Targeted Field Safety Inspection - DDS Companies

• Client / Customer Name

• Project Location Address

• Map Location
  Address

• DDS Reporting Office

  Select

• DDS Division

  Select

• Prepared by

• Conducted on

  Date

• Foreman Name

  Select

• Document Number

Daily Work Summary

• What type(s) of work are being performed today? Select all that apply.

  Select General Directional Drilling Installation of Gas Service Installation of Gas Main Backfilling Restoration Work Sitework Excavation Underground Work Cleanup Splicing Fiber Pulling Fiber Wires OTHER

  • General
  • Directional Drilling
  • Installation of Gas Service
  • Installation of Gas Main
  • Backfilling
  • Restoration Work
  • Sitework
  • Excavation
  • Underground Work
  • Cleanup
  • Splicing Fiber
  • Pulling Fiber Wires
  • OTHER

• If other, what type of work is being performed?

Today's Task Breakdown

• Break today's work into individual step-by-step-tasks below. Assess each task for hazards and controls

Administrative Safety

• Are all chemical containers properly labeled and legible?

  Yes

  No

  N/A

• Are emergency first aid supplies provided and readily available?

  Yes

  No

  N/A

• Are fire extinguishers available and placed within work areas as needed?

  Yes

  No

  N/A

• Are Safety Data Sheets (SDS) available for all hazardous materials and chemicals and information communicated to all affected employees?

  Yes

  No

  N/A

• Are all gas cylinders properly stored in an upright position and barricaded, as necessary?

  Yes

  No

  N/A

• Are all hand tools in good working condition?

  Yes

  No

  N/A

• Are DDS vehicles "back-in" parked in accordance with the "First Move Forward" initiative?

  Yes

  No

  N/A

• Have all materials and supplies been stacked and organized, so as to not cause a hazard to anyone within the work area?

  Yes

  No

  N/A

• Have slip, trip, and fall hazards been identified in the work area?

  Yes

  No

  N/A

• Is "Hot Work" being performed?

  Yes

  No

  N/A

• Has a hot work permit been completed?

  Yes

  No

  N/A

• Is the hot work permit posted and visible near the hot work area?

  Yes

  No

  N/A

• Is proper hot work PPE being utilized?

  Yes

  No

  N/A

JSA/JHA Completion

• Was a tailgate meeting in support of the JSA/JHA performed?

  Yes

  No

  N/A

• Was the JSA/JHA signed by each employee on site?

  Yes

  No

  N/A

• Does the JSA/JHA description of work adequately represent work being completed?

  Yes

  No

  N/A

• Have hazards identified by the inspector been listed on the JSA/JHA and have they been properly mitigated?

  Yes

  No

  N/A

• If not, please list the hazards:

• Do personnel have general knowledge of the JSA/JHA?

  Yes

  No

  N/A

• When required, has the foreman sent the electronic JSA/JHA to the proper Safety Manager for review?

  Yes

  No

  N/A

Trenching/Excavation Safety

• Are trenches or excavations being performed or are there any existing trenches or excavations in the work area?

  Yes

  No

  N/A

• Are excavations (not readily visible) protected by a barricade?

  Yes

  No

  N/A

• If required, has a Trench Safety Checklist been completed?

  Yes

  No

  N/A

• Are there proper means of egress from the trench or excavation?

  Yes

  No

  N/A

• Has the trench or excavation been properly benched / sloped / shored to protect against cave ins?

  Yes

  No

  N/A

• Does the Trench Box meet the 18" minimum above grade requirement and no more than 2' space between bottom of the box and the excavation floor?

  Yes

  No

  N/A

• If required, are personnel wearing O2 meters?

  Yes

  No

  N/A

• Has a stakeout been conducted and all utilities marked?

  Yes

  No

  N/A

• Please list the Primary 811 ticket number:

• Please list the Secondary 811 ticket number:

• Did the foreman properly verify the markings?

  Yes

  No

  N/A

Traffic Control Safety

• Does site work require traffic control?

  Yes

  No

  N/A

• Is traffic control addressed on the JSA/JHA?

  Yes

  No

  N/A

• Has traffic control been implemented properly?

  Yes

  No

  N/A

• If pedestrian traffic control is necessary, has it been implemented?

  Yes

  No

  N/A

• Have traffic control signs been placed to ensure adequate notification of work?

  Yes

  No

  N/A

• Are we using a 3rd party traffic control contractor?

  Yes

  No

  N/A

• Enter 3rd party company name, point of contact, phone number

• Are we in compliance with the approved job traffic control map?

  Yes

  No

  N/A

Heavy Equipment Safety

• Are all glass components in tact and free of damage (windows, doors, windshields, roof panels, etc.)?

  Yes

  No

  N/A

• Are all lights working properly?

  Yes

  No

  N/A

• Are mirrors in place and free of damage?

  Yes

  No

  N/A

• Are operators working in a safe manor?

  Yes

  No

  N/A

• Are outriggers being properly utilized and blocked as necessary?

  Yes

  No

  N/A

• Does equipment have properly functioning audible alarms?

  Yes

  No

  N/A

• Has all equipment been visually inspected prior to use?

  Yes

  No

  N/A

• Seat belts in good working condition and are operators using them?

  Yes

  No

  N/A

PPE Safety

• Is every crew member onsite wearing the minimum PPE required by DDS which includes, Hardhat, Safety Vest, Safety Glasses, Gloves and Reinforced Boots?

  Yes

  No

  N/A

• Are the proper gloves for the task being utilized?

  Yes

  No

  N/A

• If tasks are being performed requiring additional PPE outside the minimum, has the proper PPE been donned? (i.e. face shields or hearing protection.)

  Yes

  No

  N/A

• Is the PPE in good working order?

  Yes

  No

  N/A

• Are personnel confident in their ability to acquire PPE when necessary?

  Yes

  No

  N/A

Score

• Is the score 100%?

  Yes

  No

  N/A