Laserfiche WebLink
Subsurface Utility Clearance <br /> Management Program 2.9 <br /> Appendix A <br /> Roux Subsurface Utility Clearance Checklist/Utility Verification/Site Walkthrough Record <br /> Roux Subsurface Utility Clearance Checklist Date of Revision: <br /> 312024 <br /> Work site set-up and work execution <br /> COMMENTS INCLUDING JUSTIFICATION <br /> ACTIVITY aNi o Q IF RESPONSE IS NO OR NOT <br /> Z Z APPLICABLE <br /> Daily site safety meeting conducted, SPSAs performed, <br /> JSAs reviewed, appropriate work permits obtained <br /> (if applicable). <br /> HASP is available and reviewed by site workers/visitors. <br /> Subsurface Utility Clearance Procedure has been reviewed <br /> with all site workers. <br /> Mechanical intrusive work activities may not be performed <br /> at any location without authorization from the Roux Site <br /> Supervisor(SS).Clearance activities may not be performed <br /> at any location unless the SS is physically present. <br /> Work area secured; traffic control established as needed. <br /> Emergency shut-off switch located. Fire extinguishers / <br /> other safety equipment available as needed. <br /> Utility mark-outs(public/private)clear and visible. Provide <br /> Excavator's Stake-Out Reference Number/Request Date/ <br /> Time. <br /> Tolerance zone work identified. Intrusive work activities <br /> cannot be performed in areas that are in direct conflict with <br /> any markings made by public or private locators. <br /> Unless the PP&OM authorizes it, all boreholes and test pit <br /> locations must be physically cleared before using <br /> mechanized equipment. Required minimum physical <br /> clearance depths and diameters are as follows: <br /> • Physically clear to a depth of 5 feet bls. <br /> • The size of the pre-clearance exploratory test hole must be, <br /> at a minimum, twice the diameter of any downhole tool or <br /> boring device. <br /> • For direct push applications (CPT, Geoprobe®, etc.) the <br /> borehole clearance diameter shall be at least 125% to the <br /> diameter of the largest tool being pushed through the <br /> subsurface(e.g.,tip, rod,sampler,etc.). <br /> Work execution plan reviewed and adhered to (ground <br /> disturbance methods, clearance depths, any special utility <br /> protection requirements, or any other execution <br /> requirements; especially for Tolerance Zone work). <br /> 03/2025 Corporate Health and Safety Management Program ROUX 2 <br />