Title Page

Header

  • Date

  • Truck Number

  • Location
  • Risk assessment complete (both sides) and reviewed by all employees

  • Photo of front RA

  • Photo of back RA

  • Vehicle pretrip done, signed, dated.

  • Drivers log bookfilled out, signed, dated

  • Wheel chocks used

  • Confined space permit filled out

  • Work area protection adequate

  • Lock out tag out in place

  • Corrective actions for any NO answer above

PPE

  • CSA Approved hardhat worn properly

  • CSA Approved safety glasses with side shields

  • CSA Approved safety boots for electrical work, laced and tied

  • Hearing protection available/worn

  • Leather gloves worn/available

  • CSA Approved body belt properly worn, employee trained

  • CSA Approved fall arrest worn properly, employee trained

  • CSA Approved lanyard worn properly, employee trained

  • Climbers, gaffs & guards in place/worn

  • Rubber Insulating gloves worn properly, up to date

  • CSA Chainsaw chaps available and/or worn if needed

  • CSA Approved chain saw boot protectors worn/available

  • Respiratory protection worn if required, employee trained

  • Is flame retardant clothing required & worn if necessary

  • Is reflective clothing/ overalls worn

  • Corrective actions to any NO answers above

Tools and Equipment

  • What hand tools being used?

  • Good condition

  • What power tools being used?

  • Good condition

  • Extention cords not frayed, prongs not damaged

  • Lasher used/available

  • Are lights on truck not damged and operational?

  • Are ladders not damaged, 3 points of contact

  • Are scaffolds erected as per manufactures spec

  • Is a manhole being worked in? If so is a confined space plan in place?

  • Are power actuated tools being used, safe condition, employee trained

  • Is a confined space entry equipment required?

  • Are hazardous materials stored properly with labels & and does supervisor have up to date MSDS binder? Employees trained?

  • Is guard in place on chainsaw?

  • Are proper rigging practices being followed? Employees trained?

  • Is vehicle in a safe operating position? Are vehicles backed in to parking area?

  • Are items secured on vehicles?

  • Is general house keeping in good condition in vehicles and on site?

  • Corrective actions to any NO answer above

Safety Equipment

  • Has voltage tester been tested to ensure battery works?

  • Are enough traffic cones available, reflective tape on them and cones not damaged?

  • Back up warning device wofking on vehicle?

  • Corrective actions to any NO answer above

Emergency Equipment

  • Is a functioning communication device in place for the crew?

  • Is a complete enviromental spill kit on the vehicle? Do employees know where it is?

  • Is an up to date and complete vehicle binder in place?

  • Is the fire extinguisher - full, inspected, secured, and in designated place with decal?

  • First aid kit - full - who is trained, secured, designated location with decal

  • Pole top rescue kit - complete with sheath on knife.

  • Bucket evacuation kit - complete

  • Bucket rescue kit - complete

  • Corrective actions for any NO answer from above

Documents and certificates

  • MVI inspection up to date

  • Registration up to date

  • Vehicle insurance up to date

  • Drivers log book in vehicle and completed properly

  • Does supervisor have up to date MSDS? Do employees know what chemicals are on their vehicles?

  • Corrective actions for any NO answer from above.

Trailers

  • Fenders & mud flaps in good condition?

  • Light cord & socket working and in good condition

  • Do lights work properly?

  • Breakaway connections work?

  • Battery charged and working?

  • Tires, wheels, & nuts secured with good thread?

  • Safety chains & hooks available & in good condition.

  • Hitch in place & not damaged

  • Crank down legs in place & not damaged?

  • Bunks, supports & straps in place & not damaged

  • Arbours & saddles in place & not damaged

  • Collars & pins in place & not damaged

  • Corrective actions to any NO answer from above

Signatures

  • Observers signature

  • Employees/contractors signature

  • Employees/contractors signature

  • Employees/contractors signature

  • Employees/contractors signature

  • Employees/contractors signature

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.