EPS Pre-Job Brief Form

Site & Emergency Info

Date:

Job Location (include Bldg. Name and/or #):

Physical Address (include county for 911 Response):

Nearest medical facility:

AED/First Aid/Burn Kit Location:

Employee in Charge:

Employee in Charge Mobile Number:

Emergency Site Contact & Number:

Job Scope and Preparation

Job Scope & Work Instructions (including pre and post work set-up):

Operator Qualification(s) – verify crew members are qualified to perform assigned covered task(s) or are working under span of control.

Is this a NERC Space? If so, complete the following:

Does everyone have NERC access? Yes No N/A

Who will be the escort? (If needed. Shall have active NERC access on badge for specific readers at site):

Affected Component/System:

Scope Change Occurred – additional scope documented and PJB reviewed

Will PACS devices generate alarms during work, if so: Contact ESCC prior with site name and devices impacted to include FCPs.

Will VMS devices (Cameras or Ground Base Radar) be taken offline or generate alarms during work, if so: Contact ESCC prior with site name and devices impacted to include NVRs.

Safety Awareness

Actions to Take in an Emergency:

Hazard Analysis & Mitigation

Special Precautions:

Job Hazards & Mitigation:

Environmental Risks & Mitigation:

Worst Thing that Can Happen & Mitigation:

Current Weather Conditions:

Critical Steps - Business Areas

Critical step items to observe related to your jobsite location. See checklist.

PPE & Review

Standard PPE:

Hat

Boots

FR

Glasses

Gloves

Hi-Vis Vest

Additional PPE IF needed:

Inspected Harness/Climbing Gear:

Signatures

Date/Time	Signature

Post Job Review

Did Job go as planned? If NO, explain resolution: