UGI Main & Safety

• Conducted on?

  Date
• Location:
  Address

• Prepared by:

  Select

• WO#

• Service Territories

  Select

• Inspection company:

  Select

Contractor/Crew

• Contractor

  Select

• Crew Leader

• Crew Member:

• Crew Member:

• Crew Member

• Crew member:

• Crew Member:

• Are you inspecting safety today?

  Yes

  No

• Is there a Crew Job Plan on Site?

  Yes

  No

  N/A

• Ask the Foreman why not.

• OQ's checked?

  YES

  N/A

• Are everyone's OQ's up to date?

  Yes

  No

  N/A

• Tell us who is not up to date.

• How was this issue resolved?

• Proper span of control?

  Yes

  No

  N/A

• Traffic pattern set up properly?

  Yes

  No

  N/A

• What is missing?

  Select Road Signs Road cones Flaggers

  • Road Signs
  • Road cones
  • Flaggers

• Wheel chocks being used?

  Yes

  No

  N/A

• Is the job site set up properly?

  Yes

  No

  N/A

• Is PPE being worn?

  Yes

  No

  N/A

• What is missing?

  Select Hard Hat Safety Glasses FR Clothing Hearing Protection Steel Toe Shoes Safety Vest

  • Hard Hat
  • Safety Glasses
  • FR Clothing
  • Hearing Protection
  • Steel Toe Shoes
  • Safety Vest

• Was crew excavating properly?

  Yes

  No

  N/A

• Please explain.

• Is a spotter being used while excavating?

  Yes

  No

  N/A

• Please explain what the crew was doing that a spotter could not be used.

• Are all bell holes / trench, coned off or being monitored for the safety of the public?

  Yes

  No

  N/A

• Fire extinguisher present when needed?

  Yes

  No

  N/A

• FR clothing worn when needed?

  Yes

  No

  N/A

• Is a CGI being used when needed ?

  Yes

  No

  N/A

• CGI Calibrated?

  Yes

  No

  N/A

• O2 Monitor being used?

  Yes

  No

  N/A

• O2 Monitor Calibrated?

  Yes

  No

  N/A

• Other Equipment Calibrated?

  Yes

  No

  N/A

• Was excavation inspected today?

  Yes

  No

  N/A

• Competent Person Onsite?

  Yes

  No

  N/A

• Excavation Check List Completed?

  Yes

  No

  N/A

• Tabulated Data?

  Yes

  No

  N/A

• Was Shoring required?

  Yes

  No

  N/A

• Was shoring used?

  Yes

  No

  N/A

• Work order packet onsite?

  Yes

  No

  N/A

• Did you ask the foreman why no packet is onsite.

  Yes

  No

  N/A

• What was the answer?

• Were all forms completed correctly?

  Yes

  No

  N/A

• Were current gas construction standards available for viewing?

  Yes

  No

  N/A

• Where is the Gas Construction Standards book?

• Did the crew get a standards book?

  Yes

  No

  N/A

• If no, then ask and write down why the foreman did not have one.

• Work packet available to inspector within 24 hours?

  Yes

  No

  N/A

• One Call Ticket onsite?

  Yes

  No

  N/A

• Ask why the one call is not onsite.

• All Permits Available?

  Yes

  No

  N/A

• Are construction drawing on site and readily available?

  Yes

  No

  N/A

• Was 36” of cover achieved?

  Yes

  No

  N/A

• Proper Butt fuse process completed?

  Yes

  No

  N/A

• Were all existing utilities spotted?

  Yes

  No

  N/A

• Was 12” of separation from other utilities achieved?

  Yes

  No

  N/A

• Was main line valves installed and labeled properly?

  Yes

  No

  N/A

• Please explain.

• Was pipe and fittings installed correctly?

  Yes

  No

  N/A

• Please explain.

• Was proper sand bedding installed?

  Yes

  No

  N/A

• Was the ditch free of rock and debris?

  Yes

  No

  N/A

• Was proper padding installed?

  Yes

  No

  N/A

• Was tracer wire installed?

  Yes

  No

  N/A

• Please explain why no tracer wire was installed.

• Was the ditch backfilled and compacted correctly?

  Yes

  No

  N/A

• Please explain.

• Was caution tape installed correctly?

  Satisfactory

  Unsatisfactory

  N/A

• Was anode(s) installed correctly?

  Satisfactory

  Unsatisfactory

  N/A

• Is a casing being used for mains or services?

  Yes

  No

  N/A

• Is the tracer wire cad welded to the casing?

  Yes

  No

  N/A

• Are insulators or centering cradles being installed?

  Yes

  No

  N/A

• Are end seals being installed?

  Yes

  No

  N/A

• Is a test station being installed?

  Yes

  No

  N/A

• Is main being pigged?

  Yes

  No

  N/A

• Are all pigs numbered?

  Yes

  No

  N/A

• Are all pigs accounted for?

  Yes

  No

  N/A

• How many pigs are lost?

• Did pigs come out clean and dry?

  Yes

  No

  N/A

• Are pressure test forms on site?

  Yes

  No

  N/A

• Tell us why the foreman did not have a pressure test form.

• Is a air cooler being used (if using air compressor) for pressure testing?

  Yes

  No

  N/A

• Are pressure gauges calibrated?

  Yes

  No

  N/A

• Is pipe temperature being monitored?

  Yes

  No

  N/A

• Was pressure test completed successfully?

  Pass

  Fail

  N/A

• What caused the pressure test to fail?

• Is pressure test forms all filled out correctly?

  Yes

  No

  N/A

• Is a approved purge plan on site?

  Yes

  No

  N/A

• Is purge stack(‘s) installed properly?

  Yes

  No

  N/A

• Is the Purge Stack grounded properly?

  Yes

  No

  N/A

• Is nitrogen being injected properly?

  Yes

  No

  N/A

• Is CGI calibrated?

  Yes

  No

  N/A

• Is a CGI being used to monitor?

  Yes

  No

  N/A

• Was the purge successfully completed?

  Pass

  Fail

  N/A

• What went wrong.

• Is a HDD being used?

  Yes

  No

  N/A

• Is boring form on site and filled out?

  Yes

  No

  N/A

• Are all existing utilities exposed?

  Yes

  No

  N/A

• Please explain why existing utilites were not exposed?

• Is there 12” of separation from drill head and the existing utility?

  Yes

  No

  N/A

• How close was the drill head from the existing utility?

• Has drill head stopped rotation while crossing existing utility?

  Yes

  No

  N/A

• Explain why the drill head did not stop?

• Was a weak link used for pull back?

  Satisfactory

  Unsatisfactory

  N/A

• Was the pipe examined at exit pit for damage?

  Satisfactory

  Unsatisfactory

  N/A

• Is the proper material being used for the job?

  Yes

  No

  N/A

• Any damage to pipe?

  Yes

  No

  N/A

• Tell us what is damaged?

• Any damage to fittings?

  Yes

  No

  N/A

• Please explain what fittings were damaged?

• Work Completed in accordance to all permits?

  Yes

  No

  N/A

• Inspectors Summary

• Pictures

  Media

• Inspector:

  Select

• Inspector Signature:

  Sign