Tailboard Safety Meeting
IV Network Designs Inc — Pre-Work Safety Briefing
Auto-Captured:
Loading...
| GPS:
Acquiring...
Email Delivery
Job Information
Job Number / Work Order
*
Required
Client / General Contractor
Job Site Address
*
Required
Date
*
Required
Start Time
Work Type
*
Underground
Aerial
Splicing
Maintenance
Other
Scope of Work
Hazard Assessment
Select all applicable hazards:
Existing utilities
Cave-in/trench collapse
Shoring required
Dewatering needed
Confined space
Contaminated soil
Gas leak potential
Overhead power lines
Pole/structure integrity
Fall hazard
Bucket truck outrigger setup
Traffic control needed
Minimum approach distance
Fiber handling (eye protection)
Laser safety
Chemical exposure
Proper ventilation
Static discharge
Heat/cold stress
Traffic/public exposure
Heavy equipment operation
Underground utilities nearby
Slip/trip/fall
Noise exposure
Working near water
Other Hazards
Hazard Controls & Mitigation
What controls are in place?
PPE Required
Hard Hat
Safety Vest
Safety Glasses
Gloves
Steel-Toe Boots
Hearing Protection
Fall Protection/Harness
FR Clothing
Face Shield
Respirator
Barricades/Cones Needed
Yes
No
Traffic Control Plan
Yes
No
N/A
Spotter Required
Yes
No
Locate Ticket #
Locate Ticket Valid
Yes
No
Expired
Emergency Information
Nearest Hospital
Emergency Rally Point
First Aid Kit Location
Fire Extinguisher Location
Emergency Contact Name
Phone
Crew Attendance & Sign-Off
Foreman / Meeting Leader
*
Required
Crew Members
+ Add Crew Member
Witnesses
Topics Discussed
Select topics covered:
Job scope review
Hazard identification
PPE requirements
Emergency procedures
Equipment inspection
Utility locate review
Fall protection plan
Traffic control plan
Incident reporting
Weather considerations
Housekeeping
Stop work authority
Additional Topics
Photos
+ Add Photo Slot
Foreman Signature
Sign below to acknowledge understanding:
Clear
Additional Notes
Additional Notes
Clear
Send Report
