Information

  • Project Name:

  • Client

  • Conducted on

  • Auditor:

  • Location
  • Crew

  • Tasks been performed

DOCUMENTATION (COMPLETE FOR ALL JOBS)

  • JHA complete for all tasks being performed.<br>

  • Adequate control measures in place to address hazards.<br>

  • All employees have signed-off on JHA/procedures.<br>

  • JHA reviewed with all visitors to site prior to entry.<br>

  • Emergency plan complete and communicated.<br>

HOUSEKEEPING (COMPLETE FOR ALL JOBS)

  • Debris/materials not accumulating on jobsite.<br>

  • Flammable materials are properly stored.<br>

PPE (COMPLETE FOR ALL JOBS)

  • Gloves appropriate to the task are being worn.<br>

  • Hard hat, safety glasses and protective footwear in use.<br>

  • Fall protection equipment inspected and used.<br>

  • Rubber goods/hot sticks test dates are current.<br>

  • Additional PPE used as needed.<br>

ENERGIZED EQUIPMENT

  • Approach distances are maintained by all.<br>

  • Adequate cover in place on all energized parts.<br>

  • NRO advised and crew logged in with dispatch.<br>

GROUNDING

  • Lines de-energized, tested and grounded as required.<br>

  • All energy sources/induced voltage addressed.<br>

  • Grounding equipment inspect-ed and adequate for task.<br>

OPERATING ORDERS

  • Clearance, NRO or Hold Order communicated.<br>

  • Clearance points communicated and understood.<br>

WORK ZONE PROTECTION

  • Traffic control in place appropriate to the task.<br>

  • All employees are wearing high-visibility clothing.<br>

  • Road-crossing permits obtained and in effect.<br>

  • Hotline crossings are properly guarded.<br>

RIGGING

  • Rigging equipment in good condition/inspected.<br>

  • Rigging protected from sharp edges, heat, etc.<br>

EXCAVATIONS

  • Excavations inspected by competent person.<br>

  • Adequate protective systems in place.<br>

  • Barricades in place on un-attended excavations.<br>

EQUIPMENT

  • Pre-/post-use inspections complete.<br>

  • Operators are trained for equipment in use.<br>

  • Equipment is grounded as needed for the task.<br>

  • Outrigger pads in place for all lifting equipment.<br>

  • Equipment is barricaded/ chocked as needed.<br>

SUBSTATION

  • Crew reported into dispatch.<br>

  • Gates are closed/locked.<br>

  • Qualified station-entry personnel on site.<br>

HAND TOOLS

  • Power tools inspected and in good condition.<br>

  • GFCIs used on all electric-powered tools.<br>

  • Ladders in good condition and inspected.<br>

  • Hand tools in good condition and used as intended.<br>

PERSONNEL TRAINING

  • Employees have site-specific training as required.<br>

  • Other required training complete, up to date.<br>

  • ADDITIONAL COMMENTS

  • Add media

  • Jobsite Foreman/Superintend Signature

  • Auditor 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.