HAYDEN SAFETY CHECK IN
Building For A Better Tomorrow
Today's Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Company Name:
*
User Name:
*
Email:
*
Customer Site ID:
*
Tower Owner:
*
Scope Of Work:
*
Structure Type:
Rows
Self Support Tower
Monopole
Guyed Tower
Rooftop
Water Tank
Building
Flagpole
COW
Other
Row 1
Logged In With Tower Owner:
*
Yes
No
N/A
Tower Owner confirmation #: (If Applicable)
Logged In With Carrier:
*
Yes
No
N/A
Technician #1 (EVERYONE ON SITE)
Technician #2
Technician #3
Technician #4
Technician #5
Technician #6
At Least 2 Crew Members Certified in First Aid/CPR:
*
Yes
No
N/A
All Crew Certified in BBP:
*
Yes
No
N/A
All Crew Certified In RF Awareness:
*
Yes
No
N/A
All Crew Certified In Hazard Communication:
*
Yes
No
N/A
Proper Number Of NWSA TT1 Certified Crew Members (50% minimum):
*
Yes
No
N/A
Climbers Properly Certified:
*
Yes
No
N/A
Climber Certification Photo:
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Electricians NFPA 70E Certified:
*
Yes
No
N/A
JSA On Site:
*
Yes
No
Other
JSA On Site Photo 1:
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JSA On Site Photo 2:
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JSA On Site Photo 3:
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JSA On Site Photo 4:
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JSA On Site Photo 5:
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JSA On Site Photo 6:
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Tailgate Safety Meeting Documented On JSA:
*
Yes
No
JSA Ground RF Recorded:
*
Yes
No
N/A
JSA Emergency Data Populated:
Yes
No
JSA Emergency Data Page Photo 1:
*
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JSA Emergency Data Page Photo 2:
*
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Emergency Rescue Plan On Site:
*
Yes
No
N/A
Emergency Rescue Plan Photo:
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MSDS On Site:
*
Yes
No
N/A
MSDS Photo:
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Rigging Plan On Site:
*
Yes
No
N/A
Rigging Plan Photo:
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Tower Rigging Photo 1:
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Tower Rigging Photo 2:
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Tower Rigging Photo 3:
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Rope Log On Site:
*
Yes
No
N/A
Rope Log Photo:
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Climbing Gear Inspected:
*
Yes
No
N/A
Climbing Gear Inspection Log Photo:
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Certificate Book Onsite:
*
Yes
No
N/A
Certificate Book Photo:
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OSHA Safety Sign Posted:
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Site Clean/Neat:
*
Yes
No
Overall site photo 1 (Clean):
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Overall site Photo 2 (Clean):
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Overall Site Photo 3 (Clean):
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Class B First Aid Kit On Site:
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Fire Extinguisher On Site:
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Fire Extinguisher Inspection Tag Photo:
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One or More RF Monitors On Site (Minimum 2 When Climbing):
*
Yes
No
N/A
RF Monitor(s) Photo:
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RF Monitor(s) Calibration Date Photo:
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LOTO Material On Site:
*
Yes
No
N/A
LOTO Material Photo:
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Rescue Kit On SIte:
*
Yes
No
N/A
Rescue Kit Photo:
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Water On Site Photo:
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Submit
Should be Empty: