Title Page

  • Customer name

  • Job Site Name

  • Job Site Location
  • Conducted on

  • Prepared by

  • Crew Foreman

Safety Training

  • Have employees been trained on the proper use, inspection, and maintenance of tools and equipment

  • Has a job briefing been completed before the start of the job

  • Is the job briefing formal

Electrical Hazards

  • Do electrical hazards exist on this job site

  • If yes fill out the rest of the questions in the Electrical Hazards section

  • Have employees been trained to recognize and qualified to work within proximity to electrical hazards

  • Are the employees aware what the voltage of the lines are

  • Are the employees at the proper distance

  • If the distance is not correct did the employer implement a hazard abatement plan

  • Are employees using non-conductive equipment and tools when working around energized electrical conductors<br>

  • If employees are closer than 10 feet to an energized line, is there a second qualified line clearing worker within visual or voice communication

  • Are tie-ins for climbers above the work area and located so if the worker were to slip it would swing them away from the energized line<br>

Traffic Control

  • Is the job site exposed to traffic

  • If Yes, answer the following questions in the Traffic Control section

  • Have employees been trained in working next to traffic and setting up signs & barricades

  • Are employees exposed to traffic wearing high visibility apparel

Emergency Proceedures

  • Is there a first aid kit on the job site

  • Have employees been trained in identifying poisonous plants & animals

  • Have employees been trained in emergency response and rescue procedures

  • Have employees been trained in general first aid and CPR

Personal Protective Equipment Compliance

  • Hard Hat

  • Face Protection

  • Hearing Protection

  • Eye Protection

  • Cut resistant leg protection for chainsaw operators on the ground

Chain Saws

  • Do climbers have their chain saws secure when working aloft

  • Are employees operating the chain saws with two hands

  • Are climbers that are using chain saws using a second means of being secure to the tree

  • If the chain saw is being carried more than two feet is the chain brake engaged or saw shut off

General

  • Is equipment being run at least 10 feet from refueling areas

  • Are flammable liquids stored and dispensed from approved containers<br>

  • Is smoking prohibited when handling or working around flammable liquids<br>

  • Are fire extinguishers seen on the job

  • Ladders in good condition

  • Are the tree climbers secure at all times while working in the tree, including climbing up

  • If work is above 12 feet is there a second worker trained in emergency procedures within visual or voice communication

  • Is the tie-in position above the climber in the tree

  • Has a safe drop zone and communications been established between employees before cutting begins

  • Are large limbs that cannot be controlled by the climber lowered down with rigging line

  • If workers are installing a cabling system are they positioned to the side of it

  • Is brush being chipped, shredded, or dumped and not burned

Brush Chippers

  • Have employees been trained on how to operate wood chippers

  • Do chippers without mechanical in feed systems have anti-kickback device

  • Are the chippers with mechanical feeds equipt with quick stop and reversing device

  • Is the proper PPE being used loading the chipper

  • Are employees loading the chipper in a safe manner

Stump Grinders

  • Are employees properly trained on how to use wood chippers

  • Are there enclosures or guards on the grinder

Pesticide Applications

  • If pesticides are being applied fill out the rest of the questions in this section

  • Are pesticide applicators liscensed

  • Have employees been trained in OSHA's HAZCOM Standard

  • Is there a clean water source at the work site for emergency decontamination<br>

  • Is proper PPE being used based on the chemicals SDS sheets

Vehicles and Aerial Devices

  • Vehicle #

  • Are outriggers or stabilizers out and on pads

  • If there are no outriggers, are the wheels chocked<br>

  • If there are no outriggers, are the wheels chocked

  • Dielectric Date

  • Signs

  • Cones

  • Are employees wearing the correct fall protection in the bucket<br>

  • Fire Extinguisher

  • Pre/Post Trip Inspections

  • Vehicle #

  • Are outriggers or stabilizers out and on pads<br><br>

  • If there are no outriggers, are the wheels chocked

  • Are employees wearing the correct fall protection in the bucket

  • Dielectric Date

  • Signs

  • Cones

  • Fire Extinguisher

  • Pre/Post Trip Inspections

  • Vehicle #

  • Are outriggers or stabilizers out and on pads

  • If there are no outriggers, are the wheels chocked

  • Dielectric Date

  • Signs

  • Are employees wearing the correct fall protection in the bucket<br>

  • Cones

  • Fire Extinguisher

  • Pre/Post Trip Inspections

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.