Utility Quality Control/Safety Meeting Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Submittals

• Have submittals been received<br>

  Yes

  No

  N/A

• Have submittals been approved

  Yes

  No

  N/A

• All samples been received ? Stone,gravel,sand etc.

  Yes

  No

  N/A

Testing requirements and visual inspections

• Subcontractor aware all retesting fee's is their responsibility?

  Yes

  No

  N/A

• Compaction at ditches

  every l.f.

  lift depth

• Gravel and sand on site for embedment

  Yes

  No

  N/A

• Thrust blocks being installed

  Yes

  No

  N/A

• Manholes set at proper elevations

  Yes

  No

  N/A

• Verified potential conflicts with other trades ( elevations)

  Yes

  No

  N/A

• City inspection required and being performed

  Yes

  No

  N/A

• City requirement for taps been submitted and approved

  Yes

  No

  N/A

Safety

• Site specific safety program documentation received

  Yes

  No

  N/A

• Site specific safety and HAZCOM program received

  Yes

  No

  N/A

• Any utility boring required

  Yes

  No

  N/A

• Any overhead power lines in vicinity of utility installation

  Yes

  No

  N/A

• Any wet taps to be performed

  Yes

  No

  N/A

• Vests being worn on site

  Yes

  No

  N/A

• Equipment operators been trained and documented

  Yes

  No

  N/A

• Ditches properly benched back<br>

  Yes

  No

  N/A

• Are trench boxes required

  Yes

  No

  N/A

• Access to trench boxes provided

  Yes

  No

  N/A

• Are there ditches of 6 feet in depth identify depth and type of utilities

  Yes

  No

  N/A

• Access to ditches provided at 25 foot intervals(ladder)<br>

  Yes

  No

  N/A

• Site specific trench safety plan been submitted

  Yes

  No

  N/A

• Site specific confined space plan been submitted

  Yes

  No

  N/A

• Equipment being inspected

  Yes

  No

  N/A

• Valid fire extinguishers on equipment

  Yes

  No

  N/A

Environmental

• Erosion control in place

  Yes

  No

  N/A

• Has erosion control been disturbed

  Yes

  No

  N/A

• Has erosion control been repaired if disturbed

  Yes

  No

  N/A

• Fuel being stored on site

  Yes

  No

  N/A

• Equipment leaking fluids

  Yes

  No

  N/A