Basics

  • Emergency contacts and numbers

  • Task (Scope)

  • Do you know and understand the scope of work and how to do it safely?

  • Is this a standard working procedure/activity?

  • Do you know the proper and safe method to execute the job from start to finish?

  • Task operating experience

  • Critical steps

  • Step 1

  • Hazards Associated with Step 1

  • Add media

  • Safe Work Procedures/PPE for Step 1

  • Step 2

  • Hazards associated with Step 2

  • Add media

  • Safe Work Procedures/PPE for Step 2

  • Step 3

  • Hazards associated with Step 3

  • Add media

  • Safe Operating Procedures/PPE for Step 3

  • Step 4

  • Hazards associated with Step 4

  • Add media

  • Safe Operating Procedure/PPE for Step 4

  • Step 5

  • Hazards associated with Step 5

  • Add media

  • Safe Operating Procedures/PPE for Step 5

  • What is the worst thing that could happen?

  • PPE needed

  • Tools required

  • Additional hazard controls

Hazards/Precursors

  • Job hazards (check only those that are present)

  • Other hazards(s)

  • Precursors (check only those that are present)

  • Precursors

Permits/Procedures

  • Work instruction (SOP)

  • Safety risk assessment

  • LOTO procedures

  • Confined space procedures

  • Confined space permit

  • Electrical work permit

  • Hydrostatic test permit

  • Other permits/procedures

  • Review/Required for "Other"

Review and Authorization

  • EHS Review required for the following activities

  • EHS Review required for the following activities

  • Authorization

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.