Title Page

  • Work order number

  • Foreman/supervisor

  • Job date

  • Location

Tailgate

  • Breakers on one shot

  • Other utilities in area

  • PPE required

  • Traffic control needed

  • Presence of protective grounds

  • Environmental conditions

  • Other precautions to be taken

Confirmation

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.