STEMC Field Observation

• Document No.

• Work Performed

• Crew

• Conducted on

  Date

• Prepared by

• Location
  Address

• Foreman

Job Planning

• Was a Job Briefing held and documented?

  Yes

  No

  N/A

• Was the job briefing complete and properly signed by all crew members?

  Yes

  No

  N/A

• Did interviewed crew members know the work location in case of an emergency?

  Yes

  No

  N/A

Personal Protective Equipment

• Was approved eye protection being worn at all times?

  Yes

  No

  N/A

• Were hard hats being used?

  Yes

  No

  N/A

• Was proper hand protection being used?

  Yes

  No

  N/A

• Were all employees wearing proper FR clothing?

  Yes

  No

  N/A

• Was footwear appropriate for the job?

  Yes

  No

  N/A

• Was required special PPE (chaps, Face shield, etc.) being used?

  Yes

  No

  N/A

Vehicles and Equipment

• Commercial Vehicles have proper documentation:<br>Insurance Card, Registration Form, Operators Manual, Accident Reporting Guidelines, Daily Post Trip Inspection and Annual DOT Inspection

  Yes

  No

  N/A

• Were wheel chocks used properly?

  Yes

  No

  N/A

• Fire extinguishers were readily accessible and charged.

  Yes

  No

  N/A

• AED was readily accessible, charged and pads are within expiration date.

  Yes

  No

  N/A

• First aid kits and BBP kits were easily accessible, stocked and within expiration date.

  Yes

  No

  N/A

• Was vehicle lighting is working properly?

  Yes

  No

  N/A

• Were trailers inspected and properly connected?

  Yes

  No

  N/A

• Were vehicles properly grounded?

  Yes

  No

  N/A

• Was a ground guide used when backing?

  Yes

  No

  N/A

• Was housekeeping (inside cab and bed) satisfactory?

  Yes

  No

  N/A

• Are loads properly secured?

  Yes

  No

  N/A

Traffic Control

• Were proper warning lights being utilized?

  Yes

  No

  N/A

• Were reflective vest being used?

  Yes

  No

  N/A

• Were signs and cones adequate for job?

  Yes

  No

  N/A

• Was flagging adequate and Stop/Slow paddles used?

  Yes

  No

  N/A

Energized work

• Are rubber gloves field tested prior to use, of the correct rating and in date?

  Yes

  No

  N/A

• Was adequate cover- up material utilized?

  Yes

  No

  N/A

• Was "hot work" being observed?

  Yes

  No

  N/A

• Was the minimum approach distance maintained?

  Yes

  No

  N/A

• Was the Ground to Ground/ Cradle to Cradle rule adhered to?

  Yes

  No

  N/A

General Construction and Maintenance Work

• Equipment/tools inspected prior to use? (i.e. broken handles, missing parts/guards etc.)

  Yes

  No

  N/A

• Equipment/tools being used correctly?

  Yes

  No

  N/A

• Working between grounds?

  Yes

  No

  N/A

• Were grounds inspected and in good condition?

  Yes

  No

  N/A

• Were excavations evaluated and safe?

  Yes

  No

  N/A

• Were slings in good condition with proper rating tags?

  Yes

  No

  N/A

• Was there good housekeeping?

  Yes

  No

  N/A

Climbing and Elevated Work

• Was proper fall protection utilized?

  Yes

  No

  N/A

• Was climbing gear inspected prior to use?

  Yes

  No

  N/A

• Were gaff guards used?

  Yes

  No

  N/A

• Were hand lines utilized?

  Yes

  No

  N/A

Other Safety Concerns

• Were any other safety violations or concerns observed?

  Safe

  At Risk

  N/A

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