MSI Pre-Task Planning Checklist

• What is the Task

• Conducted on

  Date
• Location
  Address

• Personnel

• STOP IF PRE-TASK PLAN CANNOT BE MET OR CONDITIONS CHANGE DURING THE COURSE OF WORK

• Select date

  Date

• Task Description

PPE & SAFETY EQUIPMENT REQUIRED

• Eye/Face - Safety Glasses, Goggle, Face Shield

  Yes

  No

  N/A

• Head/Ear - Hard Hat, Bump Cap, Ear Plugs

  Yes

  No

  N/A

• Hand - Gloves, Leather, Gauntlet, Cut or Chemical Resistant

  Yes

  No

  N/A

• Fall Protection/Restraint Harness

  Yes

  No

  N/A

• NFPA 70E Arc Flash Protection Gear

  Yes

  No

  N/A

• Welding - Goggles, Hood, Sleeves, Gloves

  Yes

  No

  N/A

• Knee/Shin/Foot - Safety Toe, Rubber Soles, Knee Pads

  Yes

  No

  N/A

• Ground Fault Circuit Interupter

  Yes

  No

  N/A

• Lock Out/Tag Out Equipment

  Yes

  No

  N/A

• Fire Extinguishers for Hot Work

  Yes

  No

  N/A

• Pedestrian Control Devices: Signs, Caution Tape, Cones

  Yes

  No

  N/A

WORK SITE INSPECTION

• Customer Safety Guidelines, Permits, Pick Plans

  Yes

  No

  N/A

• Acceptable Access, Egress, Escape Route

  Yes

  No

  N/A

• First Aid Station Available

  Yes

  No

  N/A

• Emergency Phone Numbers Present

  Yes

  No

  N/A

• Proper Illumination

  Yes

  No

  N/A

• Trash Recepticles

  Yes

  No

  N/A

• Tripping ans Slipping Hazards identified

  Yes

  No

  N/A

• Unprotected edge, Skylight, or Other Fall HAzard

  Yes

  No

  N/A

• Confined Spaces

  Yes

  No

  N/A

• Weather Conditions Acceptable for Outdoor Work

  Yes

  No

  N/A

• Do You Have The Correct Power To Proceed

  Yes

  No

  N/A

TOOLS and EQUIPMENT INSPECTION

• Aerial, Scissor Lifts, Crane

  Yes

  No

  N/A

• Gantry, Chain Fall, Slings or other Lifting Equipment

  Yes

  No

  N/A

• Ladders

  Yes

  No

  N/A

• Hand and Power Tools

  Yes

  No

  N/A

• Material Handling Equipment

  Yes

  No

  N/A

TECHNICIAN COMMENTS

• Add media

  Media

ALL TECHNICIANS SIGNATURES

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign