Information

  • Customer

  • Conducted on

  • Prepared by

  • Location
  • TSU One Supervisor

  • Foreman

  • Personnel

1.Audit

2. Job safety hazard analysis (JHA) completed

  • JHA complete as required

3. Bucket Truck

  • Truck number401

  • Registration current

  • Has the DVIR been completed

  • Has both license plates

  • CURRENT DOT inspection

  • Wheel chocks and outrigger pads on all equipment where required

  • Is dielectric testing current

  • Dielectric test date

  • Truck cab are clean and free of debris

  • Belly of truck clean and clear for egress

4.Traffic Control

  • Are cones placed in roadway

5. PPE

  • Rubber gloves have been dielectrically tested within range (6 months stamp/sharpie)

  • Rubber sleeves have been dielectrically tested within range (12 months stamp/sharpie)

  • Rubber blankets have been dielectrically tested within range (12 months stamp/sharpie)

  • Rubber gloves are being worn when required

  • Sleeves are being worn when required

  • Blankets being used when required

  • Employees working aloft are wearing non-conductive body harness

  • And lanyard attached to the proper anchor point

  • Hard hats, road vest, safety glasses, and leather gloves worn as required

  • Proper FR clothing worn as required

  • Is there a qualified ground and bucket rescue person

6. Safety Protective Grounds(SPG's)

  • All equipment requiring grounds are grounded, bonded or barricaded

  • Rubber goods stored to prevent damage

  • Energized conductors and equipment properly covered

  • Neutral and all secondary points of contact properly covered

7. Crane Trucks

  • Daily inspection complete

  • Outriggers and pads properly applied

  • Man basket free of debris and in good working order

8. Rigging Inspection

  • Rating Tag, Checked for damage etc.

Comments

9. TRAILER

  • Is there a trailer on site?

  • a. TRAILER NUMBER?

  • b. IS REGISTRATION CURRENT ON TRAILER?

  • c. DOES THE TRAILER HAVE A LICENSE PLATE?

  • d. DOES THE TRAILER FLOOR HAVE HOLES?

  • e. TIRES-GOOD TREAD DEPTH/EVEN WEAR/LUG NUTS?

  • f. TRAILER LIGHTS GOOD CONDITION?

  • g. TRAILER BREAK AWAY CABLE ATTACHED AND IN GOOD CONDITION?

  • h. IS BREAKAWAY BATTERY CHARGED/GOOD CONDITION?

  • I. TRAILER CHAINS ATTACHED PROPERLY?

  • j. TRAILER RAMPS IN GOOD CONDITION?

  • k. TRAILER HITCH RECIEVER IN GOOD CONDITION?

  • l. DOES TRAILER HAVE AN ADEQUATE SPARE TIRE?

  • m. OVERALL CLEANLINESS?

  • ADDITIONAL COMMENTS

  • Comments

  • Add drawing

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.