Red Tail Tower JSA

• Job Number

• Tower Site ID

• Longitude

• Latitude

• Date

  Date
• Site Address
  Address

• Supervisor / Competent Person

• Work Being Performed (Check All That Apply)

• Line and Antennas

• Tower Erection

• Civil

• Electrical

• Maintenance

• Other

• What Type of Work Being Performed?

• Describe Elevation/Site Terrain/Environmental Concerns of Hazards

• Name (List All Employees Onsite)

• Name of Competent Climber/Rescue

• Name of Individual CPR/First Aid Certified

• Are 911 systems functional with cell phone use?

  Yes

  No

  N/A

• Rescue Procedures to Be Used

• Internal Crew (crew has to be properly trained in tower rescue)

• Other

• What other sources are being used for rescue?

• Site Specific Rescue Plan

• Evacuation Point (Location)

• Communication Point

• Closest Medical Clinics

• Local ER/Hospital (Name)

• Local Occupational Clinic (Name, If Applicable)

Physical Hazards (Check All That Apply)

• Falls From Elevations

• Slips, Trips, or Falls

• Vehicle Traffic

• Electrical Cut-Overs

• Electrical

• Underground Utilities

• Elevation/Site Terrain

• Intrusive Activity

• Drilling

• Soil Excavation

• Material Handling

• Heavy Equipment

• Overhead Utilities

• Permit Required

• Confined Space

• Night Work

• Hot Work

• Fire Hazards (Check All That Apply)

• Combustible Materials

• Fuel/Gas Containers

• Other

• List

Health Hazards (Check All That Apply)

• Heat Stress

• Cold Stress

• High Noise (<85 dBA)

• Silica Exposure (Concrete Cutting)

• Lifting Hazards

• Chemical Exposure

• EME/RF

• Other

• List

PPE/Monitoring Equipment (Check All That Apply)

• Hard Hats

• Safety Glasses

• Hearing

• Fall Protection

• RF Suits

• RF Monitors

• Face Shields

• Apron

• High Viz Vest/Clothing

• Safety Toed Shoes

• Electrical Gloves

• Insulated Tools

• Gloves (i.e. leather, mechanical, cut resistant)

• Other

• List

• Notify your HSE Manager before entering a trench/excavation that is great than 5' deep

• Notify your HSE Manager before entering a Permit Required Confined Space

• Notify your HSE Manager prior to performing night work (periods of darkness change with the seasons)

Inspections Completed (Check All That Apply)

• Tools/Equipment

• Housekeeping

• Ground Fault Protection

• Hoists

• PPE

• Ladders

• Rigging

• Tag Lines

• Gin Poles

• Ropes

• PFAS

• Other

• List

• Notify your HSE Manager before entering a trench/excavation that is greater than 5' deep

• Notify your HSE Manager before entering a Permit Required Confined Space

• Notify your HSE Manager prior to performing night work (periods of darkness change with the seasons)

Safety Program/Training (Check All that Apply)

• Tailgate Meeting Conducted?

• Site Signage Conspicuously Posted?

• Lockout/Tagout Performed?

• Excavation Log Completed?

• Permit System Completed? (Hoisting Personnel)

• Notify your Health and Safety Manager before entering a trench/excavation that is greater than 5' deep.

• Notify your Health and Safety Manager before entering a Permit Required Confined Space

• Notify your Health and Safety Manager before performing night work (periods of darkness change with the seasons)

• Task 1

• Task 2

• Task 3

• Task 4

• Task 5

• Task 6

• Task 7

• Task 8

• Task 9

• Task 10

• Hazard 1

• Hazard 2

• Hazard 3

• Hazard 4

• Hazard 5

• Hazard 6

• Hazard 7

• Hazard 8

• Hazard 9

• Hazard 10

• Control 1

• Control 2

• Control 3

• Control 4

• Control 5

• Control 6

• Control 7

• Control 8

• Control 9

• Control 10

• Other

General RF Site Requirements

• All employees or subcontractors entering into an environment that meets the criteria of the FCC/OET Bulletin 65, as a Controlled Environment, must adhere to the following requirements:

• All personnel must have annual RF site safety awareness training

• All personnel must be able to read and understand RF site signage

• All personnel must have authorized access to the RF site

• Personnel must have means of determining Maximum Permissible Exposure (MPE) levels at each work location

• Personnel must monitor MPE level requirements of the OET Bulletin 65 and other transmitting frequencies they may be exposed to

Site Specific RF Requirements

• MPE Data will be determined by the use of an RF monitor

• If MPE readings are 100% or above, all personnel must remove themselves from the RF field and contact their safety representative for further guidance

• S/N:

• MPE %:

• S/N:

• MPE %:

• Maximum MPE level recorded at work location?

Controlling Methods for Limiting RF Exposure (Check All That Apply)

• Reduce power levels of transmitting antenna

• Full removal of power from transmitting antenna/sector

• Administer Lock-out/Tag-out procedures

• Personnel Protective Equipment (RF Suit)

• Other

• Explain

• Type of Tower/Rooftop

• Type of Equipment Mount

• Fall Protection to Be Used (Check All That Apply)

• Full Body Harness

• Double Leg or Two Lanyards

• Rope Grab

• Cable Grab

• Retractable Lifeline

• Anchorage Straps

• Ropes

• Descenders

• Other

• Type

• 1. Has each employee inspected his or her fall protection equipment?

  Yes

  No

  N/A

• 2. Describe the fall protection system to be used when accessing antenna booms or performing tower erection:

• Hoisting Equipment to Be Used (Check All That Apply)

• Personnel Platform/Manbasket

• Crane/Boom Truck

• Capstan Hoist

• Gin Pole

• Winch

• Other

• Explain

Onsite Personnel

• Name

  Sign

• Name

  Sign

• Name

  Sign

• Name

  Sign

• Name

  Sign

• Name

  Sign

• Name

  Sign

• Name

  Sign

• Name

  Sign

• Name

  Sign