E.t. Job Briefing Documentation Sheet

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E.T. Job Briefing Documentation Sheet
Date:
/
/
Time:
:
Days W/O Injuries:
Gang No.
AM
PM
Work Location:
Job Briefing:
This is to be done before starting ANY job.
Person Holding Job Briefing: :
Title:
Weekly Safety Focus
Security Focus
Targeted Observation
Is the Power Director aware of the location where you will be working?
Yes
No
What are we doing?
Does everyone have all required PPE: (Hardhats, Glasses, Gloves, Footwear, FR Clothing, etc.)?
Yes
No
Does this work require special PPE: (Ear Protection, Respirator, Chaps, Face Shields, etc.)
Yes
No
Any unusual work site hazards?
Yes
No
If yes, what hazards?
Have all of the following been checked for defects?
Tools
Yes
No
Vehicles
Yes
No
Equipment
Yes
No
What defects were found?
If operating equipment, who is the operator?
Is he/she qualified?
Yes
No
Are everyone’s qualification cards up to date (RWP, AMT II, etc.):
Yes
No
Is the removal of Power necessary to complete the task?
Yes
No
Is there a clearance issued, does everyone understand, and has everyone SIGNED the clearance form?
Yes
No
Are we following the proper procedures pertaining to Testing De-Energized?
Yes
No
Work is to be performed between GROUNDS. Where will the GROUNDS be installed / applied?
Are there any ENERGIZED WIRES, APPARATUS, EQUIPMENT OR ENERGIZED A.C./D.C. BUS IN CLOSE
PROXIMITY TO YOUR WORK LOCATION, THAT ARE NOT UNDER CLEARANCE?
Yes
No
IF YES WHAT IS THE MINIMUM APPROACH DISTANCE FOR THIS CIRCUIT?
Is there a first aid kit and/or an AED available?
Yes
No
Does everyone understand where they are?
Yes
No
If we are using a BOOM TRUCK, does it need/have a Ground Cable?
Yes
No
If we are digging or using manual labor, are we using the proper equipment or techniques?
Yes
No
Nearest approved medical facility:
Other items discussed:
No one is required to sign this document until they have full understanding of the job and
Amtrak Police Emergency
all safety concerns have been addressed.
Number 1-800-331-0008
Employee Sign-Off
If working on-track, an On Track Safety briefing must be done.
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31
2
12
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32
3
13
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33
4
14
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34
5
15
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35
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36
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40
This form must be retained for 10 working days. This is not an On Track Safety Briefing.
3044 ET
NRPC
(Rev. 07/2014) front
Amtrak is a registered service mark of the National Railroad Passenger Corporation.

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