Title Page
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Conducted on
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Prepared by
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InfraSource Foreman
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Southpointe Personnel
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Location
General Procedure
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Is the Southpointe Daily JHA complete?
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Has the Southpointe JHA been signed/reviewed by all Southpointe personnel?
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Has the Southpointe JHA been signed/reviewed by all InfraSource personnel?
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Is the NiSource Work Zone Planning Form accurately completed?
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Is the NiSource Work Zone Inspection Form accurately completed up to the point of audit?
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Do all Southpointe personnel have a valid flagger certification?
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Is the flagger certification visible on all Southpointe personnel?
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Do all Southpointe personnel have on a hardhat?
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Do all Southpointe personnel have on safety glasses?
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Do all Southpointe personnel have on a safety whistle?
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Do all Southpointe personnel have on a Class III Vest?
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Do all Southpointe personnel have on Class E pants?
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Do all Southpointe personnel have on Steel Toed Boots?
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Do all Southpointe personnel have functioning 2-Way Radios?
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Is the Southpointe work vehicle parked in a safe position?
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Does the Southpointe work vehicle have cones at the front and rear bumpers?
Work Zone
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What type of work zone is present during audit?
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Is the audit taking place during site setup?
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Did one of the flaggers act as a spotter while setting signs?
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Did the flaggers unload equipment from the side of the vehicle?
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Were the strobe lights utilized on the traffic control vehicle?
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Does this setup consider both worker safety and best possible flow of traffic?
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Are the appropriate mainline lead-in signs present?
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Are the signs placed in the shoulder of the roadway?
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Is the speed limit greater than 35 mph?
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Are the mainline lead-in signs spaced at a 350' minimum?
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Are the mainline lead-in signs spaced at 100' minimum?
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How many side road approaches require signage?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
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Are all signs clearly visible without any obstructions?
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Is signage condition acceptable?
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Is there adequate site distance the flagger stations?
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Is an upstream taper present?
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Does the upstream taper have a minimum of 6 cones?
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Is the upstream taper a minimum of 50' long?
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Is a downstream taper present?
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Does the downstream taper have a minimum of 6 cones?
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Is the downstream taper a minimum of 50' long?
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Does the zone have an adequate buffer space?
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Are the tangent cones present?
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Are the tangent cones spaced correctly?
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Are the sidewalks closed where work or equipment is present?
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Are there "Sidewalk Closed" signs at the area of work?
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Are there cone bars at the sidewalk closure preventing pedestrian access?
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Are there "Sidewalk Closed Ahead, Cross Here" signs at each end of the sidewalk?
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Are there cones around all InfraSource equipment that is present?
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Are all open trenches/holes coned off?
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Are there cone bars at all open trenches/holes?
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Are steel plates readily available to allow access for emergency vehicles/school buses?
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Are there enough flaggers present?
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Are flaggers properly positioned?
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Do flaggers have a means of escape?
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Are flaggers utilizing a "Stop-Slow Paddle?"
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Are flaggers using proper hand gestures for a "Stop-Slow Paddle?"
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Are there any flaggers stationed in an intersection?
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Are the flaggers in intersections using red flags?
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Are flaggers using proper hand gestures to direct traffic?
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Are flaggers communicating clearly with one another?
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Are flaggers attentive and aware of their surroundings?
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Is the audit taking place during site tear down?
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Was all equipment loaded from the side of the vehicle?
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Did one of the flaggers act as a spotter while taking signs down?
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Did the the traffic control vehicle use its strobe lights during tear down?
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Are there any steel plates present in the roadway?
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Are there "Steel Plate Ahead" signs present?
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Did the InfraSource foreman and flaggers have a post job briefing?
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Did the flaggers ask for information about the work being performed the following day?
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Is the audit taking place during site setup?
-
Did one of the flaggers act as a spotter while setting signs?
-
Did the flaggers unload equipment from the side of the traffic control vehicle?
-
Were the strobe lights being utilized on the traffic control vehicle?
-
Does this setup consider both worker safety and best possible flow of traffic?
-
Are the appropriate mainline lead-in signs present?
-
Are the mainline lead-in signs placed on the shoulder of the road?
-
Is the speed limit greater than 35 mph?
-
Are the mainline lead-in signs spaced at a 100' minimum?
-
Are the mainline lead-in signs spaced at a 350' minimum?
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How many side road approaches require signage?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
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Are all signs clearly visible without any obstructions?
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Is signage condition acceptable?
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Is there adequate sight distance to the closure?
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Are there cones present on each side of the "Road Closed" sign?
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Are there cone bars present at the point of closure to help prevent access?
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Are the sidewalks closed where work or equipment is present?
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Are there "Sidewalk Closed" signs at the point of closure?
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Are there cone bars at the sidewalk closure preventing access?
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Are there "Sidewalk Closed Ahead, Cross Here" signs at each end of the sidewalk?
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Are there cones around all InfraSource Equipment that is present?
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Are all open trenches/holes coned off?
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Are there cone bars present around all open trenches/holes?
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Are steel plates readily available to allow access for emergency vehicles/school buses?
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Are flaggers properly positioned at the closure?
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Do flaggers have a means of escape?
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Are all flaggers using their red flag?
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Are flaggers communicating clearly with one another?
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Are flaggers attentive and aware of their surroundings?
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Is the audit taking place during site tear down?
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Was all equipment loaded from the side of the vehicle?
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Did one of the flaggers act as a spotter while taking down signs?
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Were the strobes being utilized on the traffic control vehicle?
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Are there any steel plates on the roadway?
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Are there "Steel Plate Ahead" signs present?
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Did the InfraSource foreman and flaggers have a post job briefing?
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Did the flaggers ask for information about the next day's traffic setup?
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Is the audit taking place during site setup?
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Did one of the flaggers act as a spotter while setting signs?
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Did the flaggers unload equipment from the side of the vehicle?
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Was the Arrow Board secure during transit?
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Were the safety chains crossed under hitch and secure?
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Were the strobe lights utilized on the traffic control vehicle?
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Does this setup consider both worker safety and best possible flow of traffic?
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Are the appropriate mainline lead-in signs present?
-
Are the mainline lead-in signs placed in the shoulder of the road?
-
Is the speed limit greater than 35 mph?
-
Are the mainline lead-in signs spaced at a 100' minimum?
-
Are the mainline lead-in signs spaced at a 350' minimum?
-
How many side road approaches require signage?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
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Are all signs clearly visible and free from any obstructions?
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Is signage condition acceptable?
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Is the Arrow Board placed in the correct position according to PUB 213/MUTCD standards?
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Are all support legs on the Arrow Board secure and making contact with the roadway?
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Is the Arrow Board flashing in the correct direction?
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Is a Merging Taper present?
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Does the Merging Taper have the correct number of devices for this specific roadway?
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Is the Merging Taper the correct length per PUB 213/MUTCD standards?
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Is a termination taper present?
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Does the termination taper have the correct number of devices per PUB 213/MUTCD standards?
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Does the work zone have an adequate buffer space?
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Are the tangent cones present?
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Are the tangent cones spaced correctly?
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Are the sidewalks closed where work or equipment is present?
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Are there "Sidewalk Closed" signs where the sidewalk is closed?
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Are there cone bars at the sidewalk closure to prevent access?
-
Are there "Sidewalk Closed Ahead, Cross Here" signs at each end of the sidewalk?
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Are there cones around all InfraSource equipment that is present?
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Are all open trenches/holes coned off?
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Are there cone bars present at all open trenches/ditches?
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Are steel plates readily available to allow access to emergency vehicles/school buses?
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Are flaggers properly positioned?
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Do flaggers have a means of escape?
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Are all flaggers using a red flag?
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Are flaggers communicating clearly with one another?
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Are flaggers attentive and aware of their surroundings?
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Is the audit taking place during site tear down?
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Did the flaggers demobilize the zone working from downstream to upstream?
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Was all equipment loaded from the side of the vehicle?
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Did one of the flaggers act as a spotter while taking signs down?
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Were the strobe lights utilized on the traffic control vehicle?
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Was the Arrow Board secure during transit?
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Were the safety chains crossed under hitch and secure?
-
Are there any steel plates present in the roadway?
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Are there "Steel Plate Ahead" signs present?
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Did the InfraSource foreman and flaggers have a post job briefing?
-
Did the flaggers ask for information about the work being performed the following day?