Safety Start Card

• SAFETY START CARD

• Foreman

• Conducted on

  Date
• Location
  Address

• Today's Task

SAFETY START CARD

• How could a crew member most likely get hurt today?

  Select struck by traffic struck by equipment crush / pinch dehydration fall from heights slip, trip, fall electric shock

  • struck by traffic
  • struck by equipment
  • crush / pinch
  • dehydration
  • fall from heights
  • slip, trip, fall
  • electric shock

• If other explain.

• How will the crew minimize those hazards

• Does the crew have the correct tools, training and PPE for today's task?

  Select Yes No

  • Yes
  • No

• (List the specific tool(s) and any additional PPE required - refer to PPE visual guide if needed)

  Select hard hat, vest, safety glasses, steel/composite work boots hearing protection GFCI face shield gloves leather chaps fire extinguisher cut resistant chaps goggles respiratory protection whip check rubber boots welding mask vibratory compactor toe guard

  • hard hat, vest, safety glasses, steel/composite work boots
  • hearing protection
  • GFCI
  • face shield
  • gloves
  • leather chaps
  • fire extinguisher
  • cut resistant chaps
  • goggles
  • respiratory protection
  • whip check
  • rubber boots
  • welding mask
  • vibratory compactor toe guard

• If other explain.

• 

• 

• If respirators are needed, are crews medically cleared, fit tested & trained?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• What are the pinch points that a crew member may encounter? (Hands / feet / body placement caught between equipment, material and tools)

• Have any conditions changed since we last worked in this area? (I.e. Traffic, energized power, other trades, tight work areas, weather, new crew member, etc...)

  Select Yes No

  • Yes
  • No

• If yes, explain.

SAFETY REMINDERS

• Has JHA been created / updated and reviewed for this work activity?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Does the new employee / apprentice have a buddy today?

  Yes

  No

  N/A

• Do we have the current utility locate ticket and has site been reviewed?

  Yes

  No

  N/A

• Ticket #

• Will we be near overhead power lines and has checklist been reviewed?

  Yes

  No

  N/A

• 

• 

• 

• 

• Are additional protections needed to work around structures?<br>(i.e. Bridges, buildings, foundations)

  Yes

  No

  N/A

• Do we need a job briefing from a crew that worked in the area prior?

  Yes

  No

  N/A

• Do we need any other permits or forms to perform the work?<br>(i.e. Track access, traffic, confined space, competent person inspection, etc...)

  Yes

  No

  N/A

REVIEWED BY (please print name legibly): DO NOT SIGN IF REVERSE SIDE IS BLANK!

Signature

• Name

  Sign

SAFETY END-OF-SHIFT REVIEW

• Work-related injury reported (if yes, describe below)?

  Yes

  No

• Any equipment/property damage reported (if yes, describe below)?

  Yes

  No

• Any near misses reported (if yes, describe below)?

  Yes

  No

IF YES TO ANY QUESTIONS ABOVE, PRELIMINARY INCIDENT REPORTS NEEDS TO BE COMPLETED AND SUBMITTED TO SUPERVISOR.

• Equipment inspections collected and deficiencies reported?

  Yes

  No

• Is work area cleaned up and secure?

  Yes

  No

• Add media

  Media

• Foreman Signature

  Sign