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JOBSITE SAFETY WORKSFiEET <br /> Date -,Z�l Location <br /> Lead ,d Lr Pre-Job Brlefin Time <br /> Description of Work: � <br /> � � 2 r� ��-,�ti <br /> Safety Incident & Con erns:� <br /> YES A <br /> TreHic Controt PlarAttach TCP II madmed <br /> Conflned S ace Ent Atlech Conflned S ace Permit <br /> Uncontrolled Ener ttach Lockout Te out <br /> Boom Truck Used—Atlach LIR lan if needed <br /> Overhead Ilflln Ins ect rl I belore eech use <br /> ElecMcel Hezerde 8 Controls / <br /> Overhead Unde round 6enerelor Permanent Wirin <br /> Hot Work--Describe / <br /> Hazardous Matedels Used <br /> Falls over 4 feet--Controlted b : <br /> Excavation Entry over 3�et deep <br /> F�in/al Depth �' S Widih_ Length / <br /> �r�nn Fomi ❑ Slopinp [I Trench Boz ❑ Build•a•Box � <br /> �' <br /> First Ald E ul menUTninin IFire E»In ulsher Must bs Curront <br /> Utilities Located: Water blue Power red Ges ellow Communicatlon ara e other <br /> Communlcatian with eme enc res onders rovided Radlo Dis etc hone 811 CI Phone 9-911 <br /> Personal Protective E ui ment i h-Vfs ead E es Hearin Whole Bod other <br /> Pre-Job Safet Meetin <br /> Name Assignment Name Aaslgnment <br /> SO� .�'j9/ <br /> ,s y <br /> �tc � J tx� y 6`� <br /> Revlsed 1y72/it <br />