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JOBSITE SAFETY WORKSHEET <br /> Date Location <br /> Lead Pre-Job Briefing Time <br /> Description of Work/Safety Comments <br /> If all above bold line is NIA,you do not need to complete this form YES NIA <br /> TraNic Controi Re uired—Attach TCP if modified <br /> Excavation Enlry over 3 feet deep <br /> Final Deplh Width Lenglh <br /> ❑ Finn Form ❑ Sloping ❑ Trench Box ❑ Bui�d-a-Box <br /> Confined S ace Ent —Atiach Confned S ace Pa erwork <br /> Uncontrolled Enerq —Attach Lockout <br /> Hol Work—Describe <br /> Overhead power—Minimum 10'clearance _ <br /> Overhead IiHin —Cranes&Ri in Ins ected Before Use <br /> Falls over 4(eet—Controlled by: <br /> Hazardous Materiais in Use <br /> First Aid E ui menUTrainin IFire Extin uisher Must be Current <br /> Utilities Located: ❑ Waler blue ❑ Power red ❑ Gas ellow ❑ Communication oran e ❑ other <br /> Communicalion wiih emergency responders provided <br /> ❑ Radio Dis atch ❑ Phone 911 ❑ Cit Phone 9-911 <br /> Electrical Hazards&Controls GFCI <br /> Power Tools <br /> Hea E ui ment vehicle number <br /> Personal Proleclive E ui ment ❑ Hiqh-Vis ❑ Head ❑ E es ❑ Hearin ❑ Whole Bod ❑other <br /> Pre-Job Safe Meetin <br /> Name Assignment Name Assignment <br /> Revised 9I15/09 <br />