AEU Daily Pre-Task Plan

• Job Number

• Job Leader

• Date / Time

  Date
• Location
  Address

• Safety Goals
  1. Zero People Hurt.
  2. No disruption to facility or environment.

• Task Name/Plan of Action

• Production Goal/Finish Date

Onsite Supervisor

• Supervisor

  Sign

Onsite Crew

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

Onsite Subcontractors

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

Hazard Analysis

• List Steps to Complete Task (List at least 3)

• List Hazards Associated With Each Step (List at least 3)

• Ways to Eliminate or Control Hazards (List at least 3)

• Do you have the information to complete the task?

  Yes

  No

  N/A

• What information do you need?

• Do you have to tools to complete the task?

  Yes

  No

  N/A

• What tools are needed?

• Do you have the materials to complete the task?

  Yes

  No

  N/A

• What materials are missing?

Ways to Eliminate Hazards

• Select All That Apply

  Select

General Checklist

• MSDS reviewed for task?

  Yes

  No

  N/A

• If no, why?

• Proper safety equipment on site?

  Yes

  No

  N/A

• If no, why?

• Guards and handles on power tools?

  Yes

  No

  N/A

• If no, why?

• Confined space procedure / rescure plan?

  Yes

  No

  N/A

• If no, why?

• Power lines located above/below ground?

  Yes

  No

  N/A

• If no, why?

• Rigging and harnesses inspected?

  Yes

  No

  N/A

• If no, why?

• Emergency procedure and contacts?

  Yes

  No

  N/A

• If no, why?

• Work communicated with others in area?

  Yes

  No

  N/A

• If no, Why?

Possible Hazards

• Select all that apply.

  Select

Fall Protection Work Plan

• Fall Protection Needed?

  Yes

  No

• Fall Hazards in the Work Area (select all that apply)

  Select

• Other

• Method of Fall Restraints (select all that apply)

  Select

• Other

• Overhead Protection (Select all that apply)

  Select

Additional Forms

• Rigging / Lifts

  Yes

  No

• Hot Work

  Yes

  No

• Site Specific

  Yes

  No

• Fall Arrest

  Yes

  No

• Lock Out Tag Out

  Yes

  No

• All Equipment Shut Down?

  Yes

  No

  N/A

• If no, why?

• All tools/materials properly stored?

  Yes

  No

  N/A

• If no, why?

• Work area cleaned up?

  Yes

  No

  N/A

• If no, why?

• LOTO tags released and signed off/locks removed?

  Yes

  No

  N/A

• If no, why?

• Completed task status communicated to customer?

  Yes

  No

  N/A

• If no, why?