EMCOR Betlem Pre-Task Planning Guide

The Pre-Task Planning Guide should be completed daily for each task. Post in a conspicuous location throughout the length of the task. Each employee involved with the task shall initial this Guide. If deviation from known work practices/procedures occurs, work must be stopped and re-evaluated. On project sites notify your supervisor and/or safety.

• Project Name

• Work Order/ Job Number

• Supervisor

• Conducted on

  Date
• Location of Task
  Address

• Task Description

• Does the task require special training?

  Yes

  No

• If yes, what type?

Task Information

• What are the hazards associated with the job/task?

• What will be done to eliminate/ controls the above hazards?

• Have they been reviewed by affected employees?

  Yes

  No

General Work Environment/Housekeeping

• Is there acceptable access/egress to the work site? Tripping hazards removed/addressed?

  Yes

  No

• Materials handling: Should carts or other means be used to keep materials and tools off the floor?

  Yes

  No

• Is there adequate illumination for all work?

  Yes

  No

• Barricades maintained & appropriate?

  Yes

  No

• What weather conditions could affect safe performance of this task?

• Are trash receptacles available in the work area? Water and sanitation facilities located?

  Yes

  No

• Location:

Fire Protection

• Identify the location of the nearest extinguisher and communication source.

• Are flammable/combustible materials stored, separated, inspected, labeled and secured per procedure?

  Yes

  No

Tools & Equipment

• User inspection is required on all tools, ladders, GFIs, electrical cords, rigging and safety equipment. Has this been completed?

  Yes

  No

Material Storage

• Has material storage area been identified and approved?

  Yes

  No

Fall Protection

• Have areas been identified as requiring fall protection systems? (i.e. static lines, barricades, handrails, hole covers, etc.)

  Yes

  No

• Have they been installed?

  Yes

  No

• 100% Tie-off (personal fall arrest/restraint) required at how many feet?

Personal Protective Equipment Required. (Check the general type of PPE required then select the specific type of PPE which will be used.)

• Eye/Face

• Select the Eye/Face protection type

  Z87 Glasses

  Goggles

  Face Shield

• Head/Face

• Select Head/Ear protection type

  Hard Hat

  Ear Plugs

• Hand

• Select the Hand protection type

  Gloves

  Leather

  Gauntlet

  Cut or Chemical Resistant

• Garment/Coveralls

• Select Garment/Coveralls protection type

  Traffic Vest

  Nomex

  Tyvek

• Knee/Shin/Foot

• Select Knee/Shon/Foot protection type

  Safety Toe

  Rubber

  Knee Pads

• Fall Protection Harness

• Welding

• Select Welding protection type

  Googles

  Hood

  Sleeves

• Respirator

• Select Respirator protection type

  Dust

  Welding

  Half

  Full

  Supplied Air

• NFPA 70 E- Arc Flash Protection

• Other

• Specify "Other" PPE

Equipment

• List mechanized equipment, platforms, personnel lifts and scaffolding needed:

• Do they have current inspections?

  Yes

  No

  N/A

Employee Certifications Required

• Crane Operator

• Forklift Operator

• Mobile Equipment Operator

• Scissor Lift/ JLG

• Power Actuated

• NFPA 70E

• Competent Person

• Confined Spaces

• Excavations

• Hazardous Material

• Scaffolds

• Other

• Please specify other:

Procedures/Permits Required

• Lockout/ Tagout

  Yes

  No

  N/A

• Hot Work

  Yes

  No

  N/A

• Fire Watch

  Yes

  No

  N/A

• Excavation

  Yes

  No

  N/A

• Signs/ Barricades

  Yes

  No

  N/A

• Confined Space

  Yes

  No

  N/A

• Hole Watch

  Yes

  No

  N/A

• Crane Lift

  Yes

  No

  N/A

• Line Break

  Yes

  No

  N/A

• Scaffolds

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Please specify other

Post Task Assognment

• Supervisor

• Date

  Date

• Was anyone injured or did an unplanned incident occur today?

  Yes

  No

• If "Yes", explain:

• Was it reported to Management/Safety?

  Yes

  No

  N/A

• If "Yes", state whom you told & when they were told.

• What problems did you have with today's work assignment?

• What can we do tomorrow to improve safety/ performance?

• Miscellaneous Concerns:

Involved Crew Members

Crew Member Names & Initials

• Name

• Initials

  Sign

• Supervisor Name

• Signature

  Sign

• Project Manager Name

• Signature

  Sign

• Technician Name

• Signature

  Sign