ADB Pre-Task Plan Card

• Conducted on

  Date

• Prepared by

• Location
  Address

• 1) PPE

• 2) Signs/Cones Placed

• 3)Wheels Chocked

• 4) Stretch/warm Up

• 5) Print/Job Review

• 6) Property Damage

• 7) Customer Contacted

• 8) Pre-Task Card Review

Recognized Hazards

• Chemicals

  Yes

  No

  N/A

• Material Handling

  Yes

  No

  N/A

• Pedestrian/Vehicle Traffic

  Yes

  No

  N/A

• Co Vehicle Placement

  Yes

  No

  N/A

• Job Access

  Yes

  No

  N/A

• Underground Utilities

  Yes

  No

  N/A

• Fire/Explosion

  Yes

  No

  N/A

• Sprinkler Systems

  Yes

  No

  N/A

• Propane Tanks

  Yes

  No

  N/A

• Machine Guarding

  Yes

  No

  N/A

• Heavy Equipment

  Yes

  No

  N/A

• Energized Electric

  Yes

  No

  N/A

• Struck By’s

  Yes

  No

  N/A

• Slip/Trip/Fall Hazard

  Yes

  No

  N/A

• Pinch Point/Caught Between

  Yes

  No

  N/A

• Excessive Noise

  Yes

  No

  N/A

• Eye Injury

  Yes

  No

  N/A

• Other

Hazard Protection

• Hearing Protection

  Yes

  No

  N/A

• High Voltage Electrical Protection

  Yes

  No

  N/A

• Barrier Protection Erected

  Yes

  No

  N/A

• Material Safety Data Sheet

  Yes

  No

  N/A

• Equipment Inspection

  Yes

  No

  N/A

• Tool Inspection

  Yes

  No

  N/A

• Flagger/Traffic Control

  Yes

  No

  N/A

• Discuss Yesterday’s Incidents?

  Yes

  No

  N/A

• Site Safety Orientation Complete

  Yes

  No

  N/A

• Yes

  No

  N/A

Post Job Checklist

• 1) All Excavations Secure

  Yes

  No

  N/A

• 2) Customer Equipment Secured

  Yes

  No

  N/A

• 3) Signs/Cones Removed

  Yes

  No

  N/A

• 4)Truck/Trailer/Equipment Secured

  Yes

  No

  N/A

• 5) On Site Equipment Secured

  Yes

  No

  N/A

Crew Covered in this plan

Photos:

• Add media

  Media

Other Comments:

• Notes: