Safety Inspection - Telecom

• Date

  Date

• Contractor

• Site Name

• Carrier

• Location
  Address

• Can The Site Safety Observation Be Performed? Crew present/work being performed?

  Present

  Not Present

• Crewmembers On Site

Safety Paperwork

• JSA Is Thorough and Complete?

  Good

  Fair

  Poor

• PFAS Inspection Log Completed?

  Safe

  At Risk

  N/A

• Written Rescue Plan Completed For Elevated Work?

  Safe

  At Risk

  N/A

• Crew Taking Appropriate Hazard Mitigation Steps Identified In JSA?

  Pass

  Fail

PPE

• Hard Hats

  Safe

  At Risk

  N/A

• High Vis

  Safe

  At Risk

  N/A

• Safety Glasses

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

• Work Attire

  Safe

  At Risk

  N/A

Equipment

• Rescue Kit Out And Readily Accessable?

  Compliant

  Non-Compliant

  N/A

• Rescue Kit Complete With All Necessary Hardware For Tower Rescue?

  Compliant

  Non-Compliant

  N/A

• First Aid Kit Readily Accessible?

  Compliant

  Non-Compliant

  N/A

• First Aid Kit Fully Stocked?

  Compliant

  Non-Compliant

  N/A

• Fire Extinguisher Readily Accessible?

  Compliant

  Non-Compliant

  N/A

• Fire Extinguisher Inspected?

  Compliant

  Non-Compliant

  N/A

• RF Monitor On Tower?

  Compliant

  Non-Compliant

  N/A

• Capstan Installed Correctly With Hitch Pin, Swivel Pin, & Rope Bar?

  Compliant

  Non-Compliant

  N/A

• GFCI Utilized?

  Compliant

  Non-Compliant

  N/A

• Extension Cords Are Free From Trip Hazards or Properly Marked?

  Good

  Fair

  Poor

  N/A

• Site/Job Specific PPE Available and in use?

  Safe

  At Risk

  N/A

Site

• Logged In With NOC?

  Compliant

  Non-Compliant

  N/A

• Logged In With Carrier?

  Compliant

  Non-Compliant

  N/A

• Adequate Warmth or Shade Accessible?

  Compliant

  Non-Compliant

  N/A

• Water Available For Entire Crew?

  Compliant

  Non-Compliant

  N/A

• Structure Inspected Prior To Beginning Work?

  Compliant

  Non-Compliant

  N/A

• Traffic Cones or Barricades Used When Necessary?

  Compliant

  Non-Compliant

  N/A

• Correct Use Of Rigging?

  Safe

  At Risk

  N/A

• Rigging Condition?

  Safe

  At Risk

  N/A

• Warning/Safety Banner In Use?

  Compliant

  Non-Compliant

  N/A

• Appropriate Cert Cards Avaliable? EX: Authoroized/Competent Climber, Rigging, First-Aid/CPR, RF, Crane, Aerial Lift, etc.

  Compliant

  Non-Compliant

  N/A

• Housekeeping, Site Free From Excessive Debris/Trash?

  Good

  Fair

  Poor

Signatures

• Inspector

  Sign