Newcomb and Company Pre-Task Plan Checklist

• Document No.

• Task Description

• Client / Site/Location Within

• Conducted on

  Date

• Prepared by

• Personnel

PPE & SAFETY EQUIPMENT REQUIRED (Must be wearing during work activities, NA if not applicable)

• Eye and Face Protection (Face shield over safety glasses for chemical, overhead work as needed)

  Yes

  No

  N/A

• Head Protection

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Hand Protection - Slip/Cut resistant for sharp edges, etc. Leather/denim for general use

  Yes

  No

  N/A

• Fall Protection- Proper Harness, Lanyard, and Anchor. CALL SAFETY DIRECTOR FOR GUIDANCE

  Yes

  No

  N/A

• NFPA 70E Trained - Shock and Flash Protection Available. Approach Boundaries Established (Refer to SWP5 - General Electrical Safety to set approach boundaries)<br>

  Yes

  No

  N/A

• Hot Work- Goggles, Hood with appropriate shade protection, Sleeves, Gloves

  Yes

  No

  N/A

• Knee/Foot protection. Boot chains required when working on and around snow and ice.

  Yes

  No

  N/A

• Locks and Tags available. STOP WORK NOW IF YOU DO NOT HAVE THESE AND GET THEM

  Yes

  No

  N/A

• Fire Extinguisher available for hot work

  Yes

  No

  N/A

WORK SITE INSPECTION. Stop work and notify supervisor if any deficiencies identified.

• Acceptable access, egress, escape route

  Yes

  No

  N/A

• Unprotected edges, or other fall hazards identified and controlled

  Yes

  No

  N/A

• Is Confined Space procedures needed? - If questionable - STOP NOW AND NOTIFY SAFETY OFFICE.

  Yes

  No

  N/A

• Walkways inspected for tripping and slipping hazards

  Yes

  No

  N/A

• Proper illumination

  Yes

  No

  N/A

• First aid supplies available (check expiration dates on ointments, eye drops & replace if expired)

  Yes

  No

  N/A

• Trash receptacles available

  Yes

  No

  N/A

• Weather conditions acceptable for out door work - Working on roofs when snow and ice are present requires a supervisors permission, with appropriate controls in place.

  Yes

  No

  N/A

• Customer safety guidelines met

  Yes

  No

  N/A

• Do you have adequate manpower to proceed

  Yes

  No

  N/A

TOOLS AND EQUIPMENT INSPECTION

• Ladders inspected. (If defective, place a Defective Tool tag on it and remove from service)

  Yes

  No

  N/A

• Hand and power tools inspected. Ground pin present. If found to be defective, remove from service.

  Yes

  No

  N/A

• Ground Fault Circuit Interrupters (GFCI - TEST IT!)

  Yes

  No

  N/A

• Material handling equipment available and inspected

  Yes

  No

  N/A

• Gantry, chain fall, slings and other lifting equipment inspected

  Yes

  No

  N/A

TRAINED IN

• Confined Space Operations

  Yes

  No

  N/A

• Man lift

  Yes

  No

  N/A

• Forklift

  Yes

  No

  N/A

SIGNATURE

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