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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 /> ' <br /> ACCIDENTS/EMERGENCY INFO <br /> [ ] First aid personnel identified EXCAVATIONS and TRENCHES <br /> [ ] Hospital location identified [ ] All personnel and storage at least 2R 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 /> ' [ ] 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 passageways 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 /> [ ] 15R 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 �=OK NA =Not Applicable <br /> [ ] OSHA poster displayed <br /> ' AEI Health&Safety,Injury&Illness Prevention Plan <br /> March 15,2012 <br />