Title Page
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Document Number (TBSM_YYMMDD_AREA):
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Date & Time
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Project/Task
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Location of Worksite
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Crew Lead (w/ Callsigns):
- Heather Steere (1PH30)
- Alec Patterson (1PH31)
- Chris Branting (1PH32)
- Aaron Miller (1PH2)
- Steve Simpson (1PH11)
- David Jack (1PH40)
- Simon Johnson (1PH41)
- Rob Manning (1PH42)
- Jessie Moore (1PH50)
- Mattias Morrison (1PH51)
- Eric Krasman (1PH52)
- Derek Moore (1PH60)
- Tom Porsborg (1PH61)
- Eli Simcoe-Metcalfe (1PH62)
- Wyatt Richards (1PH63)
- Others
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Crew Members (w/ Callsigns):
- Heather Steere (1PH30)
- Alec Patterson (1PH31)
- Chris Branting (1PH32)
- Aaron Miller (1PH2)
- Steve Simpson (1PH11)
- David Jack (1PH40)
- Simon Johnson (1PH41)
- Rob Manning (1PH42)
- Jessie Moore (1PH50)
- Mattias Morrison (1PH51)
- Eric Krasman (1PH52)
- Derek Moore (1PH60)
- Tom Porsborg (1PH61)
- Eli Simcoe-Metcalfe (1PH62)
- Wyatt Richards (1PH63)
- Others
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Project Safety Plan (PSP) required?
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Site Weather Conditions (Condition, POP, Wind, Sea state...etc.):
PART #1: Pre-Work Briefing
Scope of Work
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Discussion of Daily Workplan
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Hazards Identified? (i.e., vessel operations, working alone, chainsaw...etc.)
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Hazard mitigations? (i.e., PPE, ST/EPs, Training...etc.)
Communication Procedures
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Designated SafetyLine User
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SafetyLine check-in intervals (start/frequency/end)?
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Will all crew members be working together?
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Inter-group communication plan? (i.e., half hour check-ins via radio...etc.)
Emergency Procedures
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Location of First Aid Kits & Emergency Resources
- Vehicle
- Vessel
- Personal First Aid Kit
- Central Location
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Designated First Aid Attendant
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Nearest Medical Facility?
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Responding Emergency Service?
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ETA for Response?
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Extrication Point(s)
PART #2: Post Work Debrief
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Crew Members- everyone accounted for?
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Follow-up Required?
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List required actions/items for follow-up:
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Accidents, near misses, concerns?
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Discuss as required:
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Suggested Improvements or Recommendations?
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Discuss as required:
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Additional Notes:
