Field Tech Tailgate Form
General Information
Date & Time:
Address/Location*:
Weather Conditions*
Clear
Cloudy
Stormy
Windy
Hot
Cold
Rain
Snow
Fog
Job Status
Routine
Emergency/Outage
Briefing Type *
Pre-Job Site
On-Job Site (Tailgate)
Work Procedures to be Performed*
Job Site
Communication*
Radio
Cell Phone
Radio Check Performed?*
Hazards associated with the job
Energized Equipment
Confined Spaces
Falling
Driving
Traffic
Hazards to the public
Other/Cautions
Special Precautions
Other utilities
Other Crews
Dogs/Animals
Unusual Conditions
Other/Precautions
PPE
Rubber Gloves
FR Gloves
FR Clothing
Face Shield
PPE Inspections
Rubber Gloves Inspected?*
FR Gloves Inspected?*
Other PPE
Safety Check*
Visual Check (Service Equipment)
NA
Person in Charge*:
Select One
Coy
Person in Charge Signature*:
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Crew Members:
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Coy
Crew Signatures:
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