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Appendix C: Site Inspection Log <br /> PROJECT NAME: LOCATION: <br /> PROJECT NUMBER: DATE: <br /> PROJECT MANAGER: COMPLETED BY: <br /> SITE DESCRIPTION AND NATURE OF WORK: <br /> HAZARD COMMUNICATION UNDERGROUND HAZARDS <br /> [ ] Chemical hazards identified [ ] All underground hazards identified and <br /> [ ] All containers properly labeled communicated to workers on site <br /> [ ] MSDS/workplace notebook on site [ ] Utility/USA clearance confirmed <br /> [ ] Site safety briefing completed and documented [ ] Clearance dates: <br /> [ ] Clearance ID#: <br /> ACCIDENTS/EMERGENCY INFO <br /> [ ] First aid personnel identified EXCAVATIONS and TRENCHES <br /> [ ] Hospital location identified [ ] All personnel and storage at least 2ft from top <br /> [ ] Police/Fire/Ambulance phone numbers available edge of excavation <br /> [ ] Incident investigation forms available [ ] Ladder in place <br /> [ ] Fire extinguisher present [ ] Guarding/barriers in place <br /> SANITATION VEHICULAR TRAFFIC <br /> [ ] Washing facilities available [ ] All vehicular traffic routes which could impact <br /> [ ] Toilet facilities available worker safety identified and communicated <br /> [ ] Approved trash receptacle available [ ] Barriers or other methods established to <br /> [ ] <br /> Water/refreshments available prevent injury from moving vehicles <br /> STORAGE PEDESTRIAN TRAFFIC/SITE CONTROL <br /> [ ] Tools/Drill tooling/supplies safely stacked to [ ] All walkways which could be impacted by site <br /> prevent rolling or collapse activities identified and communicated <br /> [ ] Work areas and passage ways kept clear [ ] Barriers or other methods established to <br /> prevent pedestrian injury from site activities <br /> HOUSEKEEPING <br /> [ ] Work areas clean and orderly ENVIRONMENTAL HAZARDS <br /> [ ] Storage areas clean and orderly [ ] Poisonous plants, stinging or biting <br /> [ ] Combustible scrap/debris removed regularly insects, vermin, sewage, etc. identified and <br /> [ ] Waste containers of flammable or toxic materials communicated <br /> covered <br /> COMMENTS/OTHER <br /> OVERHEAD HAZARDS HAZARDS <br /> [ ] 15ft minimum clearance maintained <br /> [ ] All sources of falling objects/swinging loads/ <br /> rotating equipment identified <br /> [ ] Barriers or other methods in place to prevent <br /> injury due to overhead hazards _ <br /> POSTING <br /> [ ] Emergency phone/contact info posted <br /> [ ] OSHA poster displayed <br /> AEI Health&Safety,Injury&Illness Prevention Plan Page 20 of 25 <br /> June 24, 2011 <br />