IAEC - Bucket Rescue (version 3)

• IAEC - Bucket Rescue

• Cooperative

• Conducted on

  Date

• Safety Trainer Performing Evaluation

• Location
  Address

Annual Harness and Lanyard Inspection

• Annual harness inspection will take place prior to bucket rescue. The integrity of the harness/lanyard will be inspected (such as for fraying, fuzzy or damaged straps/stitching, illegible tags, damaged hardware and other visible defects). The tag will be inspected for proof of ANSI, ASTM F887 (arc flash rated) and other applicable regulation identification.
  

• During the inspection of the harness/lanyard, the following deficiencies were found....

Bucket Rescue

• The objective of the bucket rescue evaluation is for the cooperative employee to show their proficiency with the operation of the lower controls and tilting the bucket in the event that a rescue is needed during daily work procedures. The employee may also be asked specific questions pertaining to rescue techniques including, but not limited to, MayDay procedures, hypothetical injury scenarios, CPR, FA, AED and rigging.

• The employee operates the lower controls on the truck properly and proficiently

• The employee Tilts the bucket proficiently

• The employee answered specific rescue procedure questions accurately

Employee name and signature - By signing my name below, I agree that I have successfully completed the requirements for the annual Bucket rescue evaluation.

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Employee(s) listed below did not successfully complete the requirements needed for Bucket Rescue. Employee signature below verifies agreement.

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IAEC Safety Trainer Signature

• John Dvorak

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• Matt Pociask

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• Jim Wolfe

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• Scott Meinecke

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