Site Safety Assessment

• Document No.

• Business/Customer Name - Account Number Billing Address

• Location of bin
  Address

• Conducted on

  Date

• Reason for Site Safety Assessment

  Sales Request

  Driver Request

  Customer Request

  Damage Claim

• Prepared by

• Personnel Attended Audit

• Any item with * (Asterisk) must have a second Site Assessment Done by Route Supervisor or Safety Member. This is critical to have done before service.
  Scoring Threshold. Passing score 35% or less. Anything higher requires additional attention
  
  Each category can have one or multiple selections.
  

• Reason Site Visit

  Sales Request

  Driver Request

  Customer Request

  Damage Claim

• Time Slider

• Estimate Times (Landfill, Wait Times ETC..)

FLOW OF TRAFFIC

• Flow of Traffic

  Select *One Way Two Way *Into Traffic *Drive Through No Issue

  • *One Way
  • Two Way
  • *Into Traffic
  • *Drive Through
  • No Issue

• Road Surface

  Select Gravel Asphalt Concrete Dirt

  • Gravel
  • Asphalt
  • Concrete
  • Dirt

• Road Surface Condition

  Select New Potholes Cracked Broken No Issues

  • New
  • Potholes
  • Cracked
  • Broken
  • No Issues

• Entrance & Width

  Select Wide *Narrow Parking Lot

  • Wide
  • *Narrow
  • Parking Lot

• Flow of Traffic Notes

Overhead & Side Obstructions

• Building Side Obstructions

  Select Canapy Balcony A/C Units No Issues

  • Canapy
  • Balcony
  • A/C Units
  • No Issues

• Side Obstructions

  Select Entrance By Bin (Close) Left Side Right Side No Issues

  • Entrance
  • By Bin (Close)
  • Left Side
  • Right Side
  • No Issues

• Level & Grade

  Select Level *Uneven *Angled *Low/High Spots No Issues

  • Level
  • *Uneven
  • *Angled
  • *Low/High Spots
  • No Issues

• Wires

  Select *Entrance *Parking Lot *Over Bin *Low No Issues

  • *Entrance
  • *Parking Lot
  • *Over Bin
  • *Low
  • No Issues

• Ground Obstructions

  Select Curbs Parked Cars Poles/Bollards Light Standards No Issues

  • Curbs
  • Parked Cars
  • Poles/Bollards
  • Light Standards
  • No Issues

• Tree's and Tree Limbs

  Select Over Beside Front Behind No Issues

  • Over
  • Beside
  • Front
  • Behind
  • No Issues

• Overhead & Side Obstructions Notes

Pedestrian Hazards

• Blocking Any Pedestrian Sidewalks or Roads

  Select Side Walk Cross Walk Road Drive-Though Cycling Path/Road No Issues

  • Side Walk
  • Cross Walk
  • Road
  • Drive-Though
  • Cycling Path/Road
  • No Issues

• Pedestrian (Walking, Crossing)

  Select Before Bin Parking Lot Around Bin Behind Bin No Issues

  • Before Bin
  • Parking Lot
  • Around Bin
  • Behind Bin
  • No Issues

• Sidewalks

  Select L Side Walk R Side Walk Front Bin Behind Bin No Issues

  • L Side Walk
  • R Side Walk
  • Front Bin
  • Behind Bin
  • No Issues

• Pedestrian Hazard Notes

Container Placement & Compound

• Bin Placed onto

  Select Gravel Asphalt Concrete Dirt

  • Gravel
  • Asphalt
  • Concrete
  • Dirt

• Level Surface - where bin is placed

  Select Level *Uneven *Angled *Low/High Spots No Issues

  • Level
  • *Uneven
  • *Angled
  • *Low/High Spots
  • No Issues

• Push Pull

  Select *Down/Up Grade Level *Grade Differences

  • *Down/Up Grade
  • Level
  • *Grade Differences

• Exterior Compound Walls

  Select Garage/Room Wood Concrete Bricks None

  • Garage/Room
  • Wood
  • Concrete
  • Bricks
  • None

• Interior Walls

  Select *Drywall no Bumpers Drywall with Bumpers Wood/Concrete *Bumpers Needed

  • *Drywall no Bumpers
  • Drywall with Bumpers
  • Wood/Concrete
  • *Bumpers Needed

• Compound Wall Bumpers

  Select Wood Plastic Metal Concrete No Issues

  • Wood
  • Plastic
  • Metal
  • Concrete
  • No Issues

• Compound Door

  Select Rollup Doors Hindged Door Wood Metal Automactic Manual

  • Rollup Doors
  • Hindged Door
  • Wood
  • Metal
  • Automactic
  • Manual

• Open Securing Device

  Select Gate Drop Bolt Door Stop Chain/Rope/Wire/Bungee *Need

  • Gate Drop Bolt
  • Door Stop
  • Chain/Rope/Wire/Bungee
  • *Need

• Door Closed Locking Device

  Select Pad Lock Wood Latch Bar (backyard fence) Sliding Bolt *Need Not Needed

  • Pad Lock
  • Wood Latch
  • Bar (backyard fence)
  • Sliding Bolt
  • *Need
  • Not Needed

• Required Key or Key Pass

  Select Door Key Pad Lock Swap Pass Key Code None

  • Door Key
  • Pad Lock
  • Swap Pass
  • Key Code
  • None

• Existing Damage (Document All)

  Select Wood Plastic Metal Concrete No Issues

  • Wood
  • Plastic
  • Metal
  • Concrete
  • No Issues

• Container Placement & Compound Notes

Backing

• Backing onto Road

  Select *Busy Road *onto Hwy *Blind Spot AM Call Only No Issue

  • *Busy Road
  • *onto Hwy
  • *Blind Spot
  • AM Call Only
  • No Issue

• Backing - Hard to See

  Select Parked Cars Building Pedestrian Alleys No Issue

  • Parked Cars
  • Building
  • Pedestrian
  • Alleys
  • No Issue

• Backing Notes

Container Size Specifications

• Front End Size

  Select 2 Yrd 3 Yrd 3 Yrd 4 Yrd 6 Yrd 8 Yrd

  • 2 Yrd
  • 3 Yrd
  • 3 Yrd
  • 4 Yrd
  • 6 Yrd
  • 8 Yrd

• Text Box to write custom Bin Specs

• Roll-Off

  Select 14/15 Yrd 20 Yrd 30 Yrd 40 Yrd 50 Yrd Enclosed

  • 14/15 Yrd
  • 20 Yrd
  • 30 Yrd
  • 40 Yrd
  • 50 Yrd
  • Enclosed

• Text Box to write custom Bin Specs

Site Media

• Take Pictures from every angle

  Media

• Final Site Notes

• Name & Signature

  Sign