Title Page

  • Document No.

  • EIEC Supervisors Field Observation Form

  • Eastern Illini Electric Cooperative

  • Photos

General

  • Map Location/Line Number

  • Physical Address
  • Select date

  • Name and title of designated person in charge.

  • Name and title of workers on site.

  • Vehicles on site.

  • Type of work being performed?

  • Was a written job briefing/tailgate conducted?

PPE

  • Hi Vis Arc Rated/FR Apparel

  • Head Protection

  • Hearing Protection

  • Eye Protection

  • Face Protection

  • Hand Protection

  • Foot Protection

  • Fall Protection

  • Personal Grounds

  • Rubber Gloves

  • Rubber Sleeves

  • Other PPE used or needed.

  • Is all required PPE in use?

  • PPE comment.

Proper Tool and Equipment Use

  • Vehicle Grounds

  • Shoring Equipment

  • Hotline Tools

  • Wire Cutters

  • Voltage Indicators

  • Roller Grounds

  • Elbow Grounds

  • Spiking Tools

  • Cover Up Material

  • Tagging Devices

  • Tag Lines

  • Proper Clearences

  • Crimping Tools

  • Truck Jibs

  • Coffin Hoists

  • Other equipment used or needed.

  • Are proper tools and equipment in use, as job requires?

  • Tools and equipment comments?

Traffic Control Devices

  • Truck Flashers

  • Truck Beacons

  • Traffic Cones

  • Traffic Signs

  • Barricades

  • Traffic Flaggers

  • Other equipment used or needed.

  • Are the necessary traffic control devices being used?

  • Traffic Control Comments

Comments/Action Needed

  • Observer Comments

  • Corrective action that needs to be taken.

  • Date corrective action taken or instruction given.

Signatures

  • Designated Person in Charge

  • Observer

  • Vice President of Operations and Engineering

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