TRC - Distribution Technician & Design Engineer Field Safety Observation

• Review #

• Conducted on:

  Date

• Reporting Office:

• Personnel:

• Job Task:

• Project / Vision Proposal #

• Job Location:
  Address

• Reviewing Person:

General

• Daily Job Site Safety Briefing has been has been filled out, discussed and reviewed with all field personnel. Form is readily accessible.

  Yes

  No

  N/A

• Closest medical facility is identified, including distance to.

  Yes

  No

  N/A

• A minimum of one employee is 1st Aid and CPR trained/certified.

  Yes

  No

  N/A

• General-Additional Comments:

PPE - Personal Protective Equipment -

• Hard hats

  Compliant

  Non-Compliant

  N/A

• Safety glasses

  Compliant

  Non-Compliant

  N/A

• Correct foot wear

  Compliant

  Non-Compliant

  N/A

• Hand protection

  Compliant

  Non-Compliant

  N/A

• List glove type in use (i.e. leather; nitrile; kevlar; other):

• Safety vests

  Compliant

  Non-Compliant

  N/A

• Insulated measuring stick

  Yes

  No

  N/A

• Inspection date is current on stick, it is clean, no visible damage and operating properly

  Compliant

  Non-Compliant

  N/A

• Sufficient drinking fluids are available (personal water jug)

  Compliant

  Non-Compliant

  N/A

• Other PPE:

• PPE-Additional Comments:

Job Site Safety Practices

• Visually inspects pole and work area from a safe distance to identify any hazards prior to approaching.

  Safe

  At Risk

  N/A

• Eliminates hazards or uses safe work practices to minimize hazards. <br>

  Safe

  At Risk

  N/A

• Identifies & positions themselves to avoid pinch points (oncoming traffic, guardrails, etc.) while working

  Safe

  At Risk

  N/A

• Follows established safe work practices when walking along roads with no sidewalks.

  Safe

  At Risk

  N/A

• Follows the established safe work practices when measuring mid-spans where vehicular traffic is possible.

  Safe

  At Risk

  N/A

• Follows the established safe work practices when extending & retracting the insulated measuring stick.

  Safe

  At Risk

  N/A

• Communicates with co-worker throughout the job task.

  Safe

  At Risk

  N/A

• Properly identifies themselves and act in a professional manner when interacting with the public, customers and the client.

  Yes

  No

  N/A

• Job Site Safety Practices-Additional Comments:

Vehicle Compliance / Safety

• Vehicle parked correctly (pull in - pull out, back in - pull out, pull in - back out, etc.).

  Pass

  Fail

  N/A

• Spotter used when backing the vehicle.

  Pass

  Fail

  N/A

• Safety cones and 360 walk a round preformed correctly.

  Pass

  Fail

  N/A

• Beacon is mounted on top vehicle and operating correctly.

  Pass

  Fail

  N/A

• Vehicle registration and insurance certificate current.

  Pass

  Fail

  N/A

• Safety Equipment: fire extinguisher; first aid kit; vehicle safety tool, etc.

  Pass

  Fail

  N/A

• Equipment and other valuables are stored out of sight when vehicle is unoccupied.

  Pass

  Fail

  N/A

• Vehicle Compliance / Safety-Additional Comments:

Signatures

• Reviewer's Signature

  Sign

• Employee 1 Signature

  Sign

• Employee 2 Signature

  Sign