Information
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Cooperative name:
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Auditor(s) name:
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Date/Time:
DESCRIPTION OF THE JOB
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Jobsite location:
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Name of foreman in charge:
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Crew members:
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Describe type of work being performed:
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Are lines energized or de-energized:
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Secondary or Distribution (or both):
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Overhead or Underground:
JOB PREPARATION
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Was tailgate/job briefing conducted and documented:
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Radio operation check was performed:
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Pre-trip inspection was performed on CMV(s):
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Pre-flight of aerial unit was performed:
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Aerial lift properly set up for the task as required by manufacturer:
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Energy source controls (Energy Control/LOTO) have been identified:
PERSONAL PROTECTIVE EQUIPMENT
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Hard hat(s) properly worn and in good condition:
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Eye protection in ANSI approved and worn:
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Proper hand protection is being used:
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Safety toe boots are being used:
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Hearing protection is available:
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FR clothing is in good condition:
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Rubber gloves worn and inspected prior to use:
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Rubber sleeves worn and inspected prior to use:
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Fall protection used where appropriate and all components inspected prior to use:
GROUNDING
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Truck grounds are being used and in good condition:
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Personal grounds are being used and in good condition:
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Conductor was tested prior to grounds being installed:
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Crew members can explain proper grounding techniques:
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Grounds are properly stored:
VEHICLES
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Digger/bucket trucks are properly set up:
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Wheel chocks are being used:
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All material on the vehicle is properly stowed:
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Outrigger pads are being used:
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Reverse alarm is in working order:
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Fire extinguishers are properly charged and stored:
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First-aid kit is stocked and location is properly marked:
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AED is available and location is properly marked:
TRAFFIC CONTROL
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Beacon/strobe lights are in working order and being used:
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Traffic cones are used and properly placed:
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Road signs are adequate for the job being performed:
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Reflective vests are worn:
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A flagger is being used to control traffic:
GENERAL WORK PRACTICES
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Proper tools are being used to complete the task:
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Tools have been inspected and are in good condition:
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Live-line tools have been inspected prior to use and tested within 1 year:
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Hand lines are available and in good condition:
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Ladders have been inspected and are in good condition:
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Means of ingress/egress present in excavations >4 feet:
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Excavations >5 feet have been shored/stepped back by a competent excavation safety trained employee:
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Poles are tested prior to climbing:
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Adequate cover-up material is being used, properly covered/isolated:
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Only qualified personnel are performing hazardous work:
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Employees performing hot work are being watched by a designated observer:
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Guards are in place on tools and equipment that need them:
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Clear communication is exchanged among crew members:
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Employees can explain direction of feed and closest protection device:
AUDITOR VERIFICATION SIGNATURE(S)
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Safe jobsite:
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Safe work procedures followed:
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Comments: ("NO" items require an explanation)
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Include photo's, if applicable:
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Signature:
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Signature:
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Signature: