Sample Tailboard updated

• Utility

• WO or Job Number

• Conducted on

  Date

• Prepared by

• Foreman/GF name

• Location
  Address

• Cross Street

• Landmark

• Police, Fire, Ambulance 911

• Nearest Hospital

• Hospital Phone

• Location of Emergency Equipment, Muster Points, Ambulance Rendezvous Area)

• Designated First Aid person (name and number)

• Fire suppression Tools on Site (check all that apply)

  Yes

  No

  N/A

• Fire extinguisher

• Pulaski

• Shovel

• Water Can/Buffalo

Circuit Protection Plan

• Circuit #

• Voltage

• Clearance

  Yes

  No

  N/A

• Clearance Number

• Dispatch #

• Dispatch POC

• Nominal Voltage

• Minimum Approach Distance

• Qualified Observer (Required when working near energized equipment)

  Sign

• Isolation points verified

  Yes

  No

  N/A

• Tested

  Yes

  No

  N/A

• Grounded

  Yes

  No

  N/A

• Live Line NTO

  Yes

  No

  N/A

• Self Protection

  Yes

  No

  N/A

• Time Received

  Date

• By whom

• Time Returned

  Date

Grounding

• Following Job Grounding Plan

  Yes

  No

  N/A

• Location of grounds

• Grounding Pole tags applied

  Yes

  No

  N/A

• Is epz grounding being used

  Yes

  No

  N/A

• Time Grounds were installed

  Date

• Time Grounds Were removed

  Date

Identify Hazardous Energy

• Chemical

  Select Toxic or poisonous Flammable Explosive N/A

  • Toxic or poisonous
  • Flammable
  • Explosive
  • N/A

• Temperature

  Select Thermal heat/cold Hydration N/A

  • Thermal heat/cold
  • Hydration
  • N/A

• Biological

  Select Plant Life Animals N/A

  • Plant Life
  • Animals
  • N/A

• Pressure

  Select Hydraulic pressure Pneumatic pressure N/A

  • Hydraulic pressure
  • Pneumatic pressure
  • N/A

• Sound

  Select Equipment Operations Power tools N/A

  • Equipment Operations
  • Power tools
  • N/A

• Mechanical

  Select Equipment failure Proper pick points Loads under tension Excavation Proper rigging N/A

  • Equipment failure
  • Proper pick points
  • Loads under tension
  • Excavation
  • Proper rigging
  • N/A

• Motion

  Select Traffic control Rough terrain Unsecured loads Loading and unloading Equipment Stability Pinch points N/A

  • Traffic control
  • Rough terrain
  • Unsecured loads
  • Loading and unloading
  • Equipment Stability
  • Pinch points
  • N/A

• Electrical

  Select Energized equipment Induction Static charge Back feed Flash potential Touch potential Underground utility Step Potential

  • Energized equipment
  • Induction
  • Static charge
  • Back feed
  • Flash potential
  • Touch potential
  • Underground utility
  • Step Potential

• Gravity

  Select Aerial work Falling objects Working overwater Flying objects

  • Aerial work
  • Falling objects
  • Working overwater
  • Flying objects

Hazard assessment, control plan

• task steps

• Hazards associated with task

• Elimination or control methods

• task steps

• Hazards associated with task

• Elimination or control methods

• task steps

• Hazards associated with task

• Elimination or control methods

• task steps

• Hazards associated with task

• Elimination or control methods

• task steps

• Hazards associated with task

• Elimination or control methods

Crew members

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