Information
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Audit No.
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Field Safety Inspection & Observation Form
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Region:
- #1 (Sanford)
- #2 (AAB)
- #3 (CurryFord)
- #4 (Kissimmee)
- #5 (Ocoee)
- Business Solutions
- Network Construction
- Audit
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Conducted on
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Prepared by
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Region/Office Address:
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Additional Personnel:
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Date & Time:
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Employee Name:
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MOR Decal Number:
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Vehicle #:
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Audit Location:
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Vehicle Milage:
Vehicle Parking:
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Backed into driveway or parking space:
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Cones properly placed (front and rear)
- Pass
- Fail
- Not Observed
- N/A
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Front wheels curbed (if parked on an incline)
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Parking brake set (if parked on an incline)
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Strobes, beacon light, or flashers on (if i public roadway)
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Vehicle legally and properly parked
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Vehicle locked (if unattended)
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Vehicle chocked (if applicable)
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Media:
Personal Protective Equipment Readiness
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Climbing belt and safety strap in proper condition
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Climbing gaffs in proper condition
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Climbing gloves in proper condition
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Dust Mask - N95
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Hardhat Condition
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Hearing Protection
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Hot gloves stored properly (if applicable)
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Insecticides - wasp and ant spray
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Long sleeved shirt
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Rain gear
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Safety glasses/goggle condition
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Sunscreen
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Tech wearing approved climbing boots
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Traffic control devices - vest, flag and sign
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Voltage detector
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Media:
Personal Protective Equipment Use
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Gloves worn
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Hardhat worn
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Proper boots worn
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Proper clothing (neat, clean, and worn properly)
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Safety glasses/goggles used
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Media:
Climbing
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Climbed proper side of pole
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Equipment inspected before climbing
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Pole inspected and checked for voltage
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Proper climbing techniques
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Media:
Ladder Usage
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Belt and safety strap worn properly
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Carried ladder properly
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Climbed ladder properly
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Inspected ladder prior to climbing
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Ladder placed on vehicle when not in use
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Ladder set against strand properly
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Ladder set against structure properly (3' above roof line)
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Safety strap used properly on strand or pole
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Strand hooks in proper position (on strand)
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Vehicle parked to protect the employee and the ladder
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Media:
Power Tools
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Correct tool used for task
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Extension cord in proper condition
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Hand tools in good condition
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Power tools in working condition and cords not frayed
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Tools used properly
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Media:
Bucket Trucks
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Body Harness and lanyard properly worn and attached to boom
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Cracks in weld joint
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Damage to the fiberglass bucket
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Fall arrest attachment point securely fastened
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Hazardous conditions inside the truck
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Hydraulic fluid levels appropriate
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Inspect for hydraulic hose leaks
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Lock mechanism on bucket door functioning
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Loose and/or damaged bolts - anywhere
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Loose and/or damaged bolts attaching the bucket to the boom
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Loose or damaged pivot pins
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Lower controls inspection and in working condition
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Safety and warning decals in good in good condition and all legible
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Safety chain clasp functioning
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Safety chain properly fastened
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Wheels chocked
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Work area organized and neat
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Media:
Procedures
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Drilled cable entry holes properly
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Is the house wiring safe
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Proper tools used for the job
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Public protected from hazards
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Safe electrical practices demonstrated
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Tools were not left unattended
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Work area free of debris
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Work area organized and neat
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Media:
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Additional Comments/ Information:
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Signature of field auditor:
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Signature of employee:
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Signature of supervisor:
