Information

  • Document No.

  • Conducted on

  • CREW LEADER

  • CREW MEMBERS

  • Work Order #

  • Rescue 911 Address
  • Discussed Potential Job Hazards?

  • Discussed Procedure to Complete Job?

  • Special Precautions?

  • Personal Protective Equipment Needed.

  • Source Control (single shot) Available?

  • "Hot" Tools Clean, Tested, and Well Serviced?

  • Cover-up Required?

  • Line Grounds Required?

  • Vehicles Properly Grounded?

  • Called in Location and Circuit of Work?

  • Proper Traffic Control? (cones and signs)

  • Wheel Chocks Set?

  • Pre-Flight Aerial Lift Check Performed?

  • Outriggers set using pads?

  • DOT Walk Around Performed?

  • Signing

  • Person
  • Initials Here

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.