Title Page

  • Site conducted

  • Job Description and Location

  • Describe Job

  • Map Location and/or Pole Number

  • Feeder Number or Map Location

  • Date

  • Prepared by

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Job Summary

Daily Work Summary

  • What type(s) of work are being performed today?

  • Hazards Associated with Job

  • Are ice cleats required

  • Does everyone have ice cleats

  • Is locate complete

  • Traffic Control Needed

  • Preflight Completed

  • List any important job tasks

  • Will work be performed on energized equipment or line(s)

  • Will upstream overcurrent device be place on non-reclose

  • Upstream device number

  • Will protective grounds be installed

  • Will trucks be grounded

  • Describe alternate procedure

  • Are switching procedures involved

  • List switching procedures

Designated Observer

  • Doug Byrn

  • Bodie Western

  • Hunter Chase

  • Joseph Hagar

  • Greg Neagle

  • Richard Shaw

  • Dalton Smith

  • Braxton Shaw

  • Hunter Chase

  • Vance Frederick

  • Cameron Kirmse

  • Aaron Olson

  • James Jones

  • Payden McCarty

  • undefined

  • undefined

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Personal Protective Equipment

  • What is the required PPE to complete the job safely

  • Have Rubber Gloves/Sleeves Been Inspected

  • Does every team member have the required PPE for today's work tasks?

  • Will cover up be installed

  • Are there any additional comments

  • List additional comments

Crew Members

  • Doug Byrn

  • Signature

  • Bodie Western

  • Signature

  • Hunter Chase

  • Signature

  • Joesph Hagar

  • Signature

  • Greg Neagle

  • Signature

  • Richard Shaw

  • Signature

  • Dalton Smith

  • Signature

  • Braxton Shaw

  • Signature

  • Denton Jones

  • Signature

  • Vance Frederick

  • Signature

  • Cameron Kirmse

  • Signature

  • Greg Olson

  • Signature

  • James Jones

  • Signature

  • Payden McCarty

  • Signature

  • Other

  • Type Name

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.