Information
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Document No.
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Conducted on
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CREW LEADER
- Norb Adams
- Craig Martin
- Jim Braymer
- Scott Wilcox
- Mark Parker
- Jim Reagles
- Alvey Lester
- Gary Lilly
- Blaze Pietrowski
- John Malliard
- Ryan Marsteller
- Mark McKissock
- Corey Jordan
- Joshua Hollabaugh
- Mike Frazier
- Justin Dreese
- Aaron Butler
- Joe Bernier
- Dylan Thomas
- Ross Thomas
- Justin Sullivan
- Mitch Vallieres
- John Heilman
- Jay Bemis
- Chris Peters
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CREW MEMBERS
- Norb Adams
- Craig Martin
- Jim Braymer
- Scott Wilcox
- Mark Parker
- Jim Reagles
- Alvey Lester
- Gary Lilly
- Blaze Pietrowski
- John Malliard
- Ryan Marsteller
- Mark McKissock
- Corey Jordan
- Joshua Hollabaugh
- Mike Frazier
- Justin Dreese
- Aaron Butler
- Joe Bernier
- Dylan Thomas
- Ross Thomas
- Justin Sullivan
- Mitch Vallieres
- John Heilman
- Jay Bemis
- Chris Peters
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Work Order #
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Rescue 911 Address
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Discussed Potential Job Hazards?
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Discussed Procedure to Complete Job?
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Special Precautions?
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Personal Protective Equipment Needed.
- Hard Cover
- Rubber Cover
- Rubber Gloves
- Hearing Protection
- Chaps
- Hard Hats
- Reflective Vests
- Safety Glasses
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Source Control (single shot) Available?
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"Hot" Tools Clean, Tested, and Well Serviced?
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Cover-up Required?
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Line Grounds Required?
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Vehicles Properly Grounded?
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Called in Location and Circuit of Work?
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Proper Traffic Control? (cones and signs)
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Wheel Chocks Set?
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Pre-Flight Aerial Lift Check Performed?
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Outriggers set using pads?
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DOT Walk Around Performed?
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Signing
Person
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Initials Here
