Daily Safety Task Planner

• Document No.

• Daily Task Planner

• Conducted on

  Date

• Prepared by

• Location
  Address

Project Information

• Project Name

  Cummins Live Well

• Project Number

  140262

Project Task

• List all the steps for the job

Identify Hazards

• Identify all specific hazards found.

Hazard Control

• How do you plan on controlling the hazards?

Hazard Identification Tips

• What permits are required for this task?

  Select Confined Space Hot Work Lockout/Tagout Excavation Other

  • Confined Space
  • Hot Work
  • Lockout/Tagout
  • Excavation
  • Other

• If Other is listed please explain.

Hazard Evaluation Tips

• Use the following categories to assist you in the proper evaluation of all hazards. Can any of the following conditions occur with the hazards that have been identified?

  Select Contracting Temperature Extreme Contracting Electrical Current Environmental/ Airborne Release Moving Object/ Equipment Hazardous Substance Obstruction/Interference Struck By Struck Aginst Fall/Slip/Trip Caught In/Between Material Handling Other

  • Contracting Temperature Extreme
  • Contracting Electrical Current
  • Environmental/ Airborne Release
  • Moving Object/ Equipment
  • Hazardous Substance
  • Obstruction/Interference
  • Struck By
  • Struck Aginst
  • Fall/Slip/Trip
  • Caught In/Between
  • Material Handling
  • Other

• If other is listed please explain.

Hazard Control Tips

• Use the following categories to assist you in determining the proper control methods for all the hazards that have been identified and evaluated.

  Select Ventilation of exposed Area Isolation of Hazard from Worker Substitution of the Hazard with less severe one Elimination of the Hazard Change Work Methods Good Work Practices PPE Other

  • Ventilation of exposed Area
  • Isolation of Hazard from Worker
  • Substitution of the Hazard with less severe one
  • Elimination of the Hazard
  • Change Work Methods
  • Good Work Practices
  • PPE
  • Other

• If other please explain.

Housekeeping

• Was the site clean and secure after work.

  Yes

  No

Evacuation Route

• What is your evacuation route and assembly point?

Emergency Numbers

• Please list all Emergency Numbers, Fire, Police, Ambulance, Other

Lead Personnel Signatures

• Superintendent

  Sign

• Foreman

  Sign

• General Foreman

  Sign

Crew Signatures

• 1)

  Sign

• 2)

  Sign

• 3)

  Sign

• 4)

  Sign

• 5)

  Sign

• 6)

  Sign

• 7)

  Sign

• 8)

  Sign

• 9)

  Sign

• 10)

  Sign