Title Page
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Conducted on
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Prepared by
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Site Supervisor
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Location
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Job description
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Emergency Contact Phone Number
Site Briefing
Work Procedures
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Brief description of work procedures for job
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Will work be performed energized
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Have protective grounds been installed?
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Will work be performed as "hot"?
Hazards
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Energized equipment
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Terrain (slips, trips & falls)
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Traffic
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Working at heights
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Equipment on site (excavator, backhoe, etc.)
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Noise (chainsaw, chipper, etc.)
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Environmental Hazards
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Underground Utilities
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Have underground utilities been located?
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Other:
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Other:
Energy Source Controls
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Hot Line Tag Required
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Circuit
- Winyah Heights
- Church St.
- Ridge St.
- South Fraiser
- North St.
- Front St.
- Maryville North
- Maryville South
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Has Peak Shaving Plant been taken out of service?
Special Precautions
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Identify any special precautions that are out of the normal work activities.
PPE
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Hard Hat
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Safety Glasses
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Rubber Gloves
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Glove Class
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Rubber Sleeves
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FR/AR Uniform
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Hearing Protection
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Fall Protection
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High Visibility Clothing
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Other:
Personnel Onsite
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Name:
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Name:
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Name:
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Name:
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Name:
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Name:
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Name:
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Name: