Installer Jobsite Hazard

Case Number: 00692583 Author: Mark Tamez Date/Time: 12/6/2022 5:29 PM
Address: 35.961898-119.019642 Customer Name: Jesus Ramos Job Number:
Roof Pitch: 24 Supervisor Name: Robert Zamarripa Supervisor Number: null
Expected Temperature: 50 Expected Weather Conditions: night Workscope: new install
All sites upon leaving MUST be cleaner than when we arrived. No Unwired Broadband property shall be left onsite.
Emegerncy Action Plan
Make sure your site diagram is uploaded to schedulo. This needs to be an overhead shot of the jobsites that includes:
An X for the jobsite safe meeting area where all parties will meet in case of emergency
A drawn route of the emergency escape route from the jobsite to the safe meeting area in case of emergency the nearest first responders contact information is located in the job
Personal Protective Equipment
CarebeanersDrinking WaterBody Harness
ShadeLanyardLong Sleeves
Ladder Stablizer
Hazard Assessment
Falling From HeightAwkward LifitingSlips Trips or Falls
Hazard Assessment Mitigations
Falling From Height Mitigations: PPE Deployed
Awkward Lifting Mitigations: Team Lift
Installation Work
Vehicle maintenance up to date
Pre use inspection has been completed
Ground obstructions exist on site which pose a hazard to the completion of your workscope. These hazards are identified on our site map above. tree strumps fence posts pot holes ect.
OverheadRoof obstructions exist on site which pose a hazard to the completion of your workscope.
Animals onsite
Customer secured animals prior to work commensing
Tools inspected
Extension cords inspected
Personnel trained or qualified to use tools on site
Ladder stabilizer will be used. If it cannot be utilized a spotter will hold the ladder
Ladder placement will be in a position where the 4 to 1 ratio will be used
Ladder has been inspected prior to use
Fall protection has been inspected prior to use
Fall protection is needed
Oxygen Level
Hydrogen Sulfide Level
Carbon Monoxide Level
Combustable Gas Level
Our Anchor point will be which we have deemed to be capable of 5,000lbs per person attached. If no anchor point can be used, engineered fall protection must be used such as handrails, scaffolding, ect...
Onsite Names

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Signature Certificate
Document name: ja-{{ninja-field-id-90}}
lock iconUnique Document ID: 240561034029b7e7cec6b23bbb06ee79d9a660e5
Timestamp Audit
July 7, 2020 2:33 pm PSTja-{{ninja-field-id-90}} Uploaded by James Kinler - jkinler@getunwired.com IP