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Concrete Ready Mix Questionnaire: No Yes

This document is a concrete ready mix questionnaire that asks a series of questions about a ready mix concrete company's operations, safety practices, equipment maintenance, and subcontractor oversight. It inquires about how the company hires and trains employees, maintains its vehicles and equipment, implements safety programs, oversees any subcontracted work, and conducts its concrete mixing and delivery operations. The questionnaire is intended to gather details on the company's risk exposure and safety procedures.

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Robert Ingersoll
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© Attribution Non-Commercial (BY-NC)
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51 views4 pages

Concrete Ready Mix Questionnaire: No Yes

This document is a concrete ready mix questionnaire that asks a series of questions about a ready mix concrete company's operations, safety practices, equipment maintenance, and subcontractor oversight. It inquires about how the company hires and trains employees, maintains its vehicles and equipment, implements safety programs, oversees any subcontracted work, and conducts its concrete mixing and delivery operations. The questionnaire is intended to gather details on the company's risk exposure and safety procedures.

Uploaded by

Robert Ingersoll
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CONCRETE READY MIX QUESTIONNAIRE

Customer Name: Agent: Cust. #

U.S. DOT or Motor Carrier Number

Internet web site:

No

Yes

Web site address:


YES NO

SELECTION AND TRAINING OF EMPLOYEES How are prospective employees initially urged to apply with this company? (newspaper ads, referral by a personnel service business, etc.)

Are employees leased? If yes, what types of workers (equipment operators, clerical, etc.)?

Is there a drug and alcohol testing program for employees? If yes, when are employees tested?

How are new employees trained? Please describe.

What type of training do your mixer drivers receive to prevent rollovers?

Are driver's license/MVRs checked? If yes, when and how often are these checks performed?

Are there enforced minimum driving records standards? How much driver turnover do you experience?

Are key drivers retained year-round? Does your workforce fluctuate with the seasons? Are additional drivers hired during peak periods?

GU-3001b (11/05)

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*GU-3001*

YES How are drivers paid? (hourly, by the load, monthly, or some other means - please describe)

NO

During the busy season, how many deliveries are drivers expected to make per day? During the busy season, how many hours do drivers work per day on average? SAFETY Is there a written safety program? Does it require drivers to maintain speeds at least 5 mph below the posted speed limit? Does it require drivers to maintain at least a 5 second distance between themselves and the vehicle in front? Has it been distributed to and reviewed with all employees? What disciplinary measures are in place for drivers with violations or drivers that do not adhere to the fleet safety program?

Is personal protective equipment required to be worn by all employees on the job site? How is this enforced?

Is there a safety incentive program? If yes, please describe or attach.

EQUIPMENT Please describe the maintenance of production equipment.

Are any outside contractors used to inspect and service the equipment? Is there any customized computer software for the plant operations? How is equipment secured and protected from theft and vandalism when not in use?

Are all backing alarms in place and operating on mobile equipment? Are lockout/tagout and confined space programs in place? How are these enforced?

GU-3001b (11/05)

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YES VEHICLE/USAGE Please describe vehicle maintenance program.

NO

Is there any personal or family use of vehicles allowed by employees or company officers? If yes, please describe.

Are any vehicles left at the job site overnight? If yes, how are they secured and protected from theft?

Do you have a written policy regarding washing down equipment and trucks? SUBCONTRACTOR EXPOSURE This section may be skipped if no subcontractors are used. If skipped, please X here What type of work is subcontracted? Please provide annual estimated cost of each type of work and description.

What limits are subcontractors required to carry?

Is there a standardized written contract or agreement used? If yes, please forward a copy. Does the subcontractor agreement contain a hold harmless clause? Are the subcontractors required to name you as an additional insured? How is subcontractor supervision handled? Does the subcontractor provide their own supervisors? How are the job site operations coordinated?

OPERATIONS Do you rent U-carts or other means for your customers to haul their own concrete? If yes, please describe.

Is the mixing area of your operations ventilated by means of fans, large open shafts, or the like? How are leftover loads disposed of?

GU-3001b (11/05)

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YES Are temporary batch plants used for any of your jobs? If yes, please describe.

NO

Do you do any concrete pumping? If so, please provide the total receipts for this exposure. Please pick the following choice which most closely resembles the type of terrain in which your operations are performed: Flat plain or coastal plain areas with a few variances in road grade. Low hills with road grade variances of not more than 100' over a one mile stretch. Hilly terrain with road grade variances of more than 100' over a one mile stretch. Mountainous or rough terrain with many road grade percentages greater than 8 degrees, frequent turns and winding roads. What is your radius of operations (in miles)? Please list the cities in which you provide services and give their approximate populations. City Name and State Population

Completed By:

Date

GU-3001b (11/05)

Page 4 of 4

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