Jobsite location:

Name of foreman in charge:

Crew members:

Describe type of work being performed:

Are lines energized or de-energized:

Secondary or Distribution (or both):

Overhead or Underground:


Was tailgate/job briefing conducted and documented:

Radio operation check was performed:

Pre-trip inspection was performed on CMV(s):

Pre-flight of aerial unit was performed:

Aerial lift properly set up for the task as required by manufacturer:

Energy source controls (Energy Control/LOTO) have been identified:


Hard hat(s) properly worn and in good condition:

Eye protection in ANSI approved and worn:

Proper hand protection is being used:

Safety toe boots are being used:

Hearing protection is available:

FR clothing is in good condition:

Rubber gloves worn and inspected prior to use:

Rubber sleeves worn and inspected prior to use:

Fall protection used where appropriate and all components inspected prior to use:


Truck grounds are being used and in good condition:

Personal grounds are being used and in good condition:

Conductor was tested prior to grounds being installed:

Crew members can explain proper grounding techniques:

Grounds are properly stored:


Digger/bucket trucks are properly set up:

Wheel chocks are being used:

All material on the vehicle is properly stowed:

Outrigger pads are being used:

Reverse alarm is in working order:

Fire extinguishers are properly charged and stored:

First-aid kit is stocked and location is properly marked:

AED is available and location is properly marked:


Beacon/strobe lights are in working order and being used:

Traffic cones are used and properly placed:

Road signs are adequate for the job being performed:

Reflective vests are worn:

A flagger is being used to control traffic:


Proper tools are being used to complete the task:

Tools have been inspected and are in good condition:

Live-line tools have been inspected prior to use and tested within 1 year:

Hand lines are available and in good condition:

Ladders have been inspected and are in good condition:

Means of ingress/egress present in excavations >4 feet:

Excavations >5 feet have been shored/stepped back by a competent excavation safety trained employee:

Poles are tested prior to climbing:

Adequate cover-up material is being used, properly covered/isolated:

Only qualified personnel are performing hazardous work:

Employees performing hot work are being watched by a designated observer:

Guards are in place on tools and equipment that need them:

Clear communication is exchanged among crew members:

Employees can explain direction of feed and closest protection device:


Safe jobsite:

Safe work procedures followed:

Comments: ("NO" items require an explanation)

Include photo's, if applicable:
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.