Title Page
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Document No.
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Audit Title
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Date of Observation
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Employee
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Observer
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Date Completed
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Description
General Information
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Status
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Length of Observation
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Crew Observation
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Announced / Unannounced
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Business Hours / After Hours
Did performers conduct/participate in and effective pre-job brief (PJB)? (KTL)
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PJB Form Completed
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Circuit ID
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Closest Emergency Medical Facility
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Employee in Charge (EIC) / Designated Crew Member (DCM)
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PJB Participation (Crew and/or Traffic Control
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Potential Hostile Situations
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Correct Job Scope
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Hazard Recognition and Mitigation Planned
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Voltage and MAD Identified (CESR)
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Roles/Tasks Identfied
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Address Location Description
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Post-Job Brief
Safety (attributes noted as CESR are also KTL)
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Adheres to MAD (CESR)
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Followed Insulate and Isolate Guidelines (CESR)
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Designated Observer Identified/Documented on PJB (CESR)
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Lines/Equipment Isolated - Tested
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Mobile Equipment Appropriately Grounded and/or Barricaded (CESR)
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Job Site Left in Orderly Safe Condition
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Body Mechanics / Ergonomics
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Designated Observer Effective and Engaged During All Critical Tasks (CESR)
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Lines/Equipment Isolated - Grounded (CESR)
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Proper Hydration Work Practices, Including PJB Hydration Discussion and Use of Hydration Monitor
Are performers inspecting and utilizing appropriate PPE and clothing for the tasks? (KTL)
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Eye Protection
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Foot Protection
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Chaps Utilized Properly
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No Jewelry
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Rubber Hose Inspection (CESR)
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Blanket Inspections (CESR)
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Hearing Protection
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FR Clothing (CESR)
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Head Protection
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Work Gloves
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Rubber Gloves (CESR)
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Sleeves (CESR)
Has crew adhered to work, drop and fell zone precautions for falling objects/line of fire? (KTL)
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Public and Crew Protected
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Avoided "Line of Fire" During Work Task(s)
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Proper Drop Zone
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Proper Fell Zone
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Proper Construction Work Zone
Was appropriate fall protection properly utilized? (KTL)
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Fall Protection Used Properly and Per Manufacturer's Recommendations
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Fall Protection Equipment in Good Condition
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Harness and Lanyard FR-Rated As Appropriate (CESR)
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Three-Points of Contact Maintained
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Lanyard Clipped in Properly
Vehicles, Heavy Machinery and Other Related Equipment
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Outriggers Engaged Properly
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Wheels Chocked (KTL)
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Seatbelts Worn and/or in Good Condition (KTL)
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Dielectric Boom Testing In Date
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Utilizes Proper Towing Equipment and Procedures
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DOT Vehicle Pre-Post Inspection Up-To-Date
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Specialized Safety Devices (e.g. Audible Alarms)
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Properly Positions and Operates Vehicles and Equipment (KTL)
Are state and local traffic control zone regulations, including MUTCD, being followed? (KTL)
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Traffic Control Zone Set Up Appropriately
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Audible Alerts Available for Immediate Use (e.g. Horn, Whistle)
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Traffic Regulations Followed
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Appropriately Reflective Traffic Apparel In Use
Tools and Equipment (attributes noted as CESR are also KTL)
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Body Belt (KTL)
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Climbers (KTL)
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Proper Chainsaw Storage and Operation
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Hot Stick (CESR)
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Hand Tools
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Small Electrical Tools
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Mechanical Jumpers
Is vehicle housekeeping and material storage being maintained?
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First Aid / Blood-Borne Pathogens Kits
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Fire Extinguisher
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Environmental Spill Equipment
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Materials Maintained, Stored and Secured
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DOT Emergency Equipment
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Vehicle Interior Free of Trash/Clutter
Are effective communications being used during critical tasks?
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Confirmation When Energizing or De-Energizing Lines/Equipment
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Good General Communications (e.g. DCC, Grid, SCS, Customer)
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ETR Communications
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Designated Observer, Spotter and Equipment Operator
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Isolating and Grounding Line Communications
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Proper Use of 3-Way Communication During Critical Task(s); Including Use of Phonetic Alphabet
Work Methods (KTL) (attributes noted as CESR are also KTL)
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Pole Climbing Techniques
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Switching and Tagging (CESR)
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Poles / Adjacent Poles Tested for Structural Integrity (Visual, Probing, Sounding)
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Pole Climbing Verification
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Trenching and Excavation
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Enclosed no Confined Space Entry
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Pole Removal Equipment and Procedures
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Procedure Use and Adherence (Circle/Slash, Procedure Administration
Additional HP Tools
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Performs Self-Check (STAR)
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Uses Questioning Attitude (QVV; Stop When Unsure)
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Verification Practices (Peer Check; Concurrent Verification; Independent Verification)
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Utilizes Situational Awareness (2 Minute Drill)
Feedback & Follow-up
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Feedback to Employee
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Follow-up Required
Notes
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Notes
