Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

JOB PLAN

  • This is not a work order. Please refer to the Ivara work order for additional details.

Info

  • Work Order #

  • Asset#

  • Time and date of Job site visit.

  • Planner: Dan Courtemanche x.206 ch.1

Location

  • Area

  • Floor

  • Control Room for Lock Out

  • Map

Details

  • Problem

  • Job Scope

  • If job scope changes, check with operator to see if lock out requirements have changed.

  • Running condition

  • S/D?

  • Around the clock?

  • Duration in shop

  • Duration in Field

  • Complexity Level

  • Exhaustion Level

  • Photos

  • Sketch

  • Drawing required

  • Problems to resolve

  • Prep work required

  • Work acceptance criteria

  • Contingency

  • Notes

Permits & Procedures

  • LOTO required?

  • Line break?

  • Hot work?

  • Working from heights?

  • Confined space entry?

  • Gas test?

  • Lifting Permit?

  • Working on tank top?

  • TSSA?

  • Union Notification?

Resources

  • Skills required?

  • BOM

  • Special tools required?

  • PPE required?

  • Rigging required?

  • Mobile equipment required?

  • Bottles and masks?

  • Scaffold Required?

  • Fall arrest required?

Emergency

  • EMERGENCY: Contact Security by Phone ext.316 or Radio ch.1

  • Nearest phone

  • Nearest emergency door

  • Nearest eyewash / shower

JSA / JHA

  • Line of fire

  • Slips / Trips

  • Fall to lower level

  • Struck by / Struck against

  • Caught / Crushed

  • Cut / Puncture / Abrasion

  • Pressurized system / Compressed gas

  • Hot / Cold environment

  • Thermal Contact

  • Chemical Contact

  • PSM Chemicals

  • Non-PSM Chemicals

  • Gas Area - Carry respirator at all times.

  • Electrical

  • Radiation

  • Vibration

  • Noise

  • Noise Level

  • Confined Space

  • Entanglement

  • Obstruction

  • Fire / Explosion

  • Dust / Fumes / Vapour

  • Ergonomics

  • Visibility / Lighting

  • Access / Egress

  • Working on Roof

  • Traffic

  • Working Alone

  • Drop tool to lower level

  • Biohazardous Material

  • Insect Bite

  • Weather

  • Environmental damage

General Instruction

  • Perform 10 foot safety circle.

  • Ensure controls are in place for all identified hazards.

  • Complete job safety check sheet.

  • Keep work area tidy for the entire duration of the job.

  • Dispose of all garbage properly.

  • Place all recyclables in proper bins.

  • Return all unused parts to return bin.

  • Put away all tools and rigging.

  • Leave the job site cleaner than you found it.

  • Report activity as "Complete" in Ivara and leave feedback

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