Vectren Inspection Observation Form - Transmission

The Inspection Observation Form for Gas Transmission

• 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

Inspection Information

• Inspection Date

  Date

• Inspector's Name (if you do NOT work for Vectren)

• Vectren Employee Name

• Vectren Employee ID #

• Inspection Company

  Acuren

  MTSI

  Tulsa

  Petersen

  Vectren

Project Information

• Project Name

• Project Location (City, or County if outside city limits)

• Street Address

• Division

  NW

  SW

  NE

  SE

  OH

• Operating Center

  Select 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

  • 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

• Oracle/GAIM #

• Maximo #

Construction Information

• Construction Subtype

  Repair/Maintenance

  New Business

  Replace/Retire

  System Improvement

• Construction Company

  Select Electricom Itron Meade Mid-Ohio Miller Pipeline Minnesota Limited Patton Premier Ritter Plumbing Team Fishel Troy Construction Vectren

  • Electricom
  • Itron
  • Meade
  • Mid-Ohio
  • Miller Pipeline
  • Minnesota Limited
  • Patton
  • Premier
  • Ritter Plumbing
  • Team Fishel
  • Troy Construction
  • Vectren

• 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 #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

Crew Information

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• Crewperson's Name

• ID #

• Required OQ?

  Yes

  SOC

  No

• Working Under (only if SOC)

• 1. Work Order packet onsite (OMI 9.36): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 2. Locate Numbers onsite: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 3. Job Briefing conducted (if Vectren): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 4. Welding procedure onsite (OMI 16.21): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 5. Employee OQ records reviewed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 6. Proper Span of Control (SOC) confirmed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 8. Tapping/Stopping qualifications confirmed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 9. Welding qualifications confirmed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 39. Storm Water Pollution Prevention Plan (SWPPP) (OMI 26.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 61. System Ops Plan available and reviewed (OMI 14.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 98. Sewer locates properly documented (OMI 9.36): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 99. Sewer locates protective method used and documented (OMI 9.36): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 123. Change in Construction completed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 10. Traffic Barricades/Barrels/Cones/Arrow Board (OMI 9.34): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 11. Traffic Signage (OMI 9.32): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 12. Traffic Flaggers (OMI 9.34): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 13. Traffic Steel Plates secured: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 14. Lifting chains/slings-proper capacity: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 15. Lifting cranes/booms-proper capacity: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 16. Lifting tagline: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 17. Excavation 5' + deep sloped, shore, shielded: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 18. Egress (ladder for 4' deep, within 25' of workers): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 19. Tabulated data onsite with shoring equipment: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 20. Excavation competent person identified: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 21. Fire extinguishers (inspected and charged): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 22. Fire extinguishers (manned when required): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 23. Flash suit (flash hood, gloves, proper ppe) (OMI 9.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 24. Hard hat (OMI 9.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 25. Safety vest (OMI 9.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 26. Eye protection (OMI 9.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 27. Hearing protection (OMI 9.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 28. Hand protection (OMI 9.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 29. Foot protection (OMI 9.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 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?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 30. Gaseous Atmosphere - Oxygen Deficiency Testing: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 31. Vehicles properly parked (OMI 9.34): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 32. Outriggers utilized: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 33. DOT Inspection current: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 34. Equipment tie-downs appropriate: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 35. Voltage testing (meter sets): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 36. PCB Testing (OMI 26.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 38. Coal Tar Wrap removal (OMI 26.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 59. Proper Hydrostatic Test water discharge: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 148. Water body crossing: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 149. Frac Outs: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 55. Recording devices calibrated (within 1 year) (OMI 11.10, 11.32): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 56. Proper Size-Type recording device (OMI 11.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 57. Proper Test Pressure and duration (OMI 11.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 58. Proper Temperature Recorders when necessary: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 60. Equipment in good operating order (OMI 14.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 151. All required isolation points checked: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 62. Pressures monitored (OMI 14.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 67. Utilizing Specified/Acceptable Materials (OMI 40.10, 40.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 68. Proper Handling & Storage of Materials (OMI 40.10): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 69. Operated and lubricated & stops checked (OMI 26.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 70. Valve box aligned properly/Blocks used (OMI 26.21): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 72. Blow downs and supports installed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 73. Instrument calibration current (OMI 15.20, 20.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 74. Gas Dispatch notified: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 75. Purge through steel pipe (not plastic) (OMI 15.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 77. Insulators/Centering Cradles installed (OMI 27.33, 40.62): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 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?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 79. Vents installed (OMI 27.34, 35.1): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 79a. Test station installed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 101. Pigged (OMI 30.10, 30.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 102. Pipe Jeep Calibrated and set to proper voltage (OMI 27.35): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 103. Coating Holidays repaired and pipe re-jeeped (OMI 27.35): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 105. Field coatings applied per manufacturer's specifications (OMI 27.35): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 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?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 108. Test wires securely attached to pipe (CAD weld) (OMI 27.32, 27.34): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 109. Proper re-coating where wires attached (OMI 16.21, 27.20, 27.34, 35.31): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 110. Facilities installed at proper depth (OMI 35.10, 35.30, 35.31): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 111. Marker/Test Stations installed (OMI 9.32, 16.21, 27.20, 35.31): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 112. Facilities appropriately cut, capped, purged (OMI 22.10, 22.20): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 113. Facilities properly marked and spotted as required (OMI 9.32, 35.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 114a. Gas locate verified: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 115. Hand excavation within safe zone (OMI 9.31): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 116. Clearance maintained from other facilities (OMI 35.30, 35.31): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 117. Proper backfill materials (lifts/compaction as necessary) (OMI 35.30): Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 119. General site cleanup: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 120. Street repairs: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 121. Back-flagging completed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 146. Boring Policy followed: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• 147. Boring machine grounded/safeguarded: Observed?

• Do you need to enter a Find, Fix, and Severity Level?

  Off

  On

• Find

• Fix

• Severity Level

  Low

  Medium

  High

• Input any miscellaneous, landowner, or customer comments here

Crew Lead to Fill Out - Work Change Information

• The Crew Lead needs to check the box that applies

• I acknowledge that, for work changes during the workday, OQ was re-checked to confirm worker qualifications to perform changed work

• I acknowledge that no work changes occurred during the workday

SIGNATURES

• Crew Lead's Signature

  Sign

• Date of Signature

  Date

• Inspector's Signature

  Sign

• Date of Signature

  Date