TAILBOARD / TOOLBOX SAFETY CHECKLIST
Prepare, discuss and review the Job Plan with the Crew daily and whenever a Job change is introduced.
Job Order #
Location:
Job Being Performed:
Date All Crew Members Present (Initial)
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Major Hazard Identification List
Gravity Electricity Mechanical Kinetic/Vehicular
Falling from a Height
Live Apparatus Equipment Failure Driving Conditions
Falling Objects Induction/Backfeed Flying Objects Moving Loads
Working Over Water Static Charge Tension Loads Vehicular Stability
. Ground Gradients Moving Parts Vehicle Condition
Chemical Flash Potential Sharp Objects .
Confined Spaces Buried Conductors Pinch Points .
Toxic or Poisonous . Pressurized Systems .
Flammable or Explosive . Heat .
. . Excavation .
Have We Considered ... Elec. Energized Equipment Immediate Supervisor Sign Off;
People Procedure Hardware/Equipment
Person in Charge Isolation of Apparatus Inspection of Equipment
Qualification/Experience Check for Potential Inspection of Tools and PPE
Other Work Groups/Contractors Adequate Grounding Inspection of Vehicles
Communications Lockout Permit First Aid Equipment
Worker Fatigue Control Release MSDS Information
First Aid Attendant Clearance Fall Arrest Equipment
Public Safety Test & Work Permit Safe Loads for Rigging
Buddy System Limits of Approach Temporary Support
. Vehicle Grounds Physical Barriers
Environment Confined Space Procedure Accuracy of Permits/
Securing of Fence Gates Written Work Procedures Mimic Board
Weather Conditions Rescue Procedures .
Adjacent Hazards Man Working Alone .
Lighting Conditions Fall Protection Plan (over 25') .
Proximity to Live Circuits Hot Work Permit .
Workers Above/Below You? . .
Housekeeping . .
Have You Reviewed the Emergency Plan?
Major hazards Barrier to Eliminate or Control
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JOB STEPS PLANNING WORKSHEET
Job Steps
Major Hazards
Required Barriers
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Did Conditions Change? . .
EMERGENCY PLAN
1. Identify exact location for emergency responses.

2. How will you execute a rescue?

3. Approximate response time for emergency personnel.

EMERGENCY NUMBERS

24 Hour Environmental Emergency Number

Name of Nearest Hospital

Location directions for ambulance
Site Address
Ambulance
Police
Fire Department
First Aid
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