Daily Job Site Safety Briefing

Office Location*

Today's Date*

Date

Time*

Hour Minutes

AM/PM Option

Employee #1*

first and last name

Employee #2

first and last name

Employee #1 Has All PPE?*

if NO employee cannot work

Employee #2 Has All PPE?

if NO employee cannot work

Has Hastings Stick Been Properly Inspected and Determined Safe To Use?*

if NO explain why in comments section at end of form

What Job Task is Being Done Today?*

Location of Job Site*

city and state

Name and Distance to Closest Medical Facility*

hospital or urgent care and mileage

Temperature*

Sky Condition*

Precipitation*

Conduct a safety review of your job location and immediate surroundings where you will be working. Check for potential safety hazards and discuss as a team the associated control measures:

What type of environment is your job located in?*

if environment is Other, please specify in comments section at end of form

Utilities Next to Road: Vehicular Traffic, Working and Walking, City or Rural*

N/A Utilities at rear of lotAlways Keep Pole/Barrier between you and oncoming traffic/Avoid Pinch PointsWalk facing trafficStay off the roadway unless last resortUse “Buddy System” when entering road ways/high traffic areas/construction sitesLook for and identify what could cause any potential slips, trips or fallsFollow company policy: "Interaction with the public"Other

Utilities at Rear of Lot: Fenced or Open, Residential or Commercial, City or Rural*

N/A Utilities next to roadUse designated walkways whenever possible-It's their property not yoursFenced area-ask for permission firstFollow company policy: "Interaction with the public"Look for and identify what could cause any potential slips, trips or fallsAggressive dog: "Never turn your back & Shake your hat, dog attack"Other

Environmental: Insects, Foliage & Weather- What do you anticipate encountering?*

Insects: Insect repellent, Permethrin spray and check yourselfPoisonous Plants: Identify & point out poisonous plants/Don't touchHeavy Foliage: Cutting brush/Kevlar glovesAggressive dog: "Never turn your back & Shake your hat, dog attack"Sun/Heat: Sun block, Long sleeves, Hardhat & Drink waterCold/Snow/Rain: Layered clothing, Keep feet, hands and clothing dry & Drink waterSlips, Trips & Falls: Uneven terrain, rocks, holes, hills, icy/wet conditions, etc.Other

Utilities, Poles and Spans*

Visually assess each pole for possible hazards before approachingAssume EVERY wire is energizedN/A Utilities involved are undergroundRecord and report any unsafe conditionsIf you're not sure ask!Other

What is the posted speed limit in your work area?*

If there are various posted speed limits, check the highest posted limit.

What class safety vest must be worn?*

*Always keep the pole between you and oncoming traffic. Increase situational awareness and avoid pinch points*

Comments, Notes and Observations

Has your job site been deemed safe to proceed for work?*

YesNo

Daily Job Site Safety Briefing Form