Information
-
Company Name:
-
Utility Name
-
Auditor(s) name:
-
Date/Time:
DESCRIPTION OF THE JOB
-
Jobsite location:
-
Name of foreman in charge:
-
Describe type of work being performed:
-
Are lines energized or de-energized:
-
Secondary or Distribution (or both):
-
Overhead or Underground:
JOB PREPARATION
-
Was tailgate/job briefing conducted and documented:
-
All applicable hazards identified
-
Pre-trip inspection was performed on CMV(s):
-
Pre-flight of aerial unit was performed:
-
Energy source controls (Energy Control/LOTO) have been identified:
-
DVIR Filled out correctly
WORK ZONE EVALUATION
-
Hard hat(s) properly worn and in good condition:
-
Eye protection in ANSI approved and worn:
-
Proper hand protection is being used:
-
Safety toe boots are being used:
-
Hearing protection is available:
-
FR clothing is in good condition:
-
Rubber gloves worn and inspected prior to use:
-
Rubber sleeves worn and inspected prior to use:
-
Fall protection used where appropriate and all components inspected prior to use:
-
Hand line available and in good condition
-
Proper cover-up on work as well as second points of contact
-
Designated observer as required on HOT WORK
-
Clear 3-way communication among crew members
TRAFFIC CONTROL
-
Beacon/strobe lights are in working order and being used:
-
Traffic cones are used and properly placed:
-
Road signs are adequate for the job being performed:
-
Reflective vests are worn:
-
A flagger is being used to control traffic:
GROUNDING
-
Digger/Bucket Truck grounds are being used and in good condition:
-
Personal grounds are being used and in good condition:
-
Conductor was tested prior to grounds being installed:
-
Crew members can explain proper grounding techniques:
-
Grounds are properly stored:
VEHICLES
-
Digger/bucket trucks are properly set up:
-
Wheel chocks are being used:
-
All material on the vehicle is properly stowed:
-
Outrigger pads are being used:
-
Fire extinguishers are properly charged and stored and inspected
-
First-aid kit is stocked and location is properly marked:
-
AED is available and location is properly marked:
GENERAL WORK PRACTICES
-
Proper tools are being used to complete the task:
-
Tools have been inspected and are in good condition:
-
Live-line tools have been inspected prior to use and tested within 2 years:
-
Ladders have been inspected and are in good condition:
-
Means of ingress/egress present in excavations >4 feet:
-
Excavations >5 feet have been shored/stepped back by a competent excavation safety trained employee:
-
Poles are tested prior to climbing:
-
Only qualified personnel are performing hazardous work:
-
Guards are in place on tools and equipment that need them:
AUDITOR VERIFICATION SIGNATURE(S)
-
Safe jobsite:
-
Safe work procedures followed:
-
Comments: ("NO" items require an explanation)
-
Signature: