Title Page

  • Crew Leader

  • Site conducted

  • Conducted on

  • Location
  • Is there a work order number?

  • Work order number:

  • Task Code

  • Nominal Line voltage:

  • Within minimum approach of energized conductor?

  • Is work inside a SUB or SWITCH?

  • Site?

  • Notify Control Center?

  • Has the site been inspected for hazards or vandalism?

  • One Shot/hotline Tag

  • Is work being done where oneshot capabilities are not available?

  • Perform Switching

  • Test for voltage

  • Inform Control

  • Place grounds

  • Visual Open?

  • Test For Voltage?

  • Grounded?

  • Tagged?

  • Does work require you to work within MAD?

  • Method used?

  • Does work require you to work within MAD?

  • Method used?

  • Is the deenergized equipment a Comm. Tower or equipment?

  • Visual Open?

  • Test For Voltage?

  • Ground Line?

  • Reminder: Wear all PPE when in MAD

OSHA Requirements

JOB BRIEFING

  • Work to be done and specific job assignments.

  • Discuss and List hazards with the job? If Hazard is not listed, write it in the notes.

  • Is the Pole been hammer tested?

  • Are chaps being worn?

  • Describe hazard

  • Has Tower Rescue Plan been completed?

  • Discussed work procedures involved?

  • Discussed PPE?

  • Eye Protection

  • Hand protection

  • Safety Toe Boots

  • FR Clothing

  • Hard Hat

  • Hearing Protection

  • Rubber sleeves

  • Rubber Gloves

  • Other Additional PPE related to this job.

  • Discussed energy source controls?

  • Who is the Designated Observer(DO)?

  • Reminder: Anyone at any time can ask any question or voice any safety concern they feel is necessary or pertinent to the job. Always SPEAK UP, Always LISTEN UP!

  • Any questions?

Signatures

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

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