Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Location of Observation:

  • Date of Observation:

  • Work/Job Order #:

  • Observer:<br>

  • Crew Leader Observed:

  • Employees Observed:

Job Task:

  • Scope of Work:

  • Job Type:

  • Recommendation:

  • Issues that need to be resolved:

Vehicles:

  • Proper Traffic Control (signs & cones)

  • Wheel Chocks Set (OSHA 1910.67)

  • Outrigger Set/Solid Surface <br>(OSHA 1910.67)

  • Vehicle Condition <br>(OSHA 1910.67)

  • Pre-Flight Aerial Life Checks (OSHA 1910.67)<br><br>

  • Vehicle Properly Grounded/Barricaded (OSHA 1910.269 (q) )<br>

  • DOT Walk Around<br>

Work Area Safety Procedures:

  • Testing Procedures OK<br>

  • Hot Stick Work<br>

  • Climbing Pole/Pre-Climb Inspection<br>

  • Pole Handling<br>

  • Protective Grounding<br>

  • Ladder Safety<br>

  • Control of Hazardous Energy<br>

  • Properly Locked and/or Tagged<br>

  • Covering of Neutral <br>

  • Covering of Surrounding Phases<br>

  • Covering of Cross Arm & Pole <br>

  • Using Hot Stick to Install Truck Grounds<br>

  • Use of Hand Line on Pole During Work<br>

  • In Proper Working Position <br>

  • Circuit Open, Tested & Grounded<br>

  • Tagged Devices & Inoperative<br>

  • Line Treated as Live<br>

  • Confined/Enclosed Spaces<br>

  • Proper Use of Cover-up in Work Zone <br><br>

  • Comments:

Personal Safety:

  • Hard Hat (on and in good condition) (OSHA 1910.135)

  • Safety Glasses (OSHA 1910.133)<br>

  • Work Boots (OSHA 1910.136)<br>

  • Work Gloves (OSHA 1910.132)

  • Chainsaw Chaps<br>

  • FR Clothing (OSHA1910.269(2) )

  • Rubber Gloves & Protectors: Check for current test date. (OSHA 1910.137)<br>

  • Personal Fall Protection (OSHA 1910.269(g) )

  • Safety Vest (working in road ROW)<br>

  • Face Shield or Goggles (OSHA 1910.133)

  • Hearing Protection (OSHA 1910.95)

  • First Aid Kit (OSHA 1910.157)

  • AED<br>

  • Fire Extinguisher/s<br>

  • Seat Belt Usage<br>

  • Climbing Tools in Good Condition<br>

Work Area Safety: Tail Gates

  • Discussed Hazards

  • Work Procedures

  • Special Precautions

  • Personal Protective Equipment

  • Energy Source Control

  • Safe & Clean Work Area<br>

  • Tools in Good Working Condition<br>

  • “Hot” Tools Clean, Tested & Inspected<br>

  • Sharps covered<br>

  • Slings and Ropes<br>

  • Called in Location and Circuit of Work<br>

  • Equipment Storage on Truck<br>

  • Comments:

  • Comments of Crew/Crew Leader/Lead Lineman:

  • Discussion/Training with Crew by Inspector/ Supervisor Concerning Proper Work Practices and/or Safety Rules:

  • Comments & Review by Manager:

  • VP of Operations:

  • Operations Superintendent:

  • General Foreman:

  • Safety Director:

  • General Manager:

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.