Supervisor Audit

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Forman

• Job Number

• 811 Ticket Number

• JHA

  Yes

  No

  N/A

• Permits

  Yes

  No

  N/A

• Blue Stake

  Yes

  No

  N/A

• Job Prints

  Yes

  No

  N/A

• OSHA Card

  Yes

  No

  N/A

PPE

• PPE

  Yes

  No

  N/A

• House Keeping

  Yes

  No

  N/A

• Traffic Control

  Yes

  No

  N/A

• Barricades & Cones

  Yes

  No

  N/A

• Flaggers

  Yes

  No

  N/A

• Pedestrian Traffic

  Yes

  No

  N/A

• Road Plates

  Yes

  No

  N/A

Handling & Rigging

• Tag Line

  Yes

  No

  N/A

• Rigging Equipment WLL Tag

  Yes

  No

  N/A

Excavation

• Competent Person

  Yes

  No

  N/A

• 2'4'5'

  Yes

  No

  N/A

• Tab Data

  Yes

  No

  N/A

• Utilities Protected

  Yes

  No

  N/A

Confined Space

• Gas Monitor

  Yes

  No

  N/A

• Pre Entry Check List

  Yes

  No

  N/A

• Blower

  Yes

  No

  N/A

• Confined Space Trained

  Yes

  No

  N/A

• Gaurdrail

  Yes

  No

  N/A

• Ladder

  Yes

  No

  N/A

• DVIR Book

  Yes

  No

  N/A

• Seat Belt

  Yes

  No

  N/A

• Insurance & Registration

  Yes

  No

  N/A

• Federal Inspection

  Yes

  No

  N/A

• House Keeping Wheel Chocks

  Yes

  No

  N/A

• Lights & Alarms

  Yes

  No

  N/A

Heavy Equipment

• Seat belt

  Yes

  No

  N/A

• Inspection Book

  Yes

  No

  N/A

• Spotter

  Yes

  No

  N/A

• 3 Point Contact

  Yes

  No

  N/A

Drill Machine

• Grounded

  Yes

  No

  N/A

• Barricading & Caution Tape

  Yes

  No

  N/A

• Communication

  Yes

  No

  N/A

• Calibrated Drill Head

  Yes

  No

  N/A

• Strike Alarm

  Yes

  No

  N/A

• Pothole 2' below utilitie

  Yes

  No

  N/A

• Bore Route Marked

  Yes

  No

  N/A