Title Page
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Audit Title
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Conducted on
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Prepared by
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Location
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Competent Person
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Opening Ticket Number
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Permit Number
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Weather
1.0- Workplace
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1.1.-Code 753 (Mark Outs)
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1.2- Inspector
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1.3- Competent Person
2.0- Administrative
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2.1- Documentation of Job Briefing
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2.2- Certification, Certificates of Fitness, & Training Cards
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2.3- Air monitor in use, equipment calibrated & current
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2.4- Air monitor log on-site
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2.5- HASP on-site & Current
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2.6- Permits posted & visible
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2.7- Complete job package on-site
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2.8- Noise Mitigation Plan posted when required
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2.9- Con Edison's rule book for MUTCD on-site
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2.10- First Aid Kit on-site
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2.11- Spill Kit on-site
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2.12- Fire extinguisher visible & immediately available on-site
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2.13- Complete contact list
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2.14- Local hospital information
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2.15 SDS for chemical/products on-site
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2.16- Current RWLB Matrix Posted
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2.17- HASP Acknowledgement form on-site & signed
3.0- Work Area Protection
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3.1- Flagger posted with advanced warning signs & flags
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3.2- Crash worthy barricades in use, complete & in compliance
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3.3- Stanchions & cones connected where required
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3.4- MUTCD set-up signs in use when required
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3.5- Arrow board operating properly & in use if applicable
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3.6 Flag Trees in use if required
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3.7- Pedestrians provided with safe & clear travel
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3.8- Plates; pinned, ramped, flush, & skid proof where required
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3.09-Rubber electrical gloves dated within the expiration
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3.10- Proper PPE in use when required
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3.11- Vehicle's engines turned off (idling regulations)
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3.12- Seat belts intact & in good condition
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3.13- Wheel Chocks in use when truck is in standby
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3.14- Hydrants & bus stops clear
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3.15- All tools in good shape
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3.16- Housekeeping
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3.17- Adequate set-up
4.0- Vehicle Inspection
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4.1- Truck Operator
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4.2- License Plate #
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4.3- Body up indicator Light & Buzzer
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4.4- Truck Registration
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4.5- Truck Insurance
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4.6- Truck overweight permit
Sign off
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On-site Representative
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Auditor's Signature