Traffic Signal Safety Audit

• Conducted on

  Date

• Date and Time Audit began

  Date

• Prepared by

• Location
  Address

• Personnel

Job Site Information

• Job number?

• Who is the Foreman on the job?

• Has the Daily Huddle been done?

  Yes

  No

  N/A

• Was the Daily Huddle signed by everyone on the job?

  Yes

  No

  N/A

• Has the Foreman completed the (JSA) prior to starting the job?

  Yes

  No

  N/A

• JSA MUST BE DONE FOR EACH JOB! However, if the job description has not changed, and if no new crew member comes on the job, you can use the JSA until the job is complete. Every crew member working on the job has to sign the JSA. A new JSA must be done when the job description changes.

Required Documentation

• Compliant vehicle registrations?

  Yes

  No

  N/A

• Compliant vehicle insurance cards?

  Yes

  No

  N/A

• Compliant DOT state inspections?

  Yes

  No

  N/A

• Compliant Altec inspections?

  Yes

  No

  N/A

• Are all flaggers certifications current?

  Yes

  No

  N/A

• Pre-trip inspection book visible and easily accessible?

  Yes

  No

  N/A

Safety on the Job

• Is everyone wearing proper PPE?

  Yes

  No

  N/A

• Are lane closures set up properly with signs, cones, etc?

  Yes

  No

  N/A

• What is the speed limit for this work zone?

• Is the job site barricaded properly?

  Yes

  No

  N/A

• Has the equipment been inspected prior to using it?

  Yes

  No

  N/A

• Is everyone operating the equipment trained?

  Yes

  No

  N/A

• Is the bucket operator wearing an approved, fitted harness?

  Yes

  No

  N/A

• Is the bucket operator working over an open lane? If so, describe the scene and work being done

• Is the operator using a securely mounted tool bin?

  Yes

  No

  N/A

• Are employees climbing up and down trucks properly?

  Yes

  No

  N/A

• Are employees avoiding from working directly below employee in bucket?

  Yes

  No

  N/A

• Are employees being cautious of their surroundings?

  Yes

  No

  N/A

• Is all equipment set to the side properly when not being used? Shovel and rake blades must be laid down on the ground facing down.

  Yes

  No

  N/A

• Are wet cutting methods being used?

  Yes

  No

  N/A

• Are trucks entering traffic safely?

  Yes

  No

  N/A

• Are there short cuts being taken to complete the job?

  Yes

  No

  N/A

• Is potable water available?

  Yes

  No

  N/A

• Proper housekeeping on site?

  Yes

  No

  N/A

Excavation and Trenching

• Have pictures been taken prior to digging?

  Yes

  No

  N/A

• Has the area been marked for locates?

  Yes

  No

  N/A

• If need to dig within 36 inches of locate, has daylighting or potholing excavation occurred?

  Yes

  No

  N/A

• If needed, is there a barricade provided to help pedestrians avoid falling?

  Yes

  No

  N/A

Temporary Power

• Are drop cords rated for hard/extra hard usage?

  Yes

  No

  N/A

• Have cords been inspected before use?

  Yes

  No

  N/A

• GFCI protection?

  Yes

  No

  N/A

• Are generators being used correctly?

  Yes

  No

  N/A

Energized Work

• Hot work permit acquired?

  Yes

  No

  N/A

• Task-specific and proper PPE?

  Yes

  No

  N/A

• If insulated blanket needs to be used, is it being used properly?

  Yes

  No

  N/A

• Fiberglass fish tape available and being used?

  Yes

  No

  N/A

• Are barricades established around live parts or equipment?

  Yes

  No

  N/A

Line Trucks and Bucket Trucks

• Has the driver completed a pre-trip inspection on truck and trailer?

  Yes

  No

  N/A

• Controls working properly?

  Yes

  No

  N/A

• Are ropes, cables and hooks in good condition?

  Yes

  No

  N/A

• Is the vehicle free of leaking fluids?

  Yes

  No

  N/A

• Operating instructions and warnings are clear and legible?

  Yes

  No

  N/A

• Are there enough outrigger pads?

  Yes

  No

  N/A

• Are proper pads under outriggers?

  Yes

  No

  N/A

• Are there at least 2 chocks on the line trucks and bucket trucks?

  Yes

  No

  N/A

• Is everything safely loaded so nothing exits the trucks during transport?

  Yes

  No

  N/A

• Highway Safety Triangles available?

  Yes

  No

  N/A

• First Aid kit available?

  Yes

  No

  N/A

• Fire Extinguisher available?

  Yes

  No

  N/A

Exterior Body and Glass of Trucks

• Windshields free of damage?

  Yes

  No

  N/A

• Windshields have functioning wiper blades?

  Yes

  No

  N/A

• Driver side mirrors adjustable and free of damage?

  Yes

  No

  N/A

• Driver side windows free of cracks and chips?

  Yes

  No

  N/A

• Passenger side windows free of cracks and chips?

  Yes

  No

  N/A

• Passenger side mirrors adjustable and free of damage?

  Yes

  No

  N/A

• License plate in correct position, clean and free of damage?

  Yes

  No

  N/A

Exterior Lighting of Trucks

• High and Low Beams operational?

  Yes

  No

  N/A

• Left and Right Front Indicators operational?

  Yes

  No

  N/A

• Left and Right Rear Turn Indicators operational?

  Yes

  No

  N/A

• Left and Right Tail Lights operational?

  Yes

  No

  N/A

• Strobe Lights and all Warning Lights operational?

  Yes

  No

  N/A

• Left and Right Brake Lights operational?

  Yes

  No

  N/A

• Rear Reverse Lights operational?

  Yes

  No

  N/A

• Audible Reverse Alarm operational?

  Yes

  No

  N/A

• License Plate Lights operational?

  Yes

  No

  N/A

• Clearance and Reflectors operational?

  Yes

  No

  N/A

Tires of Trucks

• Front driver tire in good repair with no visible signs of wear or cracking in sidewall?

  Safe

  At Risk

  N/A

• Front passenger tire in good repair with no visible signs of wear or cracking in sidewall?

  Safe

  At Risk

  N/A

• Rear driver tire in good repair with no visible signs of wear or cracking in sidewall?

  Safe

  At Risk

  N/A

• Rear passenger tire in good repair with no visible signs of wear or cracking in sidewall?

  Safe

  At Risk

  N/A

• Are wheels chocked properly?

  Yes

  No

  N/A

Interior of Trucks

• Driver Seat Belt operational?

  Safe

  At Risk

  N/A

• Passenger Seat Belt operational?

  Safe

  At Risk

  N/A

• Horn functioning appropriately?

  Yes

  No

  N/A

• Interior Compartment Lights operational?

  Yes

  No

  N/A

• Dashboard Lights operational?

  Yes

  No

  N/A

• Gauges operating and showing within appropriate ranges?

  Yes

  No

  N/A

• Interior is clean and free of loose objects?

  Yes

  No

  N/A

Trailer Inspection

• Are the rails, floor, tailgate hitch, safety chains and tires in good condition?

  Yes

  No

  N/A

• Is everything safely loaded so nothing exits trailer during transport?

  Yes

  No

  N/A

• Are all tie-down straps, chains, ratchets and load binders in good condition and functioning properly?

  Yes

  No

  N/A

• Do trailers carrying poles have a flag at the end? Do poles being transported after dark or in poor visibility conditions have a flashing light with flags?

  Yes

  No

  N/A

Who Was Notified of the Findings on this Audit?

Foreman

Supervisor - Mike Sauls

Supervisor of Safety - Jamie Bragg

VP of Safety Department - Larry Richardson

My recommendation or plan of action to address and resolve any issue(s):

Additional Comments: