CVEC PRE -JOB BRIEFING

• Conducted on

  Date

• Prepared by

• Location
  Address

• HAS THE PRE-JOB BREIFING BEEN CONDUCTED AND ARE ALL MEMBERS OF THE WORKGROUP IN AGREEMENT?

  Yes

  No

  N/A

• POLICE, FIRE, RESCUE RESPONSE 911
  CHEMTREC (800) 262-8200
  POISON CONTROL (800) 221-1222
  W.E.L. ENVIRONMENTAL (800) 847-2455

GENERAL INFORMATION

• NATURE OF WORK BEING PERFORMED:

• CREW MEMBERS & VEHICLES ONSITE:

• HAZARDS ASSOCIATED WITH THE JOB: (LIST ANY AND ALL THAT APPLY)

ENERGY SOURCE CONTROLS

• IS WORK BEING PERFORMED UNDER ENERGIZED CONDITIONS?<br><br>

  Yes

  No

  N/A

• IS THIS NEW CONSTRUCTION?

  Yes

  No

  N/A

• IS EQUIPMENT DEENERGIZED?<br>

  Yes

  No

  N/A

• IS EQUIPMENT ISOLATED?

  Yes

  No

  N/A

• HAS EQUIPMENT BEEN TAGGED?

  Yes

  No

  N/A

• HAS EQUIPMENT BEEN TESTED

  Yes

  No

  N/A

• IS EQUIPMENT GROUNDED?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• HARD HAT WORN

  Yes

  No

  N/A

• PROTECTIVE EYEWEAR WORN?

  Yes

  No

  N/A

• HAND PROTECTION WORN?

  Yes

  No

  N/A

• PROTECTIVE FOOTWEAR WORN?

  Yes

  No

  N/A

• FR CLOTHING WORN?

  Yes

  No

  N/A

• HEARING PROTECTION REQUIRED? WORN?

  Yes

  No

  N/A

• HIGH-VIS VEST REQUIRED? WORN?

  Yes

  No

  N/A

• CHAIN SAW CHAPS REQUIRED? WORN?

  Yes

  No

  N/A

INSULATING PERSONAL PROTECTIVE EQUIPMENT

• RUBBER GLOVES WORN?

  Yes

  No

  N/A

• RUBBER GLOVE TEST DATE CURRENT?

  Yes

  No

  N/A

• RUBBER GLOVES INSPECTED AND AIR TESTED PRIOR TO USE?

  Yes

  No

  N/A

• RUBBER SLEEVES WORN?

  Yes

  No

  N/A

• RUBBER SLEEVE TEST DATE CURRENT?

  Yes

  No

  N/A

• RUBBER SLEEVES INSPECTED PRIOR TO USE?

  Yes

  No

  N/A

INSULATING RUBBER GOODS AND HOT LINE TOOLS

• COVER-UP REQUIRED?

  Yes

  No

  N/A

• HOSES AND BLANKETS INSPECTED PRIOR TO USE?

  Yes

  No

  N/A

• RUBBER HOSE AND BLANKET TEST DATES CURRENT?

  Yes

  No

  N/A

• LIVE LINE TOOLS INSPECTED?

  Yes

  No

  N/A

• LIVE LINE TOOL TEST DATES CURRENT?

  Yes

  No

  N/A

MECHANICAL JUMPERS / PERSONAL PROTECTIVE GROUNDS

• MECHANICAL JUMPERS REQUIRED?<br>

  Yes

  No

  N/A

• MECHANICAL JUMPERS INSPECTED PRIOR TO USE?

  Yes

  No

  N/A

• MECHANICAL JUMPER TEST DATES CURRENT?

  Yes

  No

  N/A

• PERSONAL PROTECTIVE GROUNDS REQUIRED?

  Yes

  No

  N/A

• PERSONAL PROTECTIVE GROUNDS INSPECTED PRIOR TO USE?

  Yes

  No

  N/A

• PERSONAL PROTECTIVE GROUNDS TEST DATES CURRENTS?

  Yes

  No

  N/A

VEHICLES

• VEHICLE CHOCKED?

  Yes

  No

  N/A

• VEHICLES GROUNDED?

  Yes

  No

  N/A

• EQUIPMENT INSPECTED?<br>

  Yes

  No

  N/A

• AERIAL UNITS PREFLIGHTED PRIOR TO USE?

  Yes

  No

  N/A

WORKZONE PROTECTION

• TRAFFIC CONTROL REQUIRED?

  Yes

  No

  N/A

• WORKZONE PROTECTION OUTSOURCED?

  Yes

  No

  N/A

ACKNOWLEDGEMENTS

• SPECIAL CONDITIONS NOTED:

• PERSONNEL / ASSIGNMENTS

• PERSON CONDUCTING THE BRIEFING

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• CREW MEMBERS

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