Daily Safety & Pre-Task Plan

• Superintendent

• Foreman

• Date

  Date

• Job #

• Location
  Address

AM

• Clear

• Overcast

• Rain

• Fog

• Snow

• Wind (mph)

• Temp (F)

• Site

  Muddy

  Dry

  Other

• Explain

• Site

  Muddy

  Dry

  Other

• Explain

PM

• Clear

• Overcast

• Rain

• Fog

• Wind

• Snow

• Temp (F)

• Site

  Muddy

  Dry

  Other

• Explain

Today's Tasks

Today's Goals (Tons, Yards, LF, etc.)

Key Hazards

Preventative Measures

Pre Job Checklist

• Superintendent/Foramen/Opeartors know the plan?

  Yes

  No

  N/A

• Correct Tools, Equipment & Personnel on hand?

  Yes

  No

  N/A

• Adequate, Uncontaminated Materials on hand?

  Yes

  No

  N/A

• Proper Equipment on hand for unloading materials?

  Yes

  No

  N/A

• Flaggers/Traffic Control in place?

  Yes

  No

  N/A

• Public Protection Required? (Tape, barricades, fence, etc.)

  Yes

  No

  N/A

• Proper Number of Trucks?

  Yes

  No

  N/A

• Do Truckers know proper haul route?

  Yes

  No

  N/A

• PPE, Gas Dectoror & Other Safety Equipment?

  Yes

  No

  N/A

• Confined Space/Atmospheric Testing?

  Yes

  No

  N/A

• Trench & Excavation Checklist

  Yes

  No

  N/A

• Utilities Marked? Locate #? Exp Date? Overhead Wires?

  Yes

  No

  N/A

• Equipment Walk-Around Inspections Completed?

  Yes

  No

  N/A

• New Employees/Visitors/Equipment on the Project?

  Yes

  No

  N/A

• Housekeeping? Garbage picked up?

  Yes

  No

  N/A

• Proper Mix Design/Ticket Loadout Information?

  Yes

  No

  N/A

• Are existing site conditions as anticipated?

  Yes

  No

  N/A

• Night work possible? Procedures in place?

  Yes

  No

  N/A

• Fall protection required?

  Yes

  No

  N/A

• Lockout/tagout required?

  Yes

  No

  N/A

• Pinch points or "caught between" hazards present?

  Yes

  No

  N/A

• Erosion Control devices functioning properly?

  Yes

  No

  N/A

By signing this form, it indicates that you have taken an active part in the Pre-Task Meeting/Daily Hazard Analysis & Action Plan (DHAAP) and you attest you are physically/mentally alert, capable of performing your tasks in a safe manner.

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