PEC JOB SITE SAFETY OBSERVATION

• Document No.

• TO: District Manager:

• District:

• Conducted on

  Date

• Prepared by and Date:

• Received by and Date:

• Location: Address
  Address

• Personnel on Location

• Task Description:

• Hazard Identification:

1. SAFETY MANUAL

• Safety Manual On Site?

  Yes

  No

  N/A

2. EMERGENCY PLAN IN PLACE

• Emergency Plan in Place

  Yes

  No

  N/A

3 JOB BRIEFING/TAILBOARD

• Job Briefing /Tailboard

  Yes

  No

  N/A

4. PERSONAL PROTECTIVE EQUIPMENT

• A. Hard Hat

  Yes

  No

  N/A

• B. Proper Foot Wear

  Yes

  No

  N/A

• C. Fall Protection

  Yes

  No

  N/A

• D. Eye Protection

  Yes

  No

  N/A

• E. Reflective Vest

  Yes

  No

  N/A

• F. Long Sleeve Shirt/ FR Clothing

  Yes

  No

  N/A

• G. Other

  Yes

  No

  N/A

5. RUBBER GOODS

• A. Rubber Gloves/Sleeves

  Yes

  No

  N/A

• B. Used as Required

  Yes

  No

  N/A

• C. Blankets/ Line Hose/ Cover-up

  Yes

  No

  N/A

• D. Point of Contact, Within Reach or Extended Reach are Covered

  Yes

  No

  N/A

• E. Proper Storage

  Yes

  No

  N/A

6. MATERIAL HANDLING/RIGGING

• A. Hand Line in Use

  Yes

  No

  N/A

• B. Correct Rigging Utilized

  Yes

  No

  N/A

7. GROUNDS

• A. In Safe Working Condition

  Yes

  No

  N/A

• C. Properly Applied

  Yes

  No

  N/A

• D. Voltage Indicator Used

  Yes

  No

  N/A

8. WORK AREA

• A. Traffic Control/Protection

  Yes

  No

  N/A

• B. Equipotential in Use

  Yes

  No

  N/A

• B. Properly Applied

  Yes

  No

  N/A

• C. Housekeeping

  Yes

  No

  N/A

9. TOOLS

• A. Safe Working Condition

  Yes

  No

  N/A

• B. Proper Storage

  Yes

  No

  N/A

• C. Hot Stick (Inspected)

  Yes

  No

  N/A

10. HAZARDOUS MATERIAL

• A. Proper Storage

  Yes

  No

  N/A

• B. Properly Labeled

  Yes

  No

  N/A

• MSDS Available

  Yes

  No

  N/A

11. LADDER/SCAFFOLDS

• A. In Safe Working Condition

  Yes

  No

  N/A

• B. Used Properly

  Yes

  No

  N/A

12 EXCAVATIONS

• A. Competent Person

  Yes

  No

  N/A

• B. Checklist In Use

  Yes

  No

  N/A

• C. Shored/Sloped Properly

  Yes

  No

  N/A

• D. Ladder Access within 25'

  Yes

  No

  N/A

• E. Other

  Yes

  No

  N/A

13. MANHOLES/VAULTS(Non-Permit Required)

• A. Non-Permit Checklist in Use

  Yes

  No

  N/A

• B. Monitor Blower in Use

  Yes

  No

  N/A

• C. Barricades in Use

  Yes

  No

  N/A

• D. Other

  Yes

  No

  N/A

14. TEMPORARY POWER GENERATORS

• A. Cords<br>

  Yes

  No

  N/A

• B. GFCI in Use

  Yes

  No

  N/A

15. VEHICLES/ EQUIPMENT

• A. In Safe Working Condition

  Yes

  No

  N/A

• B. Grounded/ Barricaded

  Yes

  No

  N/A

• C. Inspected/ Tested

  Yes

  No

  N/A

• D. Safety Equipment

  Yes

  No

  N/A

• E. Wheels Chocked

  Yes

  No

  N/A

16. ONE SHOT OBTAINED

• A. One Shot Obtained

  Yes

  No

  N/A