ARCHIVED REPORTS_2019 - Laserfiche WebLink

Home Browse Search

During the site inspection look for the following: ("YES" requires additional investigation and the utility must be marked properly prior to beginning subsurface intrusive work): Site Inspection Utility Color Codes a) Natural gas line present (evidence of a gas meter)? YellowYes :�]Yes No i) Feeder Lines to buildings or homes? Yes b) Evidence of electric lines: -. No iii) Unmarked manholes or valve covers in work area? i) Conduits to ground from electric meter or along wall? Yes Yes iii) Conduits from power poles running into ground? iv) Warning signs ("Call Before you Dig", etc.) on or adjacent to site? Yes ii) Light poles, electric devices with no overhead lines? Yes iii) Overhead electric lines present? (See Section 1) Yes c) Evidence of sewer drains: - No i) Restrooms or kitchen on site? Yes ii) Sewer cleanouts present? Yes iii) Combined sewer/storm lines or multiple sewer lines? Yes d) Evidence of water lines: - i) Water meter on site or multiple water lines? Yes ii) Fire hydrants in vicinity of work? JYes Yes iii) Irrigation systems? (Sprinkler heads, valve boxes, controls in building) e) Evidence of storm drains: - - i) Open curbside or slotted grate storm drains Yes ii) Gutter down spouts going into ground Yes f) Evidence of telecommunication lines: • . - i) Fiber optic warning signs in areas?Yes ::]Yes iv) Aboveground cable boxes or housings or wires in work area? g) Underground storage tanks: i) Tank pit present, tank vent present? RYes Yes ii) Product lines running to dispensers/buildings? h) Do utilities enter or exit existing structures/buildings? If Yes, confirm the utility markings outside of structure/building match up. Yes i) Proposed excavation marked in white? White Yes j) Unclassed utilities / anomalies marked in pink? , Yes k) Overhead Utilities/Communication Lines - Look Up: i) Overhead electrical conduit, pipe chases, cable trays, product lines? RYes Yes ii) Overhead fire sprinkler system? 1) Overhead Power lines in or near the work area: i) < 50 kV within 10 ft. of work area? Yes ii) >50 - 200 kV within 15 ft. of work area? Yes iii) >200-350 kV within 20 ft. of work area? Yes iv) >350-500 kV within 25 ft. of work area? Yes v) >500-750 kV within 35 ft. or work area? Yes vi) >750-1000 kV within 45 ft. of work area? Yes m) Other: Present 'RNo No No No No No M • R]No No R No No R No No R No No No No No No No No i) Evidence of linear asphalt or concrete repair? Yes No ii) Evidence of linear ground subsidence or change in vegetation? Yes No iii) Unmarked manholes or valve covers in work area? Yes No iv) Warning signs ("Call Before you Dig", etc.) on or adjacent to site? Yes No v) Utility color markings not illustrated in this checklist? - . - Yes No n) Has the Utilities & Structures Checklist been reviewed by the PM or Designee Yes eNo PM or Designee Name: Name and Signature of person completing the checklist: Date: Do not perform mechanized intrusive work within 30 inches of a utility marking without receiving pre - approval by Corporate H&S . • • 0