Title Page
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Conducted on
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Prepared by
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Location
COMPANY SUPPLIED STOCK
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28FT LADDER
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12FT
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10FT
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8FT
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6FT
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LITTLE GIANT
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Arc Flash Kit- Suit, Gloves, Sheild
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Drill Combo Kit- Drill & Impact
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1/2" , 3/4" , 1" EMT Bender
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Hammer Drill
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250 Fish Tape
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Glow Rods
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Holesaw Kit
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POWER CORD
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GFI
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Water Jug
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Caution Tape
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5Gal Bucket
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BACK PACK
SAFETY SUPPLIES
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LOCK OUT TAG OUT "LOTO"
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ROADSIDE KIT
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FIRST AID KIT
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Face Mask
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100FT SAFETY ROPE
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Hearing Protection
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Hard Hat
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Cut 4 Gloves
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Bump Cap
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Safety Vest
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FALL PROTECTION HARNESSES
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LANYARD
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RETRACTABLE LANYARD
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CROSS ARM STRAP
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FIRE EXTINGUISHER
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HOW MANY?
VEHICLE INFO
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MAKE
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MODEL
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VIN#
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MILEAGE
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IS VAN CLEAN "INSIDE & OUT"??
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GAS CARD
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INSURANCE CARD
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REGISTRATION
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Kyrus
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BLUETOOTH "HANDS FREE" SET
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PICTURE FRONT OF VEHICLE
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ANY DAMAGE?
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PICTURE DRIVERS SIDE VEHICLE
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ANY DAMAGE?
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PICTURE PASSANGER SIDE VEHICLE
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ANY DAMAGE?
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PICTURE BACK OF VEHICLE
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ANY DAMAGE?