CBEC North Job Briefing/Tailgate Form

• Document No. 1

• Corn Belt Energy Corporation Job Briefing/Tailgate

• Corn Belt Energy Cooperation Job Briefing Compliance Checklist
  

• It is understood that the Job briefing occurs before the beginning of each new job at the job site location.

  Yes

  No

• It is understood that an updated job briefing must occur if significant changes occur at the job site or new employees arrive at the job site.

  Yes

  No

• It is understood that a more extensive job briefing must be conducted if: the work involved is complicated, particularly hazardous, employees have not performed the task in the last year, or the employees cannot be expected to recognize and avoid the hazards associated with the job.

  Yes

  No

General Information

• Date/Time

  Date

• Weather

  Select Sunny Partly Sunny Partly Cloudy Cloudy Night Foggy Snow Rain Ice

  • Sunny
  • Partly Sunny
  • Partly Cloudy
  • Cloudy
  • Night
  • Foggy
  • Snow
  • Rain
  • Ice

• Temperature

  Select 100 to 110 Degreees 90 to 100 Degrees 80 to 90 Degrees 70 to 80 Degrees 60 to 70 Degrees 50 to 60 Degrees 40 to 50 Degrees 30 to 40 Degrees 20 to 30 Degrees 10 to 20 Degrees 0 to 10 Degreees -10 to 0 Degrees -20 to -10 Degrees -30 to -20 Degrees

  • 100 to 110 Degreees
  • 90 to 100 Degrees
  • 80 to 90 Degrees
  • 70 to 80 Degrees
  • 60 to 70 Degrees
  • 50 to 60 Degrees
  • 40 to 50 Degrees
  • 30 to 40 Degrees
  • 20 to 30 Degrees
  • 10 to 20 Degrees
  • 0 to 10 Degreees
  • -10 to 0 Degrees
  • -20 to -10 Degrees
  • -30 to -20 Degrees

• Wind Direction/Speed

  Select North Northeast East Southeast South Southwest West Northwest 0 to 10 MPH 10 to 20 MPH 20 to 30 MPH 30 to 40 MPH 40 to 50 MPH 50 + MPH

  • North
  • Northeast
  • East
  • Southeast
  • South
  • Southwest
  • West
  • Northwest
  • 0 to 10 MPH
  • 10 to 20 MPH
  • 20 to 30 MPH
  • 30 to 40 MPH
  • 40 to 50 MPH
  • 50 + MPH
• Physical Address
  Address

• Map Location/Line Number

• Work Order Number if Applicable

Vehicle Information

• Vehicles at Jobsite

  Select 9918 Small Service Bucket 9910 Small Service Bucket 9921 Small Service Bucket 9914 Small Service Bucket 9902 Small Service Bucket 9930 Small Service Bucket 9903 Small Service Bucket 9929 55' Large Bucket 9927 Digger 9911 Digger 9920 Digger 9901 Digger 9916 3/4 Ton Warehouse Pickup 9907 Spare 55’ Large Bucket 9925 Mechanics Truck 9926 Versalift Large Bucket

  • 9918 Small Service Bucket
  • 9910 Small Service Bucket
  • 9921 Small Service Bucket
  • 9914 Small Service Bucket
  • 9902 Small Service Bucket
  • 9930 Small Service Bucket
  • 9903 Small Service Bucket
  • 9929 55' Large Bucket
  • 9927 Digger
  • 9911 Digger
  • 9920 Digger
  • 9901 Digger
  • 9916 3/4 Ton Warehouse Pickup
  • 9907 Spare 55’ Large Bucket
  • 9925 Mechanics Truck
  • 9926 Versalift Large Bucket

• Equipment on Job Site

  Select North Equipment 9968 V5800 Trencher 9962 Small Old Trencher 9971 ASV 9970 VFlextrack 9959 Kubota Tractor 9931 Polaris Ranger 4 X 4

  • North Equipment
  • 9968 V5800 Trencher
  • 9962 Small Old Trencher
  • 9971 ASV
  • 9970 VFlextrack
  • 9959 Kubota Tractor
  • 9931 Polaris Ranger 4 X 4

• All vehicles have been inspected and daily logs filled out.

  Yes

  No

Safety Information

• Type of Work Being Performed

  Select 1 phase pole change HOT 1 phase pole change DEAD 2 phase pole change HOT 2 phase pole change DEAD 3 phase pole change HOT 3 phase pole change DEAD Primary UG Trenching Primary UG Boring Secondary UG Trenching Secondary UG Boring OH Transformer Install/Remove PAD Transformer Install/Remove Anchor Install/Remove Retire/Remove OH LIne Line Rebuild/Lean Line Primary OH Install/Remove Secondary OH Install/Remove OH Maintenance UG Maintenance Other

  • 1 phase pole change HOT
  • 1 phase pole change DEAD
  • 2 phase pole change HOT
  • 2 phase pole change DEAD
  • 3 phase pole change HOT
  • 3 phase pole change DEAD
  • Primary UG Trenching
  • Primary UG Boring
  • Secondary UG Trenching
  • Secondary UG Boring
  • OH Transformer Install/Remove
  • PAD Transformer Install/Remove
  • Anchor Install/Remove
  • Retire/Remove OH LIne
  • Line Rebuild/Lean Line
  • Primary OH Install/Remove
  • Secondary OH Install/Remove
  • OH Maintenance
  • UG Maintenance
  • Other

• If other is picked from list before or some other type of special work is being performed, please provide desciption.

• Traffic Control Measures have been discussed and all necessary are in use, to include flashers, beacons, cones, traffic vests, signs, barricades and flaggers.

  Yes

  No

  N/A

• All hazards associated with the job have been discussed.(Add notes if necessary)

  Yes

  No

• All work procedures involved have been discussed.(Add notes if necessary)

  Yes

  No

• Have nearby crews been informed of your work(Contractor or CBEC)

  Yes

  No

  N/A

• Energy source controls have been discussed to include: direction of feed, non-reclose operation, Lockout/Tagout, de-energize location and proper grounding of lines.

  Yes

  No

• Has equipment been grounded for work to be performed.

  Yes

  No

  N/A

• What energy source controls are in place?

  Select Line Grounded Lock Out/Tag Out Open Air One Shot Installed

  • Line Grounded
  • Lock Out/Tag Out
  • Open Air
  • One Shot Installed

• PPE requirements have been discussed, inspected for condition and are being utilized for hazards associated with job.

  Yes

  No

  N/A

• Has a call been made to JULIE to locate underground utilities.(800-892-0123)(811)

  Yes

  No

  N/A

• Are JULIE marks current?

  Yes

  No

  N/A

• Flags Posted?

  Yes

  No

  N/A

• All special precautions and concerns have been addressed. Please list any in notes section.

  Yes

  No

• Person in Charge

  Select Cimei, Steve Derudeis, Michael Doyle, Kris Henning, Gerry Knudsen, Adam Law, Joe Lind, Jamie Ponsetti, David Rolando, Rod Sanders, Steve Neahring, Tom Galassi, Matt Skaggs, Randy Gary Glover

  • Cimei, Steve
  • Derudeis, Michael
  • Doyle, Kris
  • Henning, Gerry
  • Knudsen, Adam
  • Law, Joe
  • Lind, Jamie
  • Ponsetti, David
  • Rolando, Rod
  • Sanders, Steve
  • Neahring, Tom
  • Galassi, Matt
  • Skaggs, Randy
  • Gary Glover

• Signature/Initials of person in charge.

  Sign

• Employees involved in Job Briefing/Tailgate

  Select Cimei, Steve Derudeis, Michael Doyle, Kris Henning, Gerry Knudsen, Adam Law, Joe Lind, Jamie Ponsetti, David Rolando, Rod Sanders, Steve Neahring, Tom Galassi, Matt Skaggs, Randy Gary Glover

  • Cimei, Steve
  • Derudeis, Michael
  • Doyle, Kris
  • Henning, Gerry
  • Knudsen, Adam
  • Law, Joe
  • Lind, Jamie
  • Ponsetti, David
  • Rolando, Rod
  • Sanders, Steve
  • Neahring, Tom
  • Galassi, Matt
  • Skaggs, Randy
  • Gary Glover

• Each employee involved in Job Briefing/Tailgate must initial the box below.

  Sign

• Before work begins, all personnel on this job site are in agreement as to the work being done, their duties in the job and safety measures to be taken. All hazards directly associated with this job have been discussed. Crew members and persons on the job site are aware of energy source controls and CBEC Dispatch has been notified of your work location. All PPE is to be inspected prior to the start of work or on a daily basis. Be Safe!!

• All Pre Job Briefings conducted CBEC property shall meet the OSHA Minimum Requirements as stated under 29 CFR 1910.269 (c) Job Briefing