Information
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Auditor(s) name:
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Truck #:
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Date/Time:
Description of the Job
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Jobsite Location:
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Crew members:
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Describe type of work being performed:
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Are lines energized or de-energized:
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Overhead or Underground (or both):
4 Life Saving Rule
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GLOVES
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COVER-UP
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Shunts (Are shunts being used?)
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TAGS (Line/Equipment properly TAGGED when Required)
JOB PREPARATION
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Was tailgate/job briefing conducted and documented:
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Radio operation check was performed: (Contractor Audits will Answer N/A)
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Pre-trip inspection was performed on CMV(s): (Contractor Audits will Answer N/A)
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Vehicle is properly parked and set up for the task as required: Example: Circle For Safety Cone is used.
PERSONAL PROTECTIVE EQUIPMENT
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PPE is properly worn and in Good Condition. Example Hard hat(s) , ANSI Approved Eye Protection, Safety Toe Boots, Hearing Protection is available.
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FR clothing is in good condition:
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Rubber gloves worn and inspected prior to use: *Reminder CHECK DATES*
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Rubber sleeves worn and inspected prior to use: * Reminder CHECK DATES*
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Fall protection used where appropriate and all components inspected prior to use:
VEHICLES
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All material on the vehicle is properly stowed: (Contractor Audits will Answer N/A)
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Fire extinguishers are properly charged and stored:(Contractor Audits will Answer N/A)
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First-aid/BBP kits is stocked and location is properly marked: (Contractor Audits will Answer N/A)
TRAFFIC CONTROL
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Beacon/strobe lights are in working order and being used:
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Traffic cones are used and properly placed:
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Road signs are adequate for the job being performed:
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Reflective vests are worn:
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A flagger is being used to control traffic:
GENERAL WORK PRACTICES
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Proper tools are being used to complete the task & Tools have been inspected and are in good working condition:
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Live-line tools have been inspected prior to use and tested within 1 year (Contractor might be within 2 year, per standard):
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Hand lines are available and in good condition:
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Ladders have been inspected and are in good condition: (Contractor Audits will Answer N/A)
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Adequate cover-up material is being used, properly covered/isolated:
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Only qualified personnel are performing hazardous work:
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Guards are in place on tools and equipment that need them: (Contractor Audits will Answer N/A)
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Clear communication is exchanged among crew members:
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Employees can explain direction of feed and closest protection device:
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Auditor's Notes:
AUDITOR VERIFICATION SIGNATURE(S)
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Safe work procedures followed:
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Include photo's, if applicable:
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Signature: