Field Observation

• Crew Leader

• Conducted on

  Date

• Prepared by

• Location
  Address

Job Planning

• Was the job briefing documented?

  Yes

  No

  N/A

• Job Briefing Pictures:

  Media

• Comments:

Personal Protective Equipment

• Is eye protection being worn at all times?

  Yes

  No

  N/A

• Are hard hats used?

  Yes

  No

  N/A

• Is hand protection being used?

  Yes

  No

  N/A

• Is foot protection appropriate to the job?

  Yes

  No

  N/A

• Is hearing protection used when needed?

  Yes

  No

  N/A

• Is proper FR clothing being worn?

  Yes

  No

  N/A

• Comments:

Vehicles

• Are vehicles properly grounded?

  Yes

  No

  N/A

• Daily inspection performed?

  Yes

  No

  N/A

• Diggers/Buckets properly set up?

  Yes

  No

  N/A

• Are wheel chocks used?

  Yes

  No

  N/A

• Comments:

Overhead and Underground Construction

• All equipment inspected prior to use?

  Yes

  No

  N/A

• All equipment used correctly?

  Yes

  No

  N/A

• Working between grounds?

  Yes

  No

  N/A

• Are grounds in good condition?

  Yes

  No

  N/A

• Are hand lines used?

  Yes

  No

  N/A

• Is there good housekeeping?

  Yes

  No

  N/A

• Are excavations evaluated and safe?

  Yes

  No

  N/A

• Comments:

Energized Work

• Are gloves the correct rating for the job being performed?

  Yes

  No

  N/A

• Were gloves tested prior to use?

  Yes

  No

  N/A

• Is sufficient cover-up material utilized?

  Yes

  No

  N/A

• Are approach distances maintained?

  Yes

  No

  N/A

• Is “hot work” being observed properly?

  Yes

  No

  N/A

• Comments:

General

• Were poles tested prior to climbing?

  Yes

  No

  N/A

• Is proper fall protection being used?

  Yes

  No

  N/A

• Are slings in good shape?

  Yes

  No

  N/A

• Was climbing gear inspected before use?

  Yes

  No

  N/A

• Are gaff guards being used?

  Yes

  No

  N/A

• Comments:

Traffic Control

• Were proper warning lights used?

  Yes

  No

  N/A

• Were reflective vests used?

  Yes

  No

  N/A

• Were cones adequate for the job?

  Yes

  No

  N/A

• Were signs adequate for the job?

  Yes

  No

  N/A

• Comments:

• Signature:

  Sign