Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Job Site Information

  • Person conducting inspection

  • Date and Time of Visit

  • Crew Leader or person in charge

  • Location of job site

  • Service area

  • Work Order #

Job Communications

  • Is the job briefing complete and correct?

  • Are job assignments clearly communicated?

  • Ground watchman assigned?

  • Is work to be performed energized or de-energized?

  • Job Breifing

  • Crew Members and Assignments

  • Work Order Drawing

Personal Protective Equipment

  • Are hard hats being worn at all times?

  • Is eye protection being worn at all times?

  • Are rubber gloves being used when required?

  • Were rubber gloves tested prior to use?

  • Is FR clothing policy being followed?

  • Are leather work gloves being used at all times?

  • Are there any other forms of PPE needed?

Personal Tools and Climbing Gear

  • Was climbing gear inspected prior to use?

  • Are gaff guards in use while hooks are not in use?

  • Are all hand tools being used properly?

Energized Work Observations

  • Is "hot work" being observed and conducted with care?

  • Has a "one shot" been applied?

  • Are "hold" cards in place?

  • Has the service area dispatch been notified?

  • Is adequate cover-up being used?

  • Has the line been de-energized?

  • Has a visual opening been achieved?

  • Has the line been tested?

  • Are crew members working between grounds?

  • Has the service area dispatch been informed?

General Site Evaluations

  • Were all poles inspected and sounded prior to climbing?

  • Is proper fall protection being used?

  • Are all slings and hand lines in good condition?

Overhead Construction and Tools

  • Are all tools and equipment inspected prior to use?

  • Are all tools and equipment being used properly?

  • Is adequate cover-up being used?

  • Are all grounds in good condition?

  • Is good housekeeping being observed?

Underground Construction and Tools

  • Are all sources of primary feed isolated and grounded?

  • Are all sources of secondary feed isolated and grounded?

  • Are all tools inspected prior to use?

  • Are all tools and equipment being used properly?

  • Is proper cover-up being used?

  • Has excavation been evaluated and safe for work?

  • Is adequate shoring and/or sloping being used?

  • Is good housekeeping being observed?

Vehicle Info and Set Up

  • Have all pre-trip inspections been performed?

  • Are all vehicles set up properly for the job?

  • Are all vehicles coned off where required?

  • Are wheel chock being used properly?

  • Are all vehicles properly grounded where required?

  • Are vehicle grounds in good condition?

  • Is good housekeeping being observed?

Traffic Control

  • Are all forms of flashing lights in operation?

  • Is traffic cone placement adequate for traffic conditions?

  • Are work zone signs adequate for traffic conditions?

  • Are crew members wearing reflective vests while in road ROW?

  • Is a flagman assigned to control and monitor traffic?

Documentation of Job Site Conditions

  • Pictures

  • General notes, corrections, and warnings.

  • Issues that need to be corrected and/or addressed at a later date.

  • Overall evaluation of job site.

  • Overall evaluation of crew members.

  • Certification of Crew Leader in Charge

  • Certification of Field Observer

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.