Template

Bucket Rescue Evaluation Checklist

by Matt Pociask, from the Community

This annual bucket rescue evaluation checklist helps electric cooperative and utility crews demonstrate proficiency in operating lower and upper controls and tilting the bucket to perform an emergency rescue. It covers knowledge of rescue techniques, Mayday procedures, CPR and AED, and rigging. Use it to document successful completion and capture trainer and employee signatures for compliance and ongoing safety training.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
IAEC Bucket Rescue Evaluation Checklist
Use this IAEC template to conduct annual bucket rescue evaluations for electric utility crews. Confirm proficiency with lower truck controls and bucket tilting, and assess knowledge of rescue protocols such as Mayday, CPR, AED, first aid, and rigging. Includes sections for evaluator notes, pass or retest outcomes, and employee and trainer signatures to document competency and compliance.
by Matt Pociask, from the Community
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Template
IAEC Pole Top Rescue for Electric Line Workers
Use this IAEC pole top rescue annual proficiency evaluation template to assess electric line workers on critical rescue skills. It covers Mayday call, donning PPE and fall restriction equipment, safe ascent, attaching a handline, securing and lowering the victim, controlled descent, and post-rescue checks including vitals and CPR. The exercise emphasizes completing the rescue within four minutes to enable timely CPR. Includes signature fields for employees and the safety instructor and timing records to establish a performance baseline.
by Matt Pociask, from the Community
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Template
Confined Spaces Plan And Rescue Arrangements
This confined spaces plan and rescue arrangements checklist helps teams prepare for safe entry and recovery in warehouse and industrial environments. It guides users to confirm current training, complete pre-entry requirements, apply and verify LOTO for a zero-energy state, and stage rescue equipment such as an evacuation chair and first aid kit. The form captures work details, SCADA location and WO numbers, defines communication methods, and selects the applicable rescue approach including self-rescue, external, or entry rescue. It records required PPE, time in and out, and signatures from entrants, supervisors, and the rescue plan author to ensure accountability and compliance.
by Thomas Bearder, from the Community
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Template
SRM Rescue Tuesday Day Shift Duties
This SRM Rescue Tuesday Day Shift Duties template helps mine rescue teams complete and document routine Tuesday tasks. Record the site and date, note which crew is completing the checks, and work through duties including removing all vertical rescue gear from Rescue 3 and Rescue 4 lockers, cleaning the equipment, and cleaning the lockers. Capture required signatures to confirm completion. Designed to support consistent emergency response readiness and equipment hygiene across shifts.
by Mitch Burgess, from the Community
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IAEC Bucket Rescue Evaluation Checklist

Use this IAEC template to conduct annual bucket rescue evaluations for electric utility crews. Confirm proficiency with lower truck controls and bucket tilting, and assess knowledge of rescue protocols such as Mayday, CPR, AED, first aid, and rigging. Includes sections for evaluator notes, pass or retest outcomes, and employee and trainer signatures to document competency and compliance.

by Matt Pociask, from the Community

Get

Template

IAEC Pole Top Rescue for Electric Line Workers

Use this IAEC pole top rescue annual proficiency evaluation template to assess electric line workers on critical rescue skills. It covers Mayday call, donning PPE and fall restriction equipment, safe ascent, attaching a handline, securing and lowering the victim, controlled descent, and post-rescue checks including vitals and CPR. The exercise emphasizes completing the rescue within four minutes to enable timely CPR. Includes signature fields for employees and the safety instructor and timing records to establish a performance baseline.

by Matt Pociask, from the Community

Get

Template

Confined Spaces Plan And Rescue Arrangements

This confined spaces plan and rescue arrangements checklist helps teams prepare for safe entry and recovery in warehouse and industrial environments. It guides users to confirm current training, complete pre-entry requirements, apply and verify LOTO for a zero-energy state, and stage rescue equipment such as an evacuation chair and first aid kit. The form captures work details, SCADA location and WO numbers, defines communication methods, and selects the applicable rescue approach including self-rescue, external, or entry rescue. It records required PPE, time in and out, and signatures from entrants, supervisors, and the rescue plan author to ensure accountability and compliance.

by Thomas Bearder, from the Community

Get

Template

SRM Rescue Tuesday Day Shift Duties

This SRM Rescue Tuesday Day Shift Duties template helps mine rescue teams complete and document routine Tuesday tasks. Record the site and date, note which crew is completing the checks, and work through duties including removing all vertical rescue gear from Rescue 3 and Rescue 4 lockers, cleaning the equipment, and cleaning the lockers. Capture required signatures to confirm completion. Designed to support consistent emergency response readiness and equipment hygiene across shifts.

by Mitch Burgess, from the Community

Get

Bucket Rescue Evaluation Checklist

About author

You might also like

IAEC Bucket Rescue Evaluation Checklist

IAEC Pole Top Rescue for Electric Line Workers

Confined Spaces Plan And Rescue Arrangements

SRM Rescue Tuesday Day Shift Duties

You might also like

IAEC Bucket Rescue Evaluation Checklist

IAEC Pole Top Rescue for Electric Line Workers

Confined Spaces Plan And Rescue Arrangements

SRM Rescue Tuesday Day Shift Duties