Title Page
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Conducted on
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Weather Conditions
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Division
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Show Up Location
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Customer
- ACE
- BGE
- DELMARVA
- PECO
- PEPCO
- Crown Castle
- Blair Park
- Storm Restoration
- Service Work
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Work Type
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Work Order Number
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Job Location
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Prepared by
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Preparer Employee Number
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Superintendent
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General Foreman
- Bob Krieger
- Al Agostino
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Supervisor/Foreman
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Job Description
Job Briefing Form
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Job Briefing Form
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Are All Applicable Event Free Performance Tools Documented on the Job Briefing Form?
Rules & Procedures
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Are All Applicable Event Free Performance Tools Being Utilized by the Crew?
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Energy Source Hazards Identified with Energy Wheel.
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360° Walkaround
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Wheel Chocks
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Outrigger Pads
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Situational Awareness / Eyes on Path
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Signaling & Spotter
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Hazard Communication
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Proper Hydration & Fatigue Management
Work Area Protection
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Green Cone
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Traffic Control
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Work Zone
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Line of Fire From Above Zone
PPE
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Head Protection
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Eye Protection
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Hand Protection
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Foot Protection
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Rubber Gloves & Sleeves
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Dielectric Footwear
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Fall Protection
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Hearing Protection
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Chainsaw Chaps
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Respiratory Protection
Rubber & Hard Cover
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Rubber Cover Inspected and in Good Condition?
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Hard Cover Inspected and in Good Condition?
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Proper Cover Installed?
Grounding & Bonding Systems
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Grounds Inspected and in Good Condition?
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Line / Equipment Tested Properly and Confirmed De-energized?
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Primary Grounds Installed as Required? (Specify EPZ, Running etc, LOF))
Tooling & Equipment
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Tool Condition
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Tool Use
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Equipment Condition
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Equipment Use
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Insulated Tools
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Voltage Testers
Ergonomics
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Three Points of Contact
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Lifting
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Work Positioning
Housekeeping
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Clutter
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Garbage
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Tripping Hazards
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Spills / Leaks
Emergency Response Material
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Fire Extinguishers
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First Aid Kits
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AED
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Burn Kit
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Eyewash Stations
Excavation Safety
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One Call / Dig Ticket
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Prudent Digging Methods
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Spoil Retention
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Excavation Securement
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Emergency Rescue
Other Hazards
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Other Hazards Identified and Mitigated?
Additional Comments
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Additional Comments
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Pictures
Audit Closeout
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Audit Closure