belt Operational

  Safe

  At Risk

  N/A

• Horn Functioning Appropriately

  Yes

  No

  N/A

• Heater and Defroster Operational

  Yes

  No

  N/A

• Air Conditioning Operational

  Yes

  No

  N/A

• Dashboard Lights Operational

  Yes

  No

  N/A

• All Gauges are Operating and Show within Appropriate Ranges

  Yes

  No

  N/A

• Interior Compartment Lights Operational

  Yes

  No

  N/A

• Interior is Clean and Free of Loose Objects that could slide under the drivers feet?

  Yes

  No

  N/A

ENGINE COMPARTMENT

• Free from visible leaks, or hose that need replacing

  Yes

  No

  N/A

• Oil Levels Adequate and Within the Minimum and Maximum Levels

  Yes

  No

  N/A

• Water Levels Adequate and Within the Minimum and Maximum Levels

  Yes

  No

  N/A

• Brake Fluid Levels Adequate and Within the Minimum and Maximum Levels

  Yes

  No

  N/A

• Windscreen Washer Fluid Functioning and Appropriately Wetting Windscreen to Clean

  Yes

  No

  N/A

• Battery In Good Visible Condition and Securely Fastened into Position

  Yes

  No

  N/A

SAFETY EQUIPMENT

• Is everyone wearing the proper PPE

  Yes

  No

  N/A

• Is there at least 2 chocks on the line trucks and bucket trucks?

  Yes

  No

  N/A

• Do you have enough outrigger pads on the line trucks and bucket trucks?

  Yes

  No

  N/A

• Are radios being used when possible

  Yes

  No

  N/A

• Proper lane closure with warning signs out

  Yes

  No

  N/A

• Is operator wearing a approved harness with factory tag in place

  Yes

  No

  N/A

• Highway safety triangles available

  Yes

  No

  N/A

• Securely mounted First Aid Kit (Ensure Completely Stocked)

  Safe

  At Risk

  N/A

• Strobe lights, and all warning lights working properly

  Yes

  No

  N/A

• Fire Extinguisher Charged and Inspected Monthly?

  Safe

  At Risk

  N/A

Is the work area safe from open holes, trash, etc.

• Yes

  No

  N/A

• Add media

  Media

Line truck / Bucket truck

• Operating instructions, and warnings clear, and legible

  Yes

  No

  N/A

• Controls working properly, not sticking and moving freely

  Yes

  No

  N/A

• Is the vehicle free of leaking fluids?

  Yes

  No

  N/A

• Are ropes, cables and hooks in good condition?

  Yes

  No

  N/A

REQUIRED DOCUMENTATION

• Is the flaggers certification current

  Yes

  No

  N/A

• Is everyone operating equipment certified on the equiptment

  Yes

  No

  N/A

• Valid Vehicle Registration is located in Vehicle

  Yes

  No

  N/A

• Valid Vehicle Insurance Certificate is Located in Vehicle

  Yes

  No

  N/A

Trailer Inspection

• Railing, floor, tail gate hitch, safety chains tires in good condition, registration current and in white tube all lights intact and working properly

  Yes

  No

  N/A

WHO WAS NOTIFIED OF THE FINDINGS ON THIS AUDIT

Driver-Employee

Foreman

Supervisor - Mike Sauls

Supervisor of Safety - Jamie Bragg

VP of Safety Department Larry Richardson

My recommendation or plan of action to address and resolve this issue

Seriousness of findings are listed below

At earliest opportunity

Within 3 business days

Before this unit can be used again !

Lindy Fann Safety/Fleet Administrator Watson Electric Construction, LLC 1500 Charleston Street SE Wilson, N.C. 27839 Ph: 252-265-5297 Cell - 252-299-1910 Fax - 252-243-1607 Lfann@watsonelec.com