Title Page
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Site conducted
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Conducted on
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Location
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Lead Lineman
- Dave Cox
- Jack Crist
- Jason Daniel
- Shannon Killday
- Joe Lay
- Ryan Booher
- Ryan Waterman
- Adam Schaller
- Greg Sutterfield
- Kevin Cottrell
- Rustyn Carter
- John McCutchan
- Derek Howes
- Colt Jennings
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Is there a work order number?
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Work order number:
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Task Code
- 583 Operations of lines
- 586 Meter expense
- 593 Overhead Maintenance
- 594 Underground Maintenance
- 583.02 Hanging transformer
- 587 Customer Installation exp.
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Voltage Present:
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Within minimum approach of energized conductor?
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Sub?
- Kahoka-1
- Canton-2
- Lewistown-3
- Baring-4
- Novelty-5
- Newark-6
- Winchester-7
- Ewing-8
- Arbela-9
- Williamstown-10
- Taylor-11
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OCR/Fuse pole number
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One Shot/Tag
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Inform Dispatch
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Ground Trucks
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Proper PPE
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Visual Open?
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Test For Voltage?
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Grounded?
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Tagged?
OSHA Requirements
JOB BRIEFING
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Discussed hazards with the job?
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Discussed work procedures involved?
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Discussed PPE?
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Discussed energy source controls?
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Any questions?
Hazard Assessment
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Assembly Value
Additional Risk/Mitigating Factors
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Additional Risk
- Chainsaw
- Chipper
- Traffic
- Trencher/Backhoe
- Skid Steer
- Lower Boom Height
- Extreme Heat and Cold
- Weather
- Outage
- Non-Traditional Pole Attachments
- Climbing
- Open Trench
- Condition of Existing Structures
- Truck Ground Capability
- Unfamiliar Situation
- Short Crew Members
- Road Conditions
- Lack of Proper Equipment
- Long Travel Time
- Adjacent Pole Condition
- Animals
- Terrain
- Monday/Friday
- OTHER 10
- OTHER 20
- OTHER 30
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Specify extra 10
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Specify extra 20
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Specify extra 30
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Mitigating Factors
- Address Distractions
- Work De-energized
- Additional Personnel
- Traffic Control
- Barricade Truck/Skid Steer
- Additional Equipment
- Close Road
- Wait Out Weather
- OTHER
- OTHER
- OTHER
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Total Assessment (Assembly Value + Additional Risk/Mitigating Factors)
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Signatures
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