Transmission Job-Site Observation Form

• Date/Time

  Date

• Inspected By

• Location
  Address

• System Work Order

• Clearance Number

• Hot Line Permit Number

• Employee In Charge

• Emergency Caller

• Crew Members

• Notes/Comments

Housekeeping

• Worksite kept neat and orderly?

  Yes

  No

  N/A

• Damaged/Replaced items removed from site?

  Yes

  No

  N/A

Pre-Job Briefing

• Pre-Job Briefing completed/all hazards reviewed?

  Yes

  No

  N/A

• Emergency procedures reviewed?

  Yes

  No

  N/A

• Everyone briefed and knowledgeable of job expectations?

  Yes

  No

  N/A

• Designated observer in place?

  Yes

  No

  N/A

• Switching procedures reviewed and understood?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• PPE in good condition?

  Yes

  No

  N/A

• Required PPE in-use?

  Yes

  No

  N/A

• Climbing equipment in good condition?

  Yes

  No

  N/A

• Fall protection worn and in good condition?

  Yes

  No

  N/A

• Tools properly inspected and tested?

  Yes

  No

  N/A

• Proper tools available and used?

  Yes

  No

  N/A

• First Aid kits stocked/available?

  Yes

  No

  N/A

• Fire extinguishers charged/available?

  Yes

  No

  N/A

Ergonomics & Working Positions

• Appropriate body positioning?

  Yes

  No

  N/A

• Lifting techniques exhibited correctly?

  Yes

  No

  N/A

• Physical limitations not exceeded?

  Yes

  No

  N/A

• 3-Points of contact used when accessing equipment?

  Yes

  No

  N/A

Energized Work Methods

• Minimum approach distances observed?

  Yes

  No

  N/A

• Voltage(s) identified and source device set to non-reclose?

  Yes

  No

  N/A

• All difference of potential within work area covered?

  Yes

  No

  N/A

• Designated qualified observer in place?

  Yes

  No

  N/A

• Step/Touch potential hazards addressed?

  Yes

  No

  N/A

Work Zone Setup

• Work zone/traffic control meets KDOT or local guidelines?

  Yes

  No

  N/A

• Locates confirmed?

  Yes

  No

  N/A

• Trenching/Excavation guidelines followed?

  Yes

  No

  N/A

• Public protection/barricades in place?

  Yes

  No

  N/A

Vehicle/Equipment Setup & Grounding

• Vehicles/Equipment chocked/outrigger pads used?

  Yes

  No

  N/A

• Vehicles/Equipment are grounded/barricaded/isolated?

  Yes

  No

  N/A

• Employees clear of equipment when in vicinity of energized lines/equipment?

  Yes

  No

  N/A

• Grounds completely uncoiled and within annual test date?

  Yes

  No

  N/A

Lock-Out / Tag-Out

• Lines and equipment to be worked identified?

  Yes

  No

  N/A

• Visible open point established and tagged?

  Yes

  No

  N/A

• Lines/Equipment tested and grounded?

  Yes

  No

  N/A

• Dispatcher and affected employees notified?

  Yes

  No

  N/A

Vehicles/Equipment

• Daily pre-trip inspection performed?

  Yes

  No

  N/A

• Wheel chocks and cones used?

  Yes

  No

  N/A

• Lights on for Safety?

  Yes

  No

  N/A

• Tools/Equipment properly secured?

  Yes

  No

  N/A

• Loads are properly secured and identifying markers in place?

  Yes

  No

  N/A

Material Handling & Rigging

• Rigging equipment properly rated and sized for load?

  Yes

  No

  N/A

• Slings/Hoists inspected prior to use?

  Yes

  No

  N/A

• Employees clear of elevated loads?

  Yes

  No

  N/A

• Proper hand signals/communication used?

  Yes

  No

  N/A