Serviceman Observation Form

• Serviceman

• Conducted on

  Date

• Prepared by

• Location
  Address

Personal Protective Equipment

• Is eye protection being worn at all times?

  Yes

  No

  N/A

• Are hard hats used?

  Yes

  No

  N/A

• Is hand protection being used?

  Yes

  No

  N/A

• Is foot protection appropriate to the job?

  Yes

  No

  N/A

• Is hearing protection used when needed?

  Yes

  No

  N/A

• Is proper FR clothing being worn?

  Yes

  No

  N/A

• Comments:

Vehicles

• Are vehicles properly grounded?

  Yes

  No

  N/A

• Daily inspection performed?

  Yes

  No

  N/A

• Bucket properly set up?

  Yes

  No

  N/A

• Are wheel chocks used?

  Yes

  No

  N/A

• Comments:

Overhead and Underground Construction

• All equipment inspected prior to use?

  Yes

  No

  N/A

• All equipment used correctly?

  Yes

  No

  N/A

• Are hand lines used?

  Yes

  No

  N/A

• Is there good housekeeping?

  Yes

  No

  N/A

• Comments:

Energized Work

• Are rubber gloves used while operating a hot stick?

  Yes

  No

  N/A

• Are rubber gloves worn while removing meters?

  Yes

  No

  N/A

• Were rubber gloves tested prior to use?

  Yes

  No

  N/A

• Are rubber gloves correct ratings for work being performed?

  Yes

  No

  N/A

• Are approach distances maintained?

  Yes

  No

  N/A

• Comments:

General

• Is proper fall arrest being used?

  Yes

  No

  N/A

• Are slings in good shape?

  Yes

  No

  N/A

• Are jobs being closed out properly?

  Yes

  No

  N/A

• Are poles inspected before climbing?

  Yes

  No

  N/A

• Was climbing gear inspected before use?

  Yes

  No

  N/A

• Are gaff guards being used?

  Yes

  No

  N/A

• Comments:

Traffic Control

• Were proper warning lights used?

  Yes

  No

  N/A

• Was reflective vest worn?

  Yes

  No

  N/A

• Were cones adequate for the job?

  Yes

  No

  N/A

• Comments:

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