Title Page
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Party Chief enter name
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First Name:
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Last Name:
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Today's Date
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Project Number:
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Project Name:
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Client:
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Survey Director
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State
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconson
- Wyoming
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County
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Expected Work Tasks
- Setting Monumentation
- Preliminary Staking
- Preliminary Topo Survey
- Utility Locating
- Boundary Survey
- Construction Staking
- As-built Survey
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Other (if task not found above)
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PPE to be Used
- Hard Hat
- Eye Protection
- Safety Shoes
- Type II Safety Vests
- Gloves
- Bug Spray
- Sun Screen
- Survey Signs
- H2S Monitor
- Strobe Light
- FRC's
- Hearing Protection
- Life Vest
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Other PPE (if not listed above)
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Hazard Analysis and Safe Work Plan (List major anticipated hazards, analyze the risk, and list your plan for working safely.)
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Safety Equipment Checklist
- Vehicle 360 Walk-around
- Smith System
- First Aid Kit
- Hospital Location Map
- Weather Report
- Tools Inspected
- Excavation Safety
- Emergency Comms Awareness
- Fences (AUTO)
- Crew/Loads Secure
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Other Safety Equipment (if not listed above)
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List all employees present for meeting:
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Signature
