DOA PRE-TASK PLAN

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Information

• Shop

• Planner

  Select Giesler Gardner Hill Elkins Habersack

  • Giesler
  • Gardner
  • Hill
  • Elkins
  • Habersack

• DOA Property

  Select McCarran NLVAT Overton Jean HEA Sloan Off Airport

  • McCarran
  • NLVAT
  • Overton
  • Jean
  • HEA
  • Sloan
  • Off Airport

• Specific location

• Describe task to be accomplished

• Start date & time

  Date

• End date & time

  Date

• Number of workers

• Housekeeping plan (trash removal, clean up, person responsible, frequency)

• Material storage & handling plan

• Access & hoisting plan

Pre-task questions

• Does every crew member know how to use assigned tools & equipment?

  Yes

  No

  N/A

• Does this task require special training?

  Yes

  No

  N/A

• Are additional or specialty personnel needed for task?

  Yes

  No

  N/A

• Are additional or specialty tools/materials needed to complete task?

  Yes

  No

  N/A

• Applicable MSDS reviewed?

  Yes

  No

  N/A

• Adequate lighting and access?

  Safe

  At Risk

  N/A

• Does task require shutdown of systems or equipment?

  Yes

  No

  N/A

• Does task have any potential to disrupt DOA or tenant activities?

  Yes

  No

  N/A

• Will weather affect safety or quality of work?

  Yes

  No

  N/A

• Are there occupied spaces adjacent or below?

  Yes

  No

  N/A

• Have shop drawings, contract drawings or as-builds been reviewed?

  Yes

  No

  N/A

• Any discharge of fluids anticipated?

  Yes

  No

  N/A

• Do any other shops need to be notified/involved?

  Yes

  No

  N/A

• Any special permits/procedures required for task?

  Yes

  No

  N/A

• "Buddy" system being used?

  Yes

  No

  N/A

• Crew knows location of fire extinguishers, eyewash, phone?

  Yes

  No

  N/A

• Does task require awkward positions, or heavy/repetitive lifting?

  Yes

  No

  N/A

Special conditions

• Public exposure

• Traffic control

• Barricades/signage

• Confined space entry

• Chemical exposure

• Ventilation

• Electrical hazards

• Lockout/tagout

• Hot work

• Critical lift plan

• MSDS/Hazcom

• Fall protection

• Hand or arm protection

• Full body protective suit

• Respirator

• Hearing protection

• Eye/face protection

• Other considerations/PPE

Work activity

• Activities observed

Activity

• Activity

• Hazards identified

• Preparation

• Additional information

Personnel

• Supervisor name & signature

  Sign

• Date & time

  Date

• Crew members

Crew member

• Add signature

  Sign

• IF WORK CONDITIONS CHANGE, WORK MUST CEASE, AND A NEW PLAN MUST BE COMPLETED.