Workplace Safety and Quality Inspection

• Project/Job Site ID

• Conducted on

  Date

• Prepared by

• Location

• Crew Leader

• Operator

• Select site weather conditions at time of this inspection (select all that<br>apply)

  Clear Sky

  Cloudy Sky

  Light Rain

On Site Procedures

• Do the written instructions have adequate TCP

  Yes

  No

  N/A

• Describe the Daily Activities and Phase of the Project (Test Pit, UG, Encasement, Backfill etc. , what is remaining to be complete)

• Photo(s)

  Media

• Is proper traffic control in place ?

  Yes

  No

  N/A

• Proper pedestrian control in place?

  Yes

  No

  N/A

• Does Crew have Job Safety Analysis on site?

  Yes

  No

  N/A

• Was Work Delayed for Any Reason?

  Yes

  No

  N/A

• Describe the Reason

• Where any onsite Verbal instructions received outside of scope or specification ?

  Yes

  No

  N/A

• Describe on Site Instruction

  Yes

  No

  N/A

Welfare-Vehicle and Equipment

• Is the vehicle(s) in good order? Tidy? With debris removed?

  Yes

  No

  N/A

• Is first aid kit present in vehicle?

  Yes

  No

  N/A

• Is fire extinguisher present?

  Yes

  No

  N/A

• Is traffic control equipment in good working condition?

  Yes

  No

  N/A

Personal Protective Equipment

• Are employees 6ft apart when possible?

  Yes

  No

  N/A

• Are all crew members wearing appropriate PPE (Mask, Vest, Gloves etc.) for the tasks they are carrying out?

  Yes

  No

  N/A

• Are proper boots worn by employees?

  Yes

  No

  N/A

Residents and Public

• Have "No Parking Signs" been posted?

  Yes

  No

  N/A

• Have there been any concerns raised by public /residents or neighbouring businesses?

  Yes

  No

  N/A

Materials and Hazardous Substances

• Do they have the right type and amount of materials to complete task for the day?

  Yes

  No

  N/A

Permits

• Is permit active?

  Yes

  No

  N/A

• Is Miss Utility ticket active?

  Yes

  No

  N/A

• Are utility markings clear and accurate?

  Yes

  No

  N/A

Excavations

• Are drawings available on site and the Crew Leader reviewed and understand the content?

  Yes

  No

  N/A

• Are the tools and equipment in good working order?

  Yes

  No

  N/A

• Is the work being performed according to standards and guidelines

  Yes

  No

  N/A

• Is completed work properly measured and reported?

  Yes

  No

  N/A

Any Other Observations?

• Is the crew staffed properly to do the work?

  Yes

  No

  N/A

• Manhole-Confined Space Set-up properly?

  Yes

  No

  N/A

• Any Major Compliance Issues found?

  Yes

  No

  N/A

• Signed by Supervisor

  Sign