Information
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Project Number
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Client / Site
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Conducted on
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Prepared by
1.0 check applicable anticipated or potential hazards
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Activities in or near traffic areas:<br><br> - Give vehicles the right of way.<br><br> - Make eye contact with drivers.<br><br> - HiVis vests should be worn in high traffic areas.
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Live electrical work (includes high test voltage and / or current)
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Lifting heavy objects:<br><br> - Use 2 men when lifting objects heavier than 50-pounds.<br><br> - Lift with your legs, not your back.<br><br> - Ensure you have proper footing when lifting or walking with heavy objects.
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Other (specify) :
2.0 critical procedures: where work involves any of the following hazards must be incorporated into JSA
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Work at heights above 6ft:<br><br> - Requires harness for elevated work.<br><br> - Harness shall be tied off to anchor points that are capable of supporting 5000-pounds.<br><br> - Inspect lanyards, harness and fall arrest equipment prior to use.<br>
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Operation of Bucket Truck, Boom or Lifts. If so, an iAuditor checklist to operate is completed before use.
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Confined space entry - Requires a Confined Space Permit prior to work.
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Electrical/Mechanical lockout (live, isolation, lock out / tag out:<br><br> - All personnel shall their own personal lockout device affixed to the energy source OR a group lockout is completed w/ site lead's locks applied and key inserted in LOTO gangbox.<br><br> - All personnel shall review the electro/mechanical drawings to ensure all energy sources have been isolated and energy has been 'bled' off source. <br><br> - All equipment is verified de-energized with a calibrated DMM ("Live-Dead-Live");<br><br> - OR - <br><br> - Low voltage equipment shall be tested with a non-contact voltage detector ("Live-Dead-Live");<br><br> - OR -<br><br> - Medium / High voltage equipment tested with HV 'Pumpkin' ("Live-Dead-Live")<br>
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Energized Work Permit Required? If so, an iAuditor checklist is required prior to commencing work.
3.0 Training Requirements
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Are all site personnel qualified OSHA 10 / 30 if required by client / project requirements?
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CPR and First Aid qualified members identified
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MSHA Safety and Health Required and all team members qualified and have OSHA card?
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Site Specific
4.0 Site Safety Checklist - Review the following hazardous tasks and identify risks that need to be mitigated prior to commencing work.
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Safe Ladder procedures reviewed.
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Hazardous Materials - MSDS available to site team.
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System(s) being tested have proper LOTO and ALL team members have locks applied.
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Verification of all Energy Storage Systems removed and verified prior to commencing work.
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Test equipment properly grounded and inspected prior to usage.
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Condition of tools and cords inspected prior to use.
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Ground Fault Circuit Interrupter (GFCI) shall be used on all temporary power sources.
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Evacuation areas identified in case of emergency?
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First aid station available and hospital location known.
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Fire extinguishers available in immediate work area.
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Strap & tie down safety inspection completed when transporting test equipment to ensure equipment is properly secured.
5.0 Tools / Equipment ( list of tools and equipment and their storage on site
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Test equipment being utilized onsite.
- High Current Test Set
- Power Factor Test Set
- CT / PT Test Set (EZCT, etc.)
- Megger
- Ductor
- Relay Test Set
- Hipot (AC / DC / VLF)
- Power Supply (AC / DC)
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Other test equipment not listed:
6.0 Personal Protective Equipment
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Personal Protective Equipment (PPE) Required
- Safety Glasses
- Hard Hat
- Hi-Vis Vest
- Safety Shoes
- FR Clothing
- 40-Cal Blast Suit
- Electrical Safety Gloves
- Protective Gloves
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Hearing protection required?
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Fall protection required?
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Portable gas monitor required?
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Breathing apparatus required?
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Other
7.0 Tool / Ground Accountability
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Ensure all tools being used for the project are accounted for at the end of each day. All tools entering the jobsite = all tools leaving the jobsite.
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Verify all shorting straps or bus are accounted for at the end of each day. Those that were required to remain in place from day before are discussed and documented in the comments.
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Verify all temporary safety grounds are properly hung before work commences and removed at the end of the project. Those required to remain in place from day before are discussed and documented in the comments.
8.0 Waste disposal (Check appropriate box where waste should be disposed):
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Waste Disposal
- Onsite in approved container per client directive
- Taken offsite and returned to WES field office for later disposal
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Other
9.0 Client Representative
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Client Representative (when required)
10.0 Site Personnel
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Check all WES Field Service personnel on jobsite:
- MATT WALLACE
- JASON CARLSON
- DEREK DAHLSTROM
- WALLY SCHWANTES
- DARIN CHURCHILL
- DERYN MINOR
- JOEL WILBUR
- JIM BOTSFORD
- MATT THOMAS
- SEAN CONLEY
- TOBY KING
- CHRIS PARRISH
- BRANDEN AGUIRRE
- BART BRANDT
- ANTHONY DIAZ
- NICK HANSEN
- SANTIAGO PARRA
- GAGE BILLINGSLEY
- GREG LOCKWOOD
- LARRY LOCKWOOD
- KYLE PETERSON
- ERIC WEISS
- MAMADOU DIALLO
- CHARLIE RAY
- ETHAN BANGS
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List all additional WES personnel onsite:
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JSA approved
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Date
