• Select date

Job Site Information

  • Describe Work Being Performed

  • Type of work being performed

  • Work is being performed

  • Grounded Work

  • Grounds and LO/TO In Place

  • Isolated Work

  • Energized Work

Crew Information

  • Crew Leader

  • Crew

  • Trucks and Equipment

PPE and Safety Precautions

  • Job Briefing - Take Photo(s) Please

  • Hard Hat

  • Safety Glasses

  • FR Clothing

  • Hearing Protection

  • Rubber Gloves

  • Rubber Sleeves

  • Fall Protection

  • Traffic Vest / Hi-Viz Garment

  • Traffic Control - Take Photo(s) Please

  • Personal Protective Ground - Visible From Worksite

  • Cover Up - Take Photo(s) Please

Equipment and Vehicle Safety

  • Wheel Chocks

  • Outrigger Pads

  • Daily Inspection

  • Equipment Grounds

  • Hand-line in Bucket

Overview of Observed Work Practices

  • What went well:

  • What went well:

  • What needs attention:

  • What needs attention:

  • Violation(s) of known safety rules:

  • Violation(s) of known safety rules:

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