Information

  • Auditor(s) name:

  • Truck #:

  • Date/Time:

Description of the Job

  • Jobsite Location:

  • Crew members:

  • Describe type of work being performed:

  • Are lines energized or de-energized:

  • Overhead or Underground (or both):

4 Life Saving Rule

  • GLOVES

  • COVER-UP

  • Shunts (Are shunts being used?)

  • TAGS (Line/Equipment properly TAGGED when Required)

JOB PREPARATION

  • Was tailgate/job briefing conducted and documented:

  • Radio operation check was performed: (Contractor Audits will Answer N/A)

  • Pre-trip inspection was performed on CMV(s): (Contractor Audits will Answer N/A)

  • Vehicle is properly parked and set up for the task as required: Example: Circle For Safety Cone is used.

PERSONAL PROTECTIVE EQUIPMENT

  • PPE is properly worn and in Good Condition. Example Hard hat(s) , ANSI Approved Eye Protection, Safety Toe Boots, Hearing Protection is available.

  • FR clothing is in good condition:

  • Rubber gloves worn and inspected prior to use: *Reminder CHECK DATES*

  • Rubber sleeves worn and inspected prior to use: * Reminder CHECK DATES*

  • Fall protection used where appropriate and all components inspected prior to use:

VEHICLES

  • All material on the vehicle is properly stowed: (Contractor Audits will Answer N/A)

  • Fire extinguishers are properly charged and stored:(Contractor Audits will Answer N/A)

  • First-aid/BBP kits is stocked and location is properly marked: (Contractor Audits will Answer N/A)

TRAFFIC CONTROL

  • Beacon/strobe lights are in working order and being used:

  • Traffic cones are used and properly placed:

  • Road signs are adequate for the job being performed:

  • Reflective vests are worn:

  • A flagger is being used to control traffic:

GENERAL WORK PRACTICES

  • Proper tools are being used to complete the task & Tools have been inspected and are in good working condition:

  • Live-line tools have been inspected prior to use and tested within 1 year (Contractor might be within 2 year, per standard):

  • Hand lines are available and in good condition:

  • Ladders have been inspected and are in good condition: (Contractor Audits will Answer N/A)

  • Adequate cover-up material is being used, properly covered/isolated:

  • Only qualified personnel are performing hazardous work:

  • Guards are in place on tools and equipment that need them: (Contractor Audits will Answer N/A)

  • Clear communication is exchanged among crew members:

  • Employees can explain direction of feed and closest protection device:

  • Auditor's Notes:

AUDITOR VERIFICATION SIGNATURE(S)

  • Safe work procedures followed:

  • Include photo's, if applicable:

  • Signature:

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.