Crew Safety Audit [Gloves, Cover-Up(Guts), Grounds, & Tags]

• Auditor(s) name:

• Truck #:

• Date/Time:

  Date

Description of the Job

• Jobsite Location:

• Name of foreman in charge:

• Crew members:

• Describe type of work being performed:

• Are lines energized or de-energized:

  Energized

  De-energized

  NA

• Secondary or Primary (or both):

  Secondary

  Primary

  Both

• Overhead or Underground (or both):

  Overhead

  Underground

  Both

4 Life Saving Rule

• GLOVES

  Yes

  No

  N/A

• COVER-UP (Guts)

  Yes

  No

  N/A

• GROUNDS (lines properly grounded when required)

  Yes

  No

  N/A

• TAGS (Line/Equipment properly TAGGED when Required)

  Yes

  No

  N/A

• Was tailgate/job briefing conducted and documented:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Pre-flight of aerial unit was performed: (Contractor Audits will Answer N/A)

  Yes

  No

  N/A

• Bucket/Digger is properly set up for the task as required: Example: Circle For Safety Cone, All Outriggers in use, Wheel Chocks put in use, Cribbing if required.

  Yes

  No

  N/A

• Energy source controls (Energy Control/LOTO) have been identified:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• FR clothing is in good condition:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Truck grounds are being used and in good condition:

  Yes

  No

  N/A

• Personal grounds are being used and in good condition:

  Yes

  No

  N/A

• Conductor was tested prior to grounds being installed:

  Yes

  No

  N/A

• Crew members can explain proper grounding techniques:

  Yes

  No

  N/A

• Grounds are properly stored:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Reverse alarm is in working order: (Contractor Audits will Answer N/A)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• AED is available and location is properly marked: Would be on Bucket Trucks Only. (Contractor Audits will answer N/A)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Traffic cones are used and properly placed:

  Yes

  No

  N/A

• Road signs are adequate for the job being performed:

  Yes

  No

  N/A

• Reflective vests are worn:

  Yes

  No

  N/A

• A flagger is being used to control traffic:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Hand lines are available and in good condition:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Trench Safety: Means of ingress/egress present in excavations >4 feet:

  Yes

  No

  N/A

• Trench Safety: Excavations >5 feet have been shored/stepped back by a competent excavation safety trained employee:

  Yes

  No

  N/A

• Poles are tested prior to climbing:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Only qualified personnel are performing hazardous work:

  Yes

  No

  N/A

• Employees performing hot work are being watched by a designated observer:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Clear communication is exchanged among crew members:

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Auditor's Notes:

• Safe work procedures followed:

  Yes

  No

  N/A

• Include photo's, if applicable:

  Media

• Signature:

  Sign