Information

  • REC Name

  • REC contact person

  • Conducted on

  • Prepared by

  • Location of inspection (individual report per location)

Person In Charge

CREW MEMBERS

DESCRIPTION OF WORK BEING PERFORMED

JOB PLANNING

  • Employee in charge on site

  • Documented Tailgate - hazards, special precautions, energy source controls, PPE required and employee fitness

  • Any alternative energy sources to be aware of (wind, solar, etc.)

  • Adequate number of crew for the job

  • Weather conditions

  • Terrain conditions in work area

PERSONAL PROTECTIVE EQUIPMENT

  • Is eye protection being worn at all times?

  • Are hard hats used according to procedure manual requirements?

  • Is hand protection being used?

  • Gloves and sleeves (if applicable) worn cradle to cradle, lock to lock, ground to ground and in good condition?

  • Proper rated FR clothing worn?

  • Is hearing protection used when needed?

  • Proper fall protection worn?

  • Add media

VEHICLES, TRAILERS AND EQUIPMENT

  • Boom clean

  • Pre-flight of controls

  • Controls marked

  • Wheels chocked

  • Outrigger pads used

  • Vehicles and equipment grounded per safety manual?

  • Co workers rubber gloves located outside of truck for possible bucket rescue

  • Current DOT inspection

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CLIMBING

  • Employee certified as climber

  • Inspected tools before climbing

  • Long sleeve shirt worn while climbing

  • Hand line used

  • Is Fall Restraint being used when climbing wood structures?

  • Add media

OVERHEAD CONSTRUCTION OR MAINTENANCE

  • Is all equipment inspected prior to use?

  • Is the equipment being used correctly?

  • Are the lines properly de-energized, tested and grounded per safety manual?

  • Are all grounds in good working condition?

  • Are handlines being used?

  • Crew maneuvered loads in a safe manner?

  • Is there good housekeeping?

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ENERGIZED WORK

  • Are gloves and sleeves correct rating and date?

  • Are gloves air tested and visually inspected prior to use?

  • Is adequate cover-up material being utilized?

  • Are minimum approach distances being maintained?

  • Is there someone observing employees performing "hot work"?

  • Is company policy followed i.e. rubber glove use? (lock to lock, ground to ground)

  • Are handlines being used?

  • Add media

GENERAL

  • Are slings, handtools, hoist, grips, handlines and all other tools in good working condition?

  • Are chainsaws and proper PPE availible? (chaps, cut resistant boots, eye protection, hearing protection and head protection)

  • Is the work area cleaned when the job is finished?

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TRAFFIC CONTROL

  • High visiblility vests worn?

  • Signs used in accordance to traffic control rules and regulations?

  • Cones used in accordance with traffic control rules and regulations?

  • Flagger used when needed?

  • Law enforcement utilized when needed?

  • Flagging done properly?

  • Four way flashers used?

  • Strobe/Rotating light in use?

  • Crew size adequete for proper traffic control?

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URD WORK

  • Competent person on job site?

  • Are all excavations evaluated and safe?

  • Adequate trench protection?

  • Means of egress in trench?

  • Spoils 2ft from trench?

  • Used approved device and method when lifting URD equipment (transformers, switchgear, peds etc.)

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HOT STICKS

  • Clean and free of moisture?

  • Stored properly

  • Live line tool test date.

  • Add media

Dairyland Power Cooperative

Steve Knudsen

  • Add signature

Troy Dahl

  • Add signature

Kraig Gay

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Lance Burke

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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.