TBG Safety: Stilt Safety Inspection Form
Worker's Name
*
First Name
Last Name
Workers Email (If you want to get a receipt of this form)
example@example.com
Phone Number
*
Please enter a valid phone number.
TBG Job Name or Number
*
Work Location (Include Room/Corridor/Floor/Building)
*
Name of TBG Foreman/Supervisor
*
Emergency Contact on Site? (Name & Phone Number)
*
Are you comfortable, competent & trained?
*
Yes
No
Have you completed the TBG Stilt Training Course?
*
Yes
No
Did you perform an inspection of your work area?
*
Yes
No
Communication of Co-workers / Peers & Traffic
*
Yes
No
Stilt Height (Foot to Floor)
*
ex: 36"
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Did you answer no to any of the questions?
Do not proceed. Please consult with your supervisor.
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