Title Page
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Crew Leader
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Personnel on Work Site
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Date / Time
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Prepared by
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Location of Field Visit
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Work Being Preformed
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Equipment on Site
Job Planning
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Crew Leader On Site
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Job Briefing Completed and Signed By Employee's
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Alternative Energy Source Identified(Wind Solar, etc.)
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Crew Size Adequate for Job
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Terrain Conditions
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Weather Conditions
Personal Protective Equipment
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Eye Protection
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Hard Hats Worn According to Procedure and Manual Requirements?
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Hand Protection Worn?
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Rubber Gloves and Sleeves(If Applicable) Worn Cradle to Cradle, Lock to Lock, All Material in Good Condition?
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Hearing Protection In Use When Needed?
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Proper Bucket Fall Protection Worn?
Vehicles, Trailers, Specialty Equipment
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Booms Clean
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Pre-Flight Controls
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Control Levers Marked
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Wheels Chocked
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Outrigger Pads in Use
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Vehicles and Equipment Grounded per Safety Manual
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Co. Workers Rubber Gloves Located Outside of Truck for Possible Bucket Rescue
Climbing
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Tool Inspection Before Climbing
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Long Sleeve Shirt Worn While Climbing
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Hand Line In Use
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Fall Restraint in Use When Climbing Wooden Structures
Overhead Construction / Maintenance
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Are All Lines Properly De-Energized, Tested and Grounded per Safety Manual
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Hold Cards in Place and Signed
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All Grounds in Good Working Condition
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Handlines in Use
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Crews Maneuvering Loads in Safe Manner.(Proper Lifting Chains/Slings)
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Housekeeping
Energized Work
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Gloves and Sleeves, Proper Class / Test Dates
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Gloves Air Tested/ Visually Inspected Prior to Use
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Minimum Approach Distance Being Maintained
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"Hot Work" Is There an Observer
General
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Are Slings, Hand tools, Hoist, Grips, Hand lines and All Other Tools in Good Working Condition
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All PPE Being Worn When Chainsaw are Operated
Traffic Control
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High Visibility Vest Worn
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Road Signs Used to Control Traffic
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Cones Used for Traffic Control
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Flagger Used When Needed / Flagging Done Properly
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Four Way Flashers in Use
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Strobe Lights in Use
URD Work
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Competent Person on Job Site
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All Excavations Evaluated and Safe
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Trench Protection
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Means of Egress in Trench
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Spoils 2ft From Trench
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Approved Methods and Lifting Slings in Use When Lifting URD Equipment(Transformers, Switchgear, Peds.)
Live Line Tools
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Clean / Free of Moisture
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Stored Properly
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Hot Line Tool Test Date
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Mark See