Title Page
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Conducted on
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Location
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Lead Lineman
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Voltage Present:
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Within minimum approach of energized conductor?
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OCR/Fuse number?
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Sub?
- 1-Winigan
- 2-Hart
- 3-Love Lake
- 4-Hager’s Grove
- 5-Lentner
- 6-Macon
- 7-Bynumville
- 8-Cairo
- 9-Axtell
- 10-Lakenan
- 12- Huntsville
- 13-Marceline
- 14-Clarence
- 15-Shelbyville
- 16-New Cambria
- 17-Ten Mile
- 18-Jacksonville
- 19-Sue City
- 20-Bevier
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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?
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Is there a work order number?
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Work order number:
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Task Code
- 583 Overhead line- OCR & Regulators
- 586 Meter Maintenance
- 593 Overhead Maintenance
- 594 Underground Maintenance
- 595 Transformer Maintenance
- 598 Security Light Maintenance
- 593 Outage/Restoration
OSHA Requirements
OSHA
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Discussed hazards with the job?
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Special precautions?
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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?
Signatures
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