Pro-safety utility damage prevention audit
Excavation, trenching, horizontal directional drilling activity
What does this form include?
This form contains 18 sections:
Pre-Construction Steps
- Site Plan/Field Sketch showing excavation limits or bore path.
- Excavation OR Horizontal Directional Drilling "PERMIT" APPROVED?
- Pre-Excavation/Boring meeting with Locator Service, High Priority Utility Owners (Fiber, High Pressure Gas, Water Sewer)?
- Area White Lined per drawings or plan.
- Utility Locate Request (CALL Before You Dig 811) sent 3 business days prior.
- Utility Locate Request Ticket Current Within 10 Days?
- Private Utilities Located?
- ALL Utilities Marked Clearly (Not Faded) per Uniform Color Code & Marking Guidelines?
- Utility Markings Photographed?
- Site Checked for visible signs of utilities that may have been missed (Pedestals, Risers, Meters, Trench Lines)?
- Verify service feeds from buildings have been located?
- Markings added to drawings?
- Toolbox Talk and/or AHA with all personnel on site?
- Emergency Action Plan communicated to all personnel?Gas Line Hit = CALL 911-EVACUATE AREA IMMEDIATELY! Then from safe distance call Supervisor AND Gas Company!Electrical Line Hit = Stay in Cab - Ground Workers use shuffle or bunny hop methods to safe area!Phone, Water, Cable, Water, Sewer, etc. = Call Supervisor Immediately!
Pre Work Photographic or Video Documentation:
- Utility Markings?
- Pedestals, Risers, Meters, etc?
- Sidewalks, Driveways, Streets, Curbs for cracks, condition and pre-existing damage?
- Trees, Shrubs, Flower Beds?
- Mail boxes, Street Signs, Monuments?
Traffic Control:
- Traffic Control Plan Developed per industry standard (MUTCD)?
- Traffic Control Plan Approved by City?
- Traffic Control Devices installed per plan?
- Traffic Control Devices adequate?
- Traffic Control Plan requires Field Modification to accommodate site hazards?
- Traffic Control DevIces maintained (Clean, Faded, Blown/Drove Over, etc.)?
- Traffic Control Devices taken down when not needed or project completion (Extended breaks, Done for the Evening)?
Personal Protective Equipment:
- ANSI Approved High Visibility Outer Clothing Worn and in good condition?
- ANSI Approved Hardhat Worn Properly (No Ball Caps, Brim Forward) and in Good Condition?
- ANSI Approved Safety Glasses by ALL Personnel?
- Minimum Short Sleeved Shirt and Long Trousers Worn?
- Heavy Duty Work Boots WORN Properly (Laced up) and in GOOD Condition?
- Appropriate Work Gloves Worn?
- Proper Lifting procedures followed for manual material handling?
Equipment Safety:
- ALL equipment and tools inspected prior to use?
- Owner's Manual for all equipment readily available?
Walkover locating equipment calibrated prior to operation?
Strike alert system operational with ground installed properly?
Photo of ground properly installed
Backreaming process visually observed when passing an existing utility?
Photo documentation of open pit protection
Photo of pre trip
Photo of safety triangles
Photo of fire extinguisher
Photo of cargo Securement
Any general comments, observations, or concerns about this site?
Add signature
Have the weekly self site audits been done?
- Have the weekly self site audits been done?
- Have all the remedials been actioned?
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