Job Brief

• Customer

• Work Order#

• Date

  Date
• Job Location
  Address

• Nearest Medical Facility

• Customer Task Mgr/PM

  Select

• Customer Phone#

• Foreman/CL

• GF

• Competent Person

• Outdoor Temp

• Wind Speed

• Precipitation

• Work Type

  Electrical

  Boring

  Civil

  Substation

  Other

• Work Type

Critical Job Tasks/ Hazards / Preventative measures/barriers

• 1. Critical Job Task / Hazard

• Preventative Measures/Barrier

• 2. Critical Job Task / Hazard

• Preventative Measures/Barrier

• 3. Critical Job Task / Hazard

• Preventative Measures/Barrier

• 4. Critical Job Task / Hazard

• Preventative Measures/Barrier

• Identify Hold Points

Work Area Protection

• Is work area Protection Required for your task?

  Yes

  No

  N/A

• Have you called Penn Dot traffic managment?

  Yes

  No

  N/A

• Please call Penn Dot Traffic Managment before any work on state roadways

• State and/or Township Rd Permit #

• Do you have a copy of the permit on site?

  Yes

  No

  N/A

• Following Traffic Control Plan?

  Yes

  No

  N/A

• Traffic Flow

  Heavy

  Medium

  Light

  N/A

• MUTCD Tad #

• Approx. # of Cones Placed

• # of Signs Placed

ZONE OF PREOTECTION (ZOP)

• Is ZOP required for your work?

  Yes

  No

  N/A

• Primary Voltage

• Secondary Voltage

• Minimum Approach Distance

• Line/Feeder/Circuit #

• Clearance / Admin Orders Reviewed # is

• 3-Part Communication w/ Designated Authority

  Yes

  No

Live Until Proven Dead!!

• Are you Preforming Lock Out Tag Out today?

  Yes

  No

  N/A

• Types of tags

• Tags Recoreded

  Yes

  No

• Equipment #'s Recorded

  Yes

  No

• Number of Grounds

• Master Ground Loc.

• Undispatched Grounds

• Tested & Grounded

• LOTO / Hold Off / Tags Placed

• ZOP Established

• Crew Understands ZOP

• Potential Backfeed Identified

Excavation

• Are you excavating today?

  Yes

  No

  N/A

• One Call Number

• Please attach OneCall ticket by photo or PDF

  Media

• Have you inspected the area for unmarked facilities?

  Yes

  No

• What facilities are in your work area?

  Select Electric Gas Telecommunications Water Sewer Other

  • Electric
  • Gas
  • Telecommunications
  • Water
  • Sewer
  • Other

• What other facilities have you found?

• Have you secured unattended Excavations?

  Yes

  No

  N/A

• Check what applies to your job site below

• Soil Type

  Type A

  Type B

  Type C

• Estimated Depth of Excavation

• Excavation Protection System Used for Excavation of 5 ft. or Greater that Meets Soil Type:

  N/A

  Trench Box

  Shoring

  Benching

  Sloping

• Ladder in Excavation at 4 ft. and Every 25 ft.

  Yes

  No

  N/A

• Water Accumulation Controlled

  Yes

  No

  N/A

• Engineer Approved Plan for Excavation in Excess of 20 ft. on Site

  Yes

  No

  N/A

CONFINED/ENCLOSED SPACE

• Will the Job Require Confined Space Entry

  Yes

  No

  N/A

• Will a Permit be Required

  Yes

  No

  N/A

• Attendant Name

• Percent Oxygen

• Percent Oxygen (Mid-Shift)

• Emergency Retrieval System Readily Available

  Yes

  No

• Space is Barricaded to Prevent Fall In

  Yes

  No

• Blower Readily Available to Force Air Ventilate

  Yes

  No

• Arc Blanket Utilized

  Yes

  No

PPE

• All basic PPE Worn? (HARD HAT,SAFETY GLASSES, HIGH VIZ VEST/CLOTHING, WORK GLOVES & SAFETY TOED BOOTS)

• FR Clothing

• 2nd layer FR

• Primary Gloves

• Sleeves

• Other

Electrical Hazards

• Inspect all Rubber Goods

• Rubber Properly Placed

• Inspect All Live Line Tools

• Equipment Checked/Calibrated

• Inspect Pole Condition

• Equipment Grounded

  Yes

  No

  N/A

• System Neutral

• Pole Ground

• Anchor

• Screw Ground

• Other

• Why?

• Induction Sources Identified

• Step/Touch Potential Identified

• Flag/Visual Ground Marker

• LOFFA Set Properly

Site Conditions/Environmental

• Site Walk Down Complete

• Uneven Surfaces

• Ice/Mud/Snow

• Pinch Points Identified

• Leaking Equipment

• Working Near a Wetland

• Poison Ivy/Oak

• Wild Life Concerns

• PCB Contaminants Presents

• Emergency Escape Plan

• Location to meet?

• Proper Dewatering

• Fire Protection Tools Checked

• Hydration Monitor - Aware of Heat Illness Plan

Vehicle/ Equipment

• Pre-Trip Inspection

• 360 Walk Around

• Use of Spotter

• Operator Wearing Seatbelt

• Line of Fire Identified

• Load Properly Secured

• Equipment Barricaded

• Public Protected

• Qualified Operator / Rigger

• Rigging Inspected

Mid-Shift/ Scope of Work Change

• Has a Mid-Shift Scope Change occurred?

  Yes

  No

• What has changed?

Discussions

• Weekly Discussion Tool

• Attach weekly discussion form

  Media

• Recent Bulletins

• Industry News

Please Write Your Own Name After Being Briefed

• Name, Role & Signiture

  Sign