Title Page

  • Crew Leader

  • Personnel on Work Site

  • Date / Time

  • Prepared by

  • Location of Field Visit
  • Work Being Preformed

  • Equipment on Site

Job Planning

  • Crew Leader On Site

  • Job Briefing Completed and Signed By Employee's

  • Alternative Energy Source Identified(Wind Solar, etc.)

  • Crew Size Adequate for Job

  • Terrain Conditions

  • Weather Conditions

Personal Protective Equipment

  • Eye Protection

  • Hard Hats Worn According to Procedure and Manual Requirements?

  • Hand Protection Worn?

  • Rubber Gloves and Sleeves(If Applicable) Worn Cradle to Cradle, Lock to Lock, All Material in Good Condition?

  • Hearing Protection In Use When Needed?

  • Proper Bucket Fall Protection Worn?

Vehicles, Trailers, Specialty Equipment

  • Booms Clean

  • Pre-Flight Controls

  • Control Levers Marked

  • Wheels Chocked

  • Outrigger Pads in Use

  • Vehicles and Equipment Grounded per Safety Manual

  • Co. Workers Rubber Gloves Located Outside of Truck for Possible Bucket Rescue

Climbing

  • Tool Inspection Before Climbing

  • Long Sleeve Shirt Worn While Climbing

  • Hand Line In Use

  • Fall Restraint in Use When Climbing Wooden Structures

Overhead Construction / Maintenance

  • Are All Lines Properly De-Energized, Tested and Grounded per Safety Manual

  • Hold Cards in Place and Signed

  • All Grounds in Good Working Condition

  • Handlines in Use

  • Crews Maneuvering Loads in Safe Manner.(Proper Lifting Chains/Slings)

  • Housekeeping

Energized Work

  • Gloves and Sleeves, Proper Class / Test Dates

  • Gloves Air Tested/ Visually Inspected Prior to Use

  • Minimum Approach Distance Being Maintained

  • "Hot Work" Is There an Observer

General

  • Are Slings, Hand tools, Hoist, Grips, Hand lines and All Other Tools in Good Working Condition

  • All PPE Being Worn When Chainsaw are Operated

Traffic Control

  • High Visibility Vest Worn

  • Road Signs Used to Control Traffic

  • Cones Used for Traffic Control

  • Flagger Used When Needed / Flagging Done Properly

  • Four Way Flashers in Use

  • Strobe Lights in Use

URD Work

  • Competent Person on Job Site

  • All Excavations Evaluated and Safe

  • Trench Protection

  • Means of Egress in Trench

  • Spoils 2ft From Trench

  • Approved Methods and Lifting Slings in Use When Lifting URD Equipment(Transformers, Switchgear, Peds.)

Live Line Tools

  • Clean / Free of Moisture

  • Stored Properly

  • Hot Line Tool Test Date

  • Mark See

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.