Title Page
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Job Site Name
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Customer
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Location
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Conducted on
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Prepared by
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Crew Foreman
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General Foreman
Safety and Personal Protective Equipment Compliance
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Employee Name
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Hearing Protection
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Eye Protection
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Chainsaw Protection
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Reflective Vest
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Head Protection
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Lanyard(s)
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Fall Protection
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Rubber Gloves
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Long Sleeve Shirt
General
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First Aid Kit
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Spill Kit
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Material Safety Data Sheets / Safety Data Sheets
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Equipment Inspection
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Daily Job Briefing
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Tailgate Safety
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Traffic / Site Control
Vehicles
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Vehicle #
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DOT Log Book
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Outrigger Pads
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Dielectric Date
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Signs
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Cones
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Flagman/Spotter
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Fire Extinguisher
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Pre/Post Trip Inspections
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Triangles
Comments
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Inspector Name
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Inspector Signature
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Crew Foreman Name
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Crew Foreman Signature