Information
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Document No.
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Conducted on
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Foreman
- Dave
- Pat
- Chad
- Justin
- Josh
- Bill
- Braden
- Shane
- Randy W
- Steve
- Tom
- Nate
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Personnel
- Dave
- Pat
- Chad
- Justin
- Josh
- Bill
- Braden
- Shane
- Randy W
- Steve
- Tom
- Nate
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Work Order
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Rescue 911 Address
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Weather
- Sunny
- Raining
- Windy
- Overcast
- Snowy
- Cold
- Night
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Hot Job
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Voltage?
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Other
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Able to get a one-shot?
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One Shot Location:
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Is switching required?
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Switching type?
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Is PPE required?
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PPE type
- Hard Cover
- Rubber Cover
- Rubber Gloves
- Hearing Protection
- Chaps
- Other
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Other
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Is Climbing required?
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Climb through obstacles?
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Pole Condition?
- Good
- Single tag
- Double tag
- Structural damage
- Badly leaning
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Safety plan?
- Secure w/ truck
- Secure with ropes
- Not changing strain
- Other
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Other
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Is Digging required?
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Is there a locate?
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Take a picture of locate marks. Write down ticket # if known.
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Ticket Number
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Take a picture of the locate marks
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Is work to be done on/near a roadway?
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Is flagging required?
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Road type?
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Using flagging company
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ODOT notified
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Using flagging company
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ODOT notified
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Why not?
- 15 minutes or less
- 10 feet from the fog line
- No traffic on roadway
- Other
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Other
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Will grounds be applied?
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Grounding type?
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Location of grounding points?
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Signing
Person
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Initials Here
