Job NumberSupervisor *Job / TaskInstructions:This form is to be prepared by the supervisor or crew leader in consultation with all memebrs of hte crew who will be performing the job. It is to be completed at the start of each job, shift or whenever there are any significant changes in the work or work procedures, and the office for filing at the conclusion of the job.Hazards Association with the Job(Check each that applies and discuss)Electrocution - work near energized electrical conductorsHazardous atmosphere - work in enclosed spaces, confined spaces, harmful dust, fumes, mist, and gases.Engulfment, cave-in or entrapmentFall Hazard - from/on an unguarded elevated platform, towere or poleChemical Hazards - toxic, flammable, reactive, or corrosive chemical products.Fall with failing pole, tower, or structureHigh noise levels - damage to hearingMoving machinery - caught in; stuck byEnvironmental Hazards - heat exhaustion/stroke, frostbiteFire/explosion - flamable, gassed liquids and dustHigh temperature/pressure - steam, compressed gases and airDrowning - above or near waterHydraulic fluid leaksWork Procedures Involved(Check each that applies and discuss)Overhead electrical work procedures (job specific)Underground electrical work procedures (job specific)High-voltage/high-power testingTransmission electrical work procedures (job specific)Special Precautions(Check each that applies and discuss)Inspect work site for safety and health hazardsInspect critical safety equipmentJob requires attendant/observeTest/monitor atmosphereAtmosphere/weather watchEnergy Source Control(Check each that applies and discuss)Lockout/tagoutGroup lockout/tagoutTransmission/distribution line de-energizationTesting for voltageCapacitors dischargeApplication of protective groundsPersonal Protective Equipment Requirements(Check each that applies and discuss)Head protectionFace/eye protectionRespiratorGlovesProtective footwearProtective clothingFall protectionElectrical protective groundsAdditional Arc Flash Protection Employee(s) attending briefing and signature(s):NameSubmit
