Title Page

  • Conducted on

  • Prepared by

  • Location

General Details

  • Foreman Name.

  • Prime Contractor.

  • Utility Company.

  • Work Description.

Personal Protective Equipment (PPE)

  • Hard Hats.

  • Safety Glasses.

  • Ear Plugs.

  • Work Boots.

  • High Vis Vest/ Shirts.

  • Appropriate Pants.

  • Leg Chaps.

  • Work Gloves

Job Safety Analysis

  • Crew Had Thorough Tailboard Documented.

  • Crew Has Documented Emergency Action Plan.

  • All Crew Members Have Participated And Signed JSA/ EAP.

  • Utility Voltage.

Fire Suppression Tools

  • All Tools Are Present And In Good Working Order.

Aerial Lift Operations

  • Clearly Marked and Enforced Drop Zone, No Hangers.

  • Tool Used Aloft Are Secured.

  • Clear Communication Among All Crew Members.

  • Fall Protection Correctly Worn, Lanyard Attached To Bucket Anchor.

  • Lift Truck Set Up With Outrigger Pads And With Chocks.

Climbing Operations

Chipper Operations

  • No Ropes Or Loose Clothing, Tear Away Vest Only, No Jewelry.

  • Safety Bar/ Emergency Stop System In Place And Working.

  • Feed Chipper From Curb Side, Butt End First.

  • Use Push Stick To Move Debris Into Chipper.

  • Lock Out Tag Out When Maintaining, Not In Use, Or Clearing A Jammed Chute.

  • Standing To The Side When Feeding Chipper.

  • All Guards And Covers In Place, Chute Properly Aimed.

  • Appropriate PPE For Safe Chipper Operations.

Ladders Use

  • Crew Maintains 3 Points Of Contact.

  • Ladder In Good Condition/ 4 To 1 Angle.

  • Non Slip Safety Feet On Each Step.

  • Engaged Obsever When Working Above 12 Feet.

Tree Felling Operations

  • Keep Body And Tools Out Of MAD Distance, Or 10 Feet In Not Qualified.

  • Rigged Pull Rope To Start Safe Fall Direction.

  • Notch And Back Cut Used To Fell Trees Over 5 DBH.

  • Tree Assessment Completed.

  • Clearly Marked And Enforced Drop Zone - 1x5X for Rope Pullers, 2X For Bystanders, 4 Or more Cones.

  • Feller Leaves Danger Zone As Soon As Tree Begins To Fall, Feller Uses Clear Path/ Escape Route.

  • Clear 3 Way Communication Among All Crew Members.

  • Crew Assess New Hazards Before Bucking And De-Limbing Felled Trees.


  • Effective Traffic Control For Job site Conditions.

  • Room To Work Inside The Work Zone.

  • Crew Faces Oncoming Traffic When Possible.

  • Crew Wearing Appropriate High Visibility Clothing.

  • Flaggers Are In A Safe Location With Retreat Paths.

  • Boom Not Over Passing Traffic or Pedestrians When Possible.

  • Chipper Feed From Curbside/ Crew Stays out Of Roadway When Possible.

Chainsaws Operation

  • Proper PPE (Including Chaps Or Pants For Ground Use) Hard Hat , Hearing Protection, Eye Protection.

  • Crew Using Right Size Saw.

  • Crew Maintains Two Hands When Operating Chain Saw.

  • Chain Saw Safety Features Are In Place And Functional. (5)

  • Crew Maintains Stable Body Postion While Operating Chain Saw.

  • Crew Uses Chain Saw Appropriately That Does Not Cause Kick Back, Crew Does Not Use Chain Saw Above Head.

  • Crew Has Secondary Tie-In When using Chain Saw Aloft.

  • Chain Saw Is Secure From Falling.

Palm Tree Operations

  • Palm Tree Operations Are Performed By A Certified Member Of The Crew.

  • Pre-Climb And Trim Assessment Completed.

  • Double Tie-In, Tied In To Main Stem With A False Crotch.

  • Body And All Tools Are Kept Out Of The Minimum Approach Distance (MAD) Or 10 Feet If Not Qualified.

  • Crew Has A Engaged Observer.

  • Fronds Cut Above Power lines Are Dropped Or Lowered With Control.

  • Fronds In Contact With Power Lines Are Removed With Non Conductive Tools.

  • Crew Has A Clearly Marked And Enforced Drop Zone.

  • Crew Ensures Tools Used Aloft Are Secured.

  • Entire Crew Is Using 3 Way Communication.


  • Pre-Trip Inspection Walk Around.

  • Seat Belts Are Worn By Every Occupent.

  • Crew Maintains Safe Following Distance.

  • Driver Uses Turn Signals As Appropriate.

  • Crew Avoids Distracted Driving, Including Cell Phone Use.

  • House Keeping No Trash In Cab, Dashboard Clear Of Obstruction.

  • Driver Slows Before Turns, And Aware For Soft Shoulders.

  • Crew Avoids Overloading For Driving Conditions.

  • Crew Checked Trailer Connection Before Driving.

  • Chains And Tie Downs Are Right For The Jobs, In Good Condition, And Used Properly, And Not Twisted.

  • Crew Conducts A Walk Around And Utilizes A Spotter If Available, Crew Avoids Backing Up When Possible.

  • Crew Manages Appropriate Speed On Declines.

  • Crew Uses Appropriate Gears For Incline And Decline Driving.

Weather Conditions

  • Weather Is Conducive For Tree Crew Operations.

  • Crew Has Ample Drinking Water.

First Aid Kit

  • Present

COVID 19 precautions

  • Face Mask/ Face Shields Present And Worn Properly

  • Crew Is Maintaining 6 Feet Apart

  • Crew Notified Supervisor If Filling ill

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.