Title Page
-
Work Order #
-
Job Briefing Form
-
Conducted on
-
Prepared by
-
Address
-
Crew Members
-
Description of Work
Hazards Associated With The Job
-
Hazardous Atmosphere-enclosed spaces/confined spaces harmful dust/mist/gases
-
Trenching Excavation (Engulfment hazards, cave-in/entrapment)
-
Hydraulic Equipment (Leaks, Use)
-
Fall Hazards (Pole Climbing, Basket Work)
-
Chemical Hazards (Oil, Hydraulic Fluids, Paints, PCB)
-
Fall with falling pole, tower, or structures
-
High Noise levels
-
Moving Machinery (Heavy Equipment, Construction, ROW)
-
Environmental Hazards (Heat, Cold, Rain, Wind, Snow etc..)
-
Fire/Explosion - Flammable Compressed Gases)
-
Drowning- Water hazards
-
Other (Please describe)
Special Precautions
-
Inspect Work Site for Safety and Health Hazards
-
Inspect Safety Equipment Prior to Use
-
Job Requires Attendant/Observer
-
Test/Monitor Equipment (Boom Test)
-
Atmosphere Weather Watch Required
-
Extra Set of Rubber Gloves within reach for Rescue
Energy Source Control
-
Name of Designated Employee Performing Energized Work
-
Lockout/Tagout Required
-
Group Lockout/Tagout
-
Transmission Line De-energized
-
Distribution Line De-energized
-
Line Placed in Single Shot
-
Testing for Voltage
-
Capacitors Discharged
-
Application of Protective Grounds
-
Rubber Goods/Cover up
-
Other (Describe)
Work Procedures Involved
-
Overhead Work Procedures
-
Substation Electrical Work Procedures
-
Transmission Work Procedures
-
Underground Work Procedures
-
High-Voltage/High Power Testing
-
Enclosed/Confined Space Entry
-
Excavation/Trenching
-
Line-Clearance Tree Trimming
-
Traffic Control/Barricading at Work Site
-
Emergency Work (Describe)
-
Other (Describe)
Personal Protective Equipment
-
Head Protection
-
Face/Eye Protection
-
Gloves
-
Protective Footwear
-
Protective Clothing
-
Fall Protection
-
Electrical Protective Grounds
-
Respirator (Dust Mask)
-
Hearing Protection
-
Other Briefing Topics/Notes
-
Employee Signatures
