Information

  • Audit No.

  • Date and Time:

  • District

  • Foreman / Supervisor:

  • Other:

  • Crew Members Involved:

  • Job Site Location
  • Member account # or 911 address if unable to locate:

  • Weather

  • Brief Description of Work:

  • Job Briefing held and documented

  • Energized Work

  • Non-Reclosing

  • Confined Space

Grounding

  • Truck Grounds Used

  • Truck Grounds within Current Inspection

  • Line: Personal Grounds Used

  • Line: Personal within Current Inspection

  • Tags Used with Required Information

Protective Equipment

  • Protective Clothing worn and inspected prior to work

  • Rubber Gloves, Sleeves, Protectors, and Bag inspected prior to work

  • Climbing Equipment inspected prior to work

  • Cover-Up Material Used

  • Cover-Up Material within Current Dielectric Test Date:

  • Safety Lanyard and Body Harness Inspected and Worn:

  • Hard Hats Inspected and Worn

  • Safety Glasses Inspected and Worn

  • Hearing Protection Inspected and Worn

  • Non-rubber, non-insulated Work Gloves Inspected and Worn

Traffic Control

  • Traffic Control Devices, i.e. signs, cones, flaggers, etc. in place:

  • Warning Lights i.e. Flash/rotating Lights in Use:

  • Hi-Vis vests worn

Tools and Equipment

  • Equipment on jobsite:

  • Required equipment is available and in good condition?

  • Properly Stored, Guarded and Marked

  • Ladders are in good condition, stored properly and current inspection?

  • Hot Sticks in good condition, stored properly/current inspection?

Vehicles

  • Wheel Chocks Available and Used:

  • Parking brake set

  • Outrigger Pads Used

  • Fire Extinguisher Checked and current inspection

  • First Aid Kit checked and required items available and current

  • Good Housekeeping - bed and cab of truck

  • Vehicle Inspection Stickers Checked

  • Vehicle Controls properly marked

  • Seat belts are in good condition and show use

  • DOT Inspections completed properly

  • Comments:

  • Pictures:

  • Observer:

  • Copy Received:

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.