Woodbury County REC - Tailgate Form

• Conducted on

  Date

• Person in charge conducting this briefing

• LOCATION - 911 if available
  Address

• Personnel

STARTING THE JOB

• The person in charge shall conduct a job briefing before the start of each job. The briefing shall cover at least the following subjects and shall be documented:
  
  a. Location - 911 if available
  b. Hazards associated with the job
  c. Work procedures involved
  d. Special precautions
  e. Energy source controls
  f. Personal protective equipment and devices
  
  After discussing and agreeing on all of the above topics, each crew member shall sign the tailgate before work commences. If anyone see's or feels that an unsafe procedure is happening or is about to happen during the work procedure, they should exercise their right to stop the work process by notifying the person in charge or the party involved with the alleged unsafe action.

JOB TO BE PERFORMED

HAZARDS ASSOCIATED WITH JOB

WORK PROCEDURES INVOLVED

SPECIAL PRECAUTIONS

ENERGY SOURCE CONTROLS

PERSONAL PROTECTIVE EQUIPMENT REQUIRED

I AGREE WITH ALL THE ITEMS OUTLINED IN THIS TAILGATE FORM

• Add signature

  Sign

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  Sign

• Any person on the job has the right to stop work when an unsafe condition or act could result in an undesirable event.

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