Title Page
The Inspection Observation Form for Gas Distribution
Inspection, Project, and Construction Information
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Information for Sections A - U, where the Inspector is to indicate what he/she observed:
Inspector to Fill out ANY Section Observed.
Check the box next to the item you observed (You are NOT required to detail more if the observation is GOOD; However, additional notes can be added if the observed item went exceptionally well and is worth noting).
Do NOT mark "observed" unless YOU observed the item.
If you DID perform a Find and Fix with the crew, document the Find and Fix AND choose a "Severity Level":
To document the "Find/Fix", click on the button next to the question, "Do you need to enter a Find, Fix, and Severity Level?".
For "Severity Level":
1) Low - can resolve onsite
2) Medium - resolved onsite but required additional action
3) High - work had to be stopped
If ANY item is marked with a "Medium" Or "High" Severity Level, you must submit it to Field_Inspections@vectren.com by the end of business TODAY.
Inspection Information
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Inspection Date
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Start Time
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Stop Time
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Inspector's Name (First and Last)
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Vectren Employee ID #
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Inspection Company
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Weather
-
Safety Meeting Topic/s
Project Information
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Project Name
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Project Location (City, or County if outside city limits)
-
Street Address
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Division
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Operating Center
- VEDI ANDERSON
- VEDI BLOOMINGTON
- VEDI BOONVILLE
- VEDI CLARKSVILLE
- VEDI COLUMBUS
- VEDI DANVILLE
- VEDI EVV ELEC CONST MAINT
- VEDI EVV ELEC MTR
- VEDI EVV ELEC SUBSTATION
- VEDI EVV GAS CONSTRUCTION
- VEDI EVV GAS UTILITY ATTD
- VEDI EVV METER READERS
- VEDI EVV SCADA TECHS
- VEDI FRANCISCO
- VEDI FRANKLIN
- VEDI GREENFIELD
- VEDI LAFAYETTE
- VEDI MARION
- VEDI MT. VERNON
- VEDI MUNCIE
- VEDI NOBLESVILLE
- VEDI RICHMOND
- VEDI ROCKPORT
- VEDI TERRE HAUTE
- VEDI WASHINGTON
- VEDO BELLEFONTAINE
- VEDO CENTERVILLE
- VEDO DAYTON WEST
- VEDO FAIRBORN
- VEDO TROY
- VEDO WASHINGTON CH
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Oracle/GAIM #
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Maximo #
-
Group # (BSCI)
Construction Information
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Construction Type
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Construction Subtype
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Construction Subtype
-
Construction Subtype
-
Construction Company
- Electricom
- Itron
- Meade
- Mid-Ohio
- Miller Pipeline
- Minnesota Limited
- Patton
- Premier
- Ritter Plumbing
- Team Fishel
- Troy Construction
- Vectren
Crew Information
-
List each crew member working on the job.
For each individual, list their ID # and whether or not they were required to have their OQ information valid.
For "Required OQ?", choose one of three options:
1) Yes - qualified for the day's covered task(s)
2) SOC (Span of Control) - not OQ'd for a covered task but working per SOC; ratio of qualified individuals to non-qualified personnel is no more than 1:3 (plastic joining, welding, tapping/stopping may not be performed under SOC)
3) No - no covered task is being performed
If listed SOC, indicate who the crew member was working under.
Crew Lead Information
-
What is the name of the Crew Lead?
-
Crew Lead ID #
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Required OQ?
-
Working Under (only if SOC)
Crew Information
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Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
-
Crewperson's Name
-
ID #
-
Required OQ?
-
Working Under (only if SOC)
A - Paperwork
-
1. Work Order packet onsite (OMI 9.36): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
2. Locate Numbers onsite: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
3. Job Briefing conducted (if Vectren): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
4. Welding procedure onsite (OMI 16.21): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
5. Employee OQ records reviewed: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
6. Proper Span of Control (SOC) confirmed: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
7. Plastic qualifications confirmed: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
8. Tapping/Stopping qualifications confirmed: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
9. Welding qualifications confirmed: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
39. Storm Water Pollution Prevention Plan (SWPPP) (OMI 26.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
61. System Ops Plan available and reviewed (OMI 14.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
98. Sewer locates properly documented (OMI 9.36): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
99. Sewer locates protective method used and documented (OMI 9.36): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
123. Change in Construction completed: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
B - Safety
-
10. Traffic Barricades/Barrels/Cones/Arrow Board (OMI 9.34): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
11. Traffic Signage (OMI 9.32): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
12. Traffic Flaggers (OMI 9.34): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
13. Traffic Steel Plates secured: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
14. Lifting chains/slings-proper capacity: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
15. Lifting cranes/booms-proper capacity: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
16. Lifting tagline: Observed?
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Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
17. Excavation 5' + deep sloped, shore, shielded: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
18. Egress (ladder for 4' deep, within 25' of workers): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
19. Tabulated data onsite with shoring equipment: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
20. Excavation competent person identified: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
21. Fire extinguishers (inspected and charged): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
22. Fire extinguishers (manned when required): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
23. Flash suit (flash hood, gloves, proper ppe) (OMI 9.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
24. Hard hat (OMI 9.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
25. Safety vest (OMI 9.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
26. Eye protection (OMI 9.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
27. Hearing protection (OMI 9.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
28. Hand protection (OMI 9.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
29. Foot protection (OMI 9.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
118. Adherence to redzone (within striking distance of equipment, machinery, materials, etc.) (OMI 35.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
30. Gaseous Atmosphere - Oxygen Deficiency Testing: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
31. Vehicles properly parked (OMI 9.34): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
32. Outriggers utilized: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
C - Environmental
-
36. PCB Testing (OMI 26.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
38. Coal Tar Wrap removal (OMI 26.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
59. Proper Hydrostatic Test water discharge: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
D - Service/Meter Set
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35. Voltage testing (meter sets) (OMI CSP Section 4 - all sections): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
40. Service installed at proper depth (OMI 36.10, 36.2): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
41. Curb Valve installed properly (OMI 36.20, 36.32): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
42. Curb Valve removed properly (OMI 22.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
44. EFV installed and checked for proper size (OMI 36.10, 36.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
45. EFV tag installed properly (attached and location) (OMI 36.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
155. EFV (Excess Flow Valve) activated: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
46. Meter Set installation (plumb, level, painted, etc.) (OMI 37.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
47. Meter Set installed in approved location (OMI 36.32, 37.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
48. Meter support installed (OMI 37.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
49. Locking devices installed (OMI 37.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
50. Protective posts/barricades installed (OMI 9.34, 37.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
82S. Fusion Power Source (GFCI) (OMI 16.22, 35.32): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
153. Tracer Wire installed - S/M: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
154. Warning Tape installed - S/M: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
E - Customer Service
-
51. Customer fuel lines tested (OMI 11.20, CSP 4.30, 4.32): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
52. Relights completed per CSP (OMI CSP 4.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
53. Customer communication/notification pre-work (OMI 9.36, 35.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
54. Customer communication/notification post-work: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
F - Pressure Testing
-
55. Recording devices calibrated (within 1 year) (OMI 11.10, 11.32): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
56. Proper Size-Type recording device (OMI 11.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
57. Proper Test Pressure and duration (OMI 11.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
58. Proper Temperature Recorders when necessary: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
G - Tapping/Stopping
-
60. Equipment in good operating order (OMI 14.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
151. All required isolation points checked: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
62. Pressures monitored (OMI 14.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
I - Material Handling
-
67. Utilizing Specified/Acceptable Materials (OMI 40.10, 40.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
68. Proper Handling & Storage of Materials (OMI 40.10): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
J - Valves
-
69. Operated and lubricated & stops checked (OMI 26.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
70. Valve box aligned properly/Blocks used (OMI 26.21): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
72. Blow downs and supports installed: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
K - Purging
-
73. Instrument calibration current (OMI 15.20, 20.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
75. Purge through steel pipe (not plastic) (OMI 15.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
L - Casing
-
76. Coating damage minimized on carrier pipe (OMI 9.39, 27.33, 27.34, 27.35, 35.30): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
77. Insulators/Centering Cradles installed (OMI 27.33, 40.62): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
78. End Seals installed (OMI 27.35, 35.10, 35.32, 40.62): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
79. Vents installed (OMI 27.34, 35.1): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
79a. Test station installed: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
M - Plastic Piping
-
80. Pigged (OMI 30.10, 30.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
81. Condition of Fusing Equipment (irons/faces): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
82P. Fusion Power Source (GFCI) (OMI 16.22, 35.32): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
83. Fusion Iron Temperature for fusion type: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
84. Fusion Iron Temperature with Pyrometer: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
85. Pipe Condition Exterior (I.e., scratches): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
86. Pipe Condition Interior (I.e., contaminants): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
88. Melt bead: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
89. Squeeze off tool grounded (OMI 16.31): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
90. Squeeze off static electricity controlled (OMI 16.31): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
91. Squeeze off support clamp installed (OMI 16.22, 40.75): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
92. Pipe end condition (faced, chamfered, etc.) (OMI 16.22, 35.32): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
94. Anodes properly installed on tracer wire (OMI 9.39): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
96. Installed at proper depth (OMI 9.33): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
100. Pipeline markers/locate stations installed (OMI 27.34): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
156. Tracer Wire installed - PP: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
157. Warning Tape installed - PP: Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
N - Steel Piping
-
101. Pigged (OMI 30.10, 30.20): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
102. Pipe Jeep Calibrated and set to proper voltage (OMI 27.35): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
103. Coating Holidays repaired and pipe re-jeeped (OMI 27.35): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
104. Dual coated pipe when necessary (OMI 27.20, 27.35): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
105. Field coatings applied per manufacturer's specifications (OMI 27.35): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
106. Rock shield installed as necessary (OMI 35.30, 35.31, 40.77): Observed?
-
Do you need to enter a Find, Fix, and Severity Level?
-
Find
-
Fix
-
Severity Level
-
108. Test wires securely attached to pipe (CAD weld) (OMI 27.32, 27.34): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
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Severity Level
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109. Proper re-coating where wires attached (OMI 16.21, 27.20, 27.34, 35.31): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
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Severity Level
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110. Facilities installed at proper depth (OMI 35.10, 35.30, 35.31): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
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Severity Level
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111. Marker/Test Stations installed (OMI 9.32, 16.21, 27.20, 35.31): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
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Severity Level
O - Retirement of Facilities
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112. Facilities appropriately cut, capped, purged (OMI 22.10, 22.20): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
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Severity Level
P - Excavation/Backfill
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113. Facilities properly marked and spotted as required (OMI 9.32, 35.30): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
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Severity Level
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114a. Gas locate verified: Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
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Severity Level
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115. Hand excavation within safe zone (OMI 9.31): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
-
Fix
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Severity Level
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116. Clearance maintained from other facilities (OMI 35.30, 35.31): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
-
Fix
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Severity Level
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117. Proper backfill materials (lifts/compaction as necessary) (OMI 35.30): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
-
Fix
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Severity Level
Q - Cleanup and Restoration
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119. General site cleanup: Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
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Severity Level
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120. Street repairs: Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
-
Fix
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Severity Level
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121. Back-flagging completed: Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
-
Fix
-
Severity Level
S - Boring Policy
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97. Plastic Pipe installed using Weak Link (if bored) (OMI 35.32): Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
-
Fix
-
Severity Level
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146. Boring Policy followed: Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
-
Fix
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Severity Level
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147. Boring machine grounded/safeguarded: Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
-
Fix
-
Severity Level
U - Locate Policy
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150. All New Facilities can be toned for accurate locating: Observed?
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Do you need to enter a Find, Fix, and Severity Level?
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Find
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Fix
-
Severity Level
End Page
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Inspector Summary
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Change in Construction?
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Elaborate
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Were there any items observed that had a "Severity Level" of "Medium"?
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What external resource was used to resolve the issue? (If more than one, list all that are relevant)
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Were there any items observed that had a "Severity Level" of "High"?
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What action/s followed?
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Input any Miscellaneous, Landowner, or Customer comments here
Crew Lead to Fill Out - Work Changes
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The Crew Lead needs to check the box that applies
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I acknowledge that, for work changes during the workday, OQ was re-checked to confirm worker qualifications to perform changed work
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I acknowledge that no work changes occurred during the workday
SIGNATURES
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Crew Lead's Signature
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Date of Signature
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Inspector's Signature
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Date of Signature
