Gilbane Safety Task Assignment - FINAL

• Location
  Address

• Conducted on

  Date

• Prepared by

• Personnel On Site

• Job #:

• My Safety Principles:
  
  Plan Every Job
  Anticipate Unexpected Events
  Use the Right Tool For The Job
  Use Procedures As Tools
  Isolate The Equipment
  Identify The Hazards
  Minimize The Hazards
  Protect The Person
  Assess People's Abilities
  Audit These Principles

• SUBMIT THIS FORM ELECTRONICALLY TO PROJECT MANAGEMENT WITHIN 24-HOURS!

• The STA should be completed daily for each task. Each crew-member involved with the task should sign this STA. Post this STA in a conspicuous location throughout the length of the task and at the end of the task, save the STA for project record. If deviation from known safe work practice/procedure occurs, work must be stopped. Modify the STA before proceeding.

• Company: Danboise Mechanical

• Task Description:

• Identify Ways To Eliminate or Control Potential Hazards:

• Task Competent Person:

• All necessary special training related to performing this task has already been conducted.

  Yes

  No

  N/A

• What special training needs to be performed?

• STA Communicated to the following individuals:

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign

• Are the workers capable of planning this work safely?

  Yes

  No

  N/A

• Contact your company supervisor before proceeding!

• Have all personnel on site attended AT&T Network Awareness Training (NAT)?

  Yes

  No

  N/A

• Do you have an approved MOP for this work?

  Yes

  No

  N/A

• Have all AT&T and local alarm centers been notified of this work?

  Yes

  No

  N/A

• Are the following hazards appropriately addressed and accounted for?

• Chemical Burn

  Yes

  No

  N/A

• Extreme Heat/Cold

  Yes

  No

  N/A

• Particles in Eye

  Yes

  No

  N/A

• Overexertion

  Yes

  No

  N/A

• Elevated Load

  Yes

  No

  N/A

• Falls over 6ft

  Yes

  No

  N/A

• Overhead Work

  Yes

  No

  N/A

• Sprains/Strains

  Yes

  No

  N/A

• Falling Objects

  Yes

  No

  N/A

• Vehicle Traffic

  Yes

  No

  N/A

• Live utility/Electrical shock

  Yes

  No

  N/A

• Using hazardous materials

  Yes

  No

  N/A

• Trips/Slips/Falls

  Yes

  No

  N/A

• Fire/Explosion

  Yes

  No

  N/A

• Spills

  Yes

  No

  N/A

• Abrasions/Cuts

  Yes

  No

  N/A

• Cave-Ins

  Yes

  No

  N/A

• Loud noises

  Yes

  No

  N/A

• Heat/Cold

  Yes

  No

  N/A

• Pinch points

  Yes

  No

  N/A

• Lead/Asbestos

  Yes

  No

  N/A

• Cranes/Rigging

  Yes

  No

  N/A

• Other (Explain)?

Mandatory Personal Protective Equipment (Required at all times for all workers):

• Safety Glasses

  Yes

  No

  N/A

• Hard Hat

  Yes

  No

  N/A

• Cut Resistant Gloves

  Yes

  No

  N/A

• Work Boots

  Yes

  No

  N/A

• Fall Protection Over 6ft

  Yes

  No

  N/A

Additional PPE (If Required):

• Select Fall Protection Respirator Foot/Shin Hearing OSHA 70 E PPE Mono Goggles Face Shield Specialty Hood Welding Shield Welding Apparel

  • Fall Protection
  • Respirator
  • Foot/Shin
  • Hearing
  • OSHA 70 E PPE
  • Mono Goggles
  • Face Shield
  • Specialty Hood
  • Welding Shield
  • Welding Apparel

• Other?

• Is the work area free of debris?

  Yes

  No

  N/A

• Tripping hazards removed?

  Yes

  No

  N/A

• HEPA Vacuum on site?

  Yes

  No

  N/A

• Telco equipment protected?

  Yes

  No

  N/A

• Rubber blankets on live bus?

  Yes

  No

  N/A

• Water intrusion measures?

  Yes

  No

  N/A

• Griffolyn protection required?

  Yes

  No

  N/A

• Hazardous fumes from materials used are contained?

  Yes

  No

  N/A

• MSDS Sheets are on site before the material is exposed?

  Yes

  No

  N/A

• MSDS has been reviewed for health hazards prior to material use?

  Yes

  No

  N/A

• Select the necessary procedures/certifications/or permits required

  Select Hot Work Lock Out/Tag Out Excavation Signs/Barricades Confined Space Crane Lift Line Break/Hot Tapping Scaffolds Crane Operator Competent Person (Lead, Asbestos, Excavation, Confined Space, Hazcom, Scaffolding)

  • Hot Work
  • Lock Out/Tag Out
  • Excavation
  • Signs/Barricades
  • Confined Space
  • Crane Lift
  • Line Break/Hot Tapping
  • Scaffolds
  • Crane Operator
  • Competent Person (Lead, Asbestos, Excavation, Confined Space, Hazcom, Scaffolding)

• Hot work requires a fire watch

• Other (Specify):

• Have underground utilities been marked?

  Yes

  No

  N/A

• Has the AT&T Damage Prevention Group been made aware of this work?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Will the employee using the ladder utilize the three points of contact rule? Tools/Materials transported separately?

  Yes

  No

  N/A

• Has the scaffold tag been signed?

  Yes

  No

  N/A

• Has a hazardous material storage area been identified, approved, & secured & stored per AT&T NAT?

  Yes

  No

  N/A

• Are you using the appropriate equipment and techniques to transport or set the work materials safely?

  Yes

  No

  N/A

• Identify hazardous work material and equipment: