Title Page
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Work Order/Service Order Number
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Date
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Location
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Supervisor in charge
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Abnormal Weather Conditions
Risk Identification
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Were job assignments and hazards associated with the job identified and discussed?
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Were safety rules and work procedures discussed?
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Was the 300' mowing area checked for employees and members of the public?
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Were obstacles identified in the tree fall area?
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Was utility equipment identified (pedestals, waterline valve covers, gas equipment, etc.)?
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Was the jobsite terrain checked for ditches or steep slopes?
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Were trees checked for dead or broken branches?
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Were energy sources located (line feed, proximity of power line)?
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PPE Used (select all that apply)
- Hard Hats
- Safety Glasses
- Rubber Gloves
- Sleeves
- FR Clothing
- Harness
- Other
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Were gloves visually inspected and air tested?
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List other PPE used
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Was traffic control equipment used?
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Equipment Inspected
- Skidsteers
- Chipper and Dump Bed Truck
- Other
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List other inspected equipment
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Questions/Comments
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Supervisor
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Crew
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