Title Page

  • Cooperative

  • Prepared by

  • Conducted on

  • Location
  • Person In Charge/Foreman/Lead Lineman

  • Crew Members

Description of Work Performed

General Information

  • Job Planning On Site

  • Employee In Charge on Site

  • Alternate energy sources to be aware of (wind, solar, generator, etc.)

  • Adequate number of crew for the job

  • Weather Conditions

  • Terrain conditions at work site

  • Add media

  • Comments

Personal Protective Equipment

  • Is eye protection required?

  • Are hard hats used according to safety manual requirements?

  • Is hand protection required

  • Rubber Gloves/Sleeves (if applicable) worn cradle to cradle, lock to lock, ground to ground and in good condition

  • Properly rated FR clothing worn

  • Is hearing protection worn (if required)

  • Is fall protection worn

  • Add media

  • Comments

Vehicles, Trailers, And Equipment

  • Boom clean

  • Pre-flight of controls

  • Controls marked

  • Wheels chocked

  • Outrigger Used

  • Outrigger Pads Used

  • Co-workers rubber gloves located outside of truck for possible bucket rescue

  • Current DOT inspection

  • Current di-electric inspection

  • Is document truck inspection packet current and available

  • Add media

  • Comments

Climbing

  • Employee certified to climb

  • Climbers/tool belt inspected prior to climb

  • Pole inspected prior to climb

  • Long sleeve shirt worn while climbing

  • Hand line used

  • Is proper fall restraint system used when climbing wooden poles

  • Add media

  • Comments

Overhead Construction or Maintenance

  • Equipment inspected prior to use

  • Equipment being used correctly

  • Are lines properly de-energized, tested, and grounded per safety manual

  • Are all grounded in working condition

  • Are handlines being used

  • Are loads maneuvered in safe manner

  • Used approved device and method when lifting OH equipment (Transformers, OCR's)

  • Good housekeeping

  • Pics

  • Comments

Underground Work

  • Competent person on job site

  • Are all excavations evaluated and safe

  • Trench protection

  • Means of Egress in trench

  • Spoils 2 ft from trench

  • Used approved device and method when lifting URD equipment (transformers, switchgear, peds etc)

  • Add media

  • Comments

Hot Sticks

  • Clean and free of moisture

  • Stored properly

  • Live Line Test Date

Energized Work

  • Glove and Sleeves correct rating and date

  • Date stamped on Gloves

  • Date stamped on Sleeves

  • Adequate cover-up material being utilized

  • Date stamped cover up

  • Minimum approach distances maintained

  • Is there a qualified crew member observing employees performing "hot work"

  • Is the Safety Manual procedures rubber glove use being followed (lock to lock, ground to ground )

  • Are handlines being used

  • Add media

  • Comments

General

  • Are slings, handtools, hoirsts, grips, handlines and all other tools in good working condition

  • Are chainsaws, and proper PPE available (chaps, cut resistant boots, eye protection, hearing protection, and head protection)?

  • Is the work-site cleaned when job is completed

  • Add media

  • Comments

Traffic Control

  • Hi-Visibility Safety Vests Worn

  • Signs used in Accordance with traffic control rules and regulations

  • Cones used in accordance with traffic control rules and regulations

  • Flagger used when required

  • Law enforcement utilized when required

  • Flagging done properly

  • Four way flashers/strobes and beacons used

  • Crew size adequate for traffic control

  • Add media

  • Comments

  • Signature of Auditor:

  • Select date

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.