Information
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Service Order Number
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WE Asset Number
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Conducted on
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Location
Tech Details
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Tech Name
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Tech Company
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Is Tech on list of Approved Workers from Chorus?
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Can Tech produce evidence of WTC's
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Photo of evidence
Auditor Details
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Auditor Name
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Auditor Company
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Signature
Site Detials
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Is CAP available?
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Photo of CAP doc
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Has CAP been completed correctly?
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Is JSA form available on site?
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Photo of JSA
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Is site safe for Public and Tech?
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2 photos of site
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Is Tech aware of the MAD measurement?
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Has the MAD been maintained?
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IS PPE Compliant?
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Were harness, carabiners and fall arrest system inspected before use?
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Is ladder secured appropriately to the pole?
