NII Pre-Task Plan for Safety - duplicate

• Conducted on

  Date

• Prepared by

• City

• Job Site Name

• NII Job #

• Note: This document must be completed by NII's Supervisor on the project, is valid for one shift only, and must be maintained / posted at the job site.

Pre-Task Plan for Safety

• Job:

• Location:

• Date:

• Supervisor:

• Safe Job / Energy Control Procedures

• Description of Work

Personal Protective Equipment

• Eye and Face Protection

  Yes

  No

• Hand Protection

  Yes

  No

• Head Protection (Brim Forward)

  Yes

  No

• Respiratory Protection

  Yes

  No

• Foot Protection (Metatarsal)

  Yes

  No

• Torso Protection

  Yes

  No

• Welding Shield

  Yes

  No

• Leather Sleeves / Coat

  Yes

  No

• Long Sleeve Shirts

  Yes

  No

• Fire Retardant Clothing

  Yes

  No

• Cut Resistant Protection

  Yes

  No

• Specialized Clothing

  Yes

  No

• Personal Gas Detectors Required

  Yes

  No

Energized Equipment

• Lock Outs Verified

  Yes

  No

• All Locks Labeled / Tagged

  Yes

  No

• Broken / Exposed Wiring

  Yes

  No

Fire Protection

• Proper Fire Extinguisher

  Yes

  No

• Flammable Materials Removed

  Yes

  No

• Fire Blankets

  Yes

  No

• Fire Watch Required

  Yes

  No

• Area Needs to be Flagged

  Yes

  No

Tools

• Proper Tools for the Job

  Yes

  No

• Ladder Inspection

  Yes

  No

• Hand Tools in Good Condition

  Yes

  No

• Air Hoses Secured

  Yes

  No

• Oxygen / Acetylene

  Yes

  No

• Flash Back Arrester in Place

  Yes

  No

• Work Permit

  Yes

  No

• Excavation

  Yes

  No

• Confined Space

  Yes

  No

• Hot Work

  Yes

  No

• MSDS Available

  Yes

  No

• Special Written Procedures

  Yes

  No

Housekeeping

• Work Surface Level

  Yes

  No

• Aisles, Stairs, Floors Clean

  Yes

  No

• Storage of Materials

  Yes

  No

Material Handling / Equipment Inspection

• Cranes or Cherry Pickers

  Yes

  No

• Rigging Checked

  Yes

  No

• Cables, Ropes, Slings

  Yes

  No

• Chain Falls

  Yes

  No

• Pre-Lift Required

  Yes

  No

• Come-a-Long

  Yes

  No

• Mobile Equipment

  Yes

  No

Fall Protection

• Rope Grabs

  Yes

  No

• Retractables

  Yes

  No

• Vertical Lifelines

  Yes

  No

• Guardrail Systems

  Yes

  No

• Floor Openings Protected

  Yes

  No

• Ladders Secured

  Yes

  No

• Scaffolds Inspected

  Yes

  No

• Rebar Protected

  Yes

  No

• Pinch Points

  Yes

  No

• Trailer Inspection

  Yes

  No

• GFI Protection in Place

  Yes

  No

• No Touch Policy Reviewed

  Yes

  No

• Asbestos Policy & Procedure

  Yes

  No

• Spill Reporting Procedure

  Yes

  No

• Emergency Signals & Numbers

  Yes

  No

Danger Zone Identification

• Moving Equipment Such as Mobile

• Equipment, Railroad Hazards

• Chemical Hazards

• Fire Hazards

• Fall Hazards

• Utility and Process Flow

• Electrical Hazards

• Working Above / Below Hazards

• Crane Operations

• Radiation / Laser Hazards

• Other:

Danger Zone Control Measures

• Area Secured / Flagging / Physical

• Barricades (Safety Personnel Posted)

• Warning Ribbon & ID Tagging in Place

• Hot Work / Permits Complete

• Special Guarding Requirements

• Lock Out & Tag Out Devices Applied

• Procedures (Regulatory and NII)

• Permits in Place

• Fall Protection & Fall Arrest System

• Roof Perimeter Protection

• Personal Protective Equipment

• Emergency Evacuation Routes Identified

• Assembly Areas Designated

• Railroad Track Protection

• Gas Monitoring

High Gas Hazard Area

• Personal gas detectors are required for all individuals entering or working in these areas.

Post Task & Inspection Checklist

• Job Complete

  Yes

  No

• If Job Incomplete – Temporary

  Yes

  No

• Provisions, Barricades, Safety

  Yes

  No

• Locks, Lighting in Place, etc.

  Yes

  No

• Housekeeping Inspected

  Yes

  No

• All Guarding Replaced

  Yes

  No

• Permits Closed

  Yes

  No

• Equipment Secured

  Yes

  No

• Operations Notified

  Yes

  No

Plant Emergency Numbers

• Ambulence:

• Fire:

• Medical:

• Security

• Environmental:

• Materials Management:

• Hazmat;

• Confined Space Entry Notification:

• Chemical Emergencies:

• DOT:

• Safety / Industrial Hygiene Office: Safety / Industrial Hygiene Office:

• Asbestos Emergencies:

• SDS Center:

• Guard Shack:

• Other: