Graycor Pre-work, Pre-incident Review

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

WHAT ARE WE GOING TO DO?

• TIME BRIEFING CONDUCTED:

  Date

• Are the procedures and work scope understood?

  Yes

  No

  N/A

• Are there written Job Safety Analysis (JSA) for this activity?

  Yes

  No

  N/A

• If this job meets the definition of a high hazard job, then a JSA must be used in conjunction with this checklist for the Pre-job briefing.

• JSA #'s :

• Have the Foreman / lead-person and crew/team analyzed the work assignment for safety hazards?

  Yes

  No

  N/A

• Are the roles of the workers/task leader identified?

  Yes

  No

  N/A

• DAILY DISCUSSION:

WHAT IS THE WORST THING THAT COULD HAPPEN?

• Have the safety hazards been identified and ways to control these hazards discussed for each task?

  Yes

  No

  N/A

• Have other safety considerations been identified and discussed?

  Yes

  No

  N/A

• Is there a significant potential for personnel injury?

  Yes

  No

• Are Rescue plans in place: Means of contacting emergency agencies, a list of phone numbers, and a description of worksite locations? Police, Fire, emergency numbers posted?

  Yes

  No

  N/A

• Have there been additional discussions held about significant changes, which might affect safety, occurring during the course of the work being performed?

  Yes

  No

• DAILY DISCUSSION:

WHAT ARE WE GOING TO DO,ESPECIALLY AT THOSE CRITICAL STEPS, TO MAKE SURE THAT A MISTAKE DOESN'T HAPPEN?

• Insured that communication lines where clearly understood.

  Yes

  No

  N/A

• Insured that a work plan or procedure was in place? If YES list below or NO explain.

  Yes

  No

  N/A

• WorkPlan # or Reason for NO written plan?

• Identified the barriers or defenses to be depended on?

  Yes

  No

  N/A

• Time Out (understood to mean STOP when unsure).

  Yes

  No

  N/A

• All procedures are to be followed as written or are to be revised first. (not to proceed if procedures are not accurate)

  Yes

  No

  N/A

• Identified the criteria for suspending work activities?

  Yes

  No

  N/A

• DAILY DISCUSSION:

WHAT ARE THE ERROR-LIKELY SITUATIONS?

• Is there a potential for distractions and if yes, how will they be minimized?

  Yes

  No

• Is this a first time job function being performed?

  Yes

  No

  N/A

• Is this the first working day after days off?

  Yes

  No

  N/A

• Are there other error precursors (task demands, work environment, individual capability, human nature?

  Yes

  No

• Are procedures new or recently revised?

  Yes

  No

  N/A

• Are personnel familiar with the task?

  Yes

  No

  N/A

• Has time / schedule / out-of-service time been considered?

  Yes

  No

  N/A

• DAILY DISCUSSION:

WHAT ARE OUR SAFETY CONCERNS?

• Clearance-boundaries have been walked down and discussed with the team members?

  Yes

  No

  N/A

• Adequate scaffolding / ladders / rigging available and in proper working order? (including all annual inspections)

  Yes

  No

  N/A

• Have all environmental, chemical and health related hazards been identified and appropriate actions taken?

  Yes

  No

  N/A

• PPE (hard hats, safety glasses, fall protection equipment, gloves hearing protection, face shields and Fire Retardant clothing) available for use as required?

  Yes

  No

  N/A

• High temperature extremes and potential employee exposure discussed?

  Yes

  No

  N/A

• Do you have any identified or potential Confined Spaces to enter and are proper precautions being taken? (Confined Space training required for entry)

  Yes

  No

  N/A

• DAILY DISCUSSION:

OPERATING EXPERIENCE (related industry events either internal or external)

• Discussed applicable recent industry events and/or Lessons Learned?

  Yes

  No

  N/A

• DAILY DISCUSSION:

GENERAL

• Are the performers task qualified to do the task and are they current?

  Yes

  No

  N/A

• Are the proper tools available to perform the task(s)?

  Yes

  No

  N/A

• Is inspected rigging equipment available and has the right equipment been selected to perform the task(s)?

  Yes

  No

  N/A

• Is proper flagging material available for use and application identified?

  Yes

  No

  N/A

• Have we considered housekeeping, area cleanliness, and posting requirements for the job?

  Yes

  No

  N/A

• Are aerial lifts, cranes, forklifts, bucket trucks and other such equipment being inspected and documented at least daily before use?

  Yes

  No

  N/A

• Are there any special requirements associated with this work activity?

  Yes

  No

• Is there sensitive equipment in the area that needs to be considered before, during and/or after the work activity?

  Yes

  No

• Are there limitations on radio and cell phone use before, during and/or after this work activity'

  Yes

  No

• Have issues related to the environment been discussed? (weather, terrain, time-of-day, dust, noise, lighting etc.).

  Yes

  No

  N/A

• DAILY DISCUSSION:

• ATTENDEES initial:

  Sign

• 3/12/2013 Frank Deller