Title Page
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Site conducted
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PM Number
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Notification Number (If multiple Notification numbers separate them by a comma.)
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Conducted on
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Inspector Name
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Inspector LanID
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Division
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Group Location
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MAT
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Contractor Name (include subcontractor name if applicable)
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Crew Foreman's name (First & Last)
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Crew Size
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Was there a Safety Professional present on the job site? (If so add their name/s)
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What equipment was on-site?
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Work Location
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Job Scope
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Circuit/Voltage
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AFW Type and Switch log number
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Was job found completed on arrival? (If so mark all questions N/A on the next page.)
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Was the job cancelled?
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Reason for cancellation?
General Safety
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1.0 Did you attend crew tailboard?
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1.1 Was all required PPE used?
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1.2 Were all Covid protocols followed? Mask, social distancing, visitor log etc
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1.3 Was PSP (Programmatic Safety Plan) or PSSP (Project Site Safety Plan) on site?
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1.4 Were adequate fire mitigation measures in place (per TD1464S)
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1.5 Were safe worksite practices used including use of spotters, wheel chocks, parking brakes, outriggers, booms/buckets/forks lowered when parked or stored
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1.6 M&TE (Material & Test Equipment) that is to be used for a job has been checked for calibration compliance; Equipment dielectric certification valid.
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1.7 Was traffic control needed?
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1.7a Was traffic control safe and effective?
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1.7b Even though not needed was Traffic Control present?
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1.8 Were there any issues with material availability?
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1.9 Was any equipment leaking?
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Was environmental contacted?
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Was equipment returned to contractor yard or PGE facility?
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1.10 Was a crane required?
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1.10a Were all certifications in place?
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1.11 If a helicopter was used, was a preflight tailboard with the pilot and crew conducted
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1.12 Was Vegetation clearing needed (4' minimum clearance) and completed?
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1.12a Was a tag created if necessary?
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1.13 Is your work site in a forest, brush or grass covered land?
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1.14 Is your work site an R4 or above?
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1.15 Has the water buffalo been tested and is ready for service?
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1.16 Have all potential fire hazards been mitigated?
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1.16 Have all potential fire hazards been mitigated? Comment here.
Electric
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3.0 Were Rubber Gloves air and water tested prior to use?
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3.1 Were all second points of contact covered?
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3.2 Are conductive objects hanging on the outside of the Bucket?
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3.3 Was required fall protection in place?
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3.4 Was voltage detector tested prior to use?
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3.5 Was Customer Voltage verified prior to and after work was completed by you?<br>(Example: Check Voltage/Rotation after Transformer replacement at meter<br>panel) (Refer to attached document)<br>
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3.6 Was the equipment voltage (Name Plate) verified by you? If not, why?
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Examples of Name Plate pictures
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5MM_Neutral_ID_Voltage_Testing (003)
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Voltage and Phase Rotation Check on Secondary Connections
Job Completion
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4.0 Did outage start on time?
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Why?
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4.1 Did outage end on time?
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Why?
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4.2 Was all work completed as planned (ready for closeout) or in progress over multiple days?
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4.3 Blank (Question related to Cancellation moved to Title Page)
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4.4 Did you encounter issues during planning or execution of the job?
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Include recommendations to prevent recurrence
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4.5 Was the job built to PGE safety, quality, and compliance standards?
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Describe any issues
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4.6 Attach minimum 3 photos of each location (Bottom Half, Top Half, Whole Pole/Location) of completed work.
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4.7 Please use this area to add any notes and corresponding photos concerning this job that you deem appropriate. (Add notes concerning Red Line Approvals in this area also)
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4.8 How many questions were marked Red?
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Inspectors Signature
