DEMO Tailgate Form
General Information
Date & Time:
Work Order # / Job Name: *
GPS Coordinates:
Address/Location:*
Weather Conditions *
Clear
Cloudy
Stormy
Windy
Hot
Cold
Rain
Snow
Fog
Job Status
Routine
Emergency/Outage
Construction
Briefing Type *
Pre-Job Site
On-Job Site (Tailgate)
Work Procedures to be Performed *
Job Site
Communication *
Radio
Cell Phone
Cell Phone In Bucket
NA
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
Energy Source Controls
Recloser Pole #:
Switch #:
Substation: *
▼
altamont
Duchesne
Tabby
Feeder/Breaker #:
Voltage:
Voltage 7200/12470 - MAD Distance 2'2"/2'3"
Voltage 7620/13200 - MAD Distance 2'2"/2'3"
Voltage 14400/24900 - MAD Distance 2'7"/3'
Voltage 19900/34500 - MAD Distance 2'10"/3'3"
Voltage 69kv - MAD Distance 3'4"/4'
Voltage 138kv - MAD Distance 4'6"/4'10"
Voltage Secondary
Control:
Re-close
Non Re-close
Hot Line Tag
Lock/Tag
Capacitor Bank
PPE
Rubber Gloves
Rubber Sleeves
Hot Sticking
Rubber Hose
Blankets
FR Clothing
Face Shield
Safety Glasses
Hard Hat
Safety Vest
Hearing Protection
Chaps
Safety Shoes
Hand Protection
Body Harness
Proximity Tester
PPE Inspections:
Rubber Gloves Tested/Inspected? *
Rubber Sleeves Inspected? *
Proximity Tester Inspected? *
Other PPE:
Safety Check *
Visual Opening
Test for Dead
Pre-Flight
Voltage Proximity Sensor
NA
Grounding *
Personal
Digger
Bucket
NA
Person in Charge: *
Select One
Coy Burton
Lee Neilson
Matt Draper
Nathan Goodrich
Person in Charge Signature: *
Clear
Spotter: *
Select One
Coy Burton
Lee Neilson
Matt Draper
Nathan Goodrich
Spotter Signature: *
Clear
Crew Members:
▼
Coy Burton
Lee Neilson
Matt Draper
Nathan Goodrich
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Crew Signatures:
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