Work Zone Inspection

• Site conducted

  Select

• Work Location

• Actual Location
  Address

• Date and Time of Inspection

  Date

• Foreman Name

• Inspected by

GENERAL INFORMATION

• Customer work description

  Gas

  Electric

  Other

• Flaggers Names

• Truck #

• Type of Closure

  Flagging

  Lane Closure

  Lane Shift

  Road Closure

  Shoulder Closure

WORK ZONE

ADVANCE WARNING SIGNS

• Are the correct signs placed?

  Yes

  No

  N/A

• Are all signs in good condition (clean, legible, and reflective)?

  Yes

  No

  N/A

• Do all sign placements conform to the CAMUTCD?

  Yes

  No

  N/A

CHANNELIZING DEVICES

• Are all channelization devices in good condition?

  Yes

  No

  N/A

• Are they all set out with proper spacing?

  Yes

  No

  N/A

• Are the taper lengths correct?

  Yes

  No

  N/A

• Is the number of devices placed appropriately?

  Yes

  No

  N/A

WORK AREA

• Is the Zone set up per Local or CA-MUTCD Standards?

  Yes

  No

  N/A

• Is there an escape route established for flaggers?

  Yes

  No

  N/A

• Are the flagger stations preceded by advance warning signs?

  Yes

  No

  N/A

• Are flaggers clearly visible to approaching traffic?

  Yes

  No

  N/A

• Are the flagger stations illuminated? (Night time)

  Yes

  No

  N/A

• Are sidewalk closures correctly set up?

  Yes

  No

  N/A

• Is Arrowboard, PCMS, or Light towers set up correctly?

  Yes

  No

  N/A

• Do all flaggers have radios?

  Yes

  No

  N/A

General Site Inspection List

• Plenty of Ice and Water on Site?

  Yes

  No

  N/A

• Everyone have ISN ID on display?

  Yes

  No

  N/A

• Are all employees following Company Policies?

  Yes

  No

  N/A

• What is the policy violation?

• Are trucks clean and organized?

  Yes

  No

  N/A

• Picture of Default

  Media

• Is there a cone placed at the rear corner of the trucks?

  Yes

  No

  N/A

• Fire Equipment in trucks?

  Yes

  No

  N/A

• Truck Binder in good condition and readily available?

  Yes

  No

  N/A

• Is tailboard filled out correctly and signed by all employees?

  Yes

  No

  N/A

Personal Protective Equipment

• Are employees wearing all required PPE?

  Yes

  No

  N/A

• What is missing and who is missing it?

• Is all PPE in clean and serviceable condition?

  Yes

  No

  N/A

• Is the proper PPE being worn for time of day and weather conditions?

  Yes

  No

  N/A

COMPLETION

• Comments

• Overall assessment

  Compliant

  Not in Compliance

• What is not in compliance?

• Picture of Deficiency

  Media

• Corrective Action

• Kudos

  Yes

  No

  N/A

• What are the Kudos for?

• Name and Signature of Inspector

  Sign

• Name and Signature of Foreman

  Sign