Site Visit Report - P&CG

• Site conducted

  Select

• Location Title

• Inspection Date

  Date

• Weather

  Select Hot Cold Sunny Overcast Rain Snow/sleet Windy

  • Hot
  • Cold
  • Sunny
  • Overcast
  • Rain
  • Snow/sleet
  • Windy

• Prepared by

  Select Tim Laursen Cole Hardenbrook John Seward

  • Tim Laursen
  • Cole Hardenbrook
  • John Seward
• Site Location
  Address

• Division

  Select Gas Signal High Voltage Low Voltage Transportation Civil Subway Towers KBH-E Other

  • Gas
  • Signal
  • High Voltage
  • Low Voltage
  • Transportation
  • Civil
  • Subway
  • Towers
  • KBH-E
  • Other

• Onsite Foreman

• Project Manager

  Select Slusar Willey Starr Goodwin Buchinger Drumm Dickenson Coleman Lee Walker Carroll Wierzba Schadt Rigney Lloyd Pattridge Planert Jones, Sr. Nagel Other

  • Slusar
  • Willey
  • Starr
  • Goodwin
  • Buchinger
  • Drumm
  • Dickenson
  • Coleman
  • Lee
  • Walker
  • Carroll
  • Wierzba
  • Schadt
  • Rigney
  • Lloyd
  • Pattridge
  • Planert
  • Jones, Sr.
  • Nagel
  • Other

• Project Manager Name

• # of Support Crew On-site

Sub-contractor Personnel On-site

• How Many?

• Project No.

• Work in Progress

• Observations

• Safety Opportunities

• Additional Comments

• Safety Champion Awarded?

  Yes

  No

• Personnel Name(s)

• Toolbox Talk Completed

  Yes

  No

• What was the Topic?

• Daily Job Brief Completed

  Yes

  No

• Photo Copy

  Media

• DVIR Available

  Yes

  No

Fire Extinguishers On-site

• Annual Inspection Current?

  Compliant

  Non-Compliant

  N/A

• Monthly Inspection Current?

  Compliant

  Non-Compliant

  N/A

• 1st Aid Kit On-site

  Yes

  No

• PPE Distributed to Personnel?

  Yes

  No

• What PPE was distributed?

• Respirator in use?

  Yes

  No

• Used in compliance with OSHA standards

  Compliant

  Non-Compliant

  N/A

Wheels chocked?

• Yes

  No

  N/A

Work zone traffic control

• Yes

  No

  N/A

• Personnel operating equipment on-site?

  Yes

  No

• What is the operator's proficiency?

• Is retraining needed?

  Yes

  No

• Is Daily Equipment Log Complete?

  Yes

  No

• Overall Impression of Site

  Outstanding

  Above Average

  Average

  Below Average

• State reason(s) Site Visit was Below Average

• Safety Representative Signature

  Sign

Site Photographs

• Attach Site Photographs here

  Media