Northern Industrial Insulation Pre-Task Safety Plan

• Job Site Name

• City

• NII Job #

• Conducted on

  Date

• Prepared by

• 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 jobsite.

• Job

• Location

• Date

  Date

• Supervisor

• Safe Job / Energy Control Procedures

• Description of Work

Task Safety Checklist

Personal Protective Equipment

• Eye and Face Protection

  Yes

  No

  N/A

• Hand Protection

  Yes

  No

  N/A

• Head Protection (Brim Forward)

  Yes

  No

  N/A

• Respiratory Protection

  Yes

  No

  N/A

• Foot Protection (Metatarsal)

  Yes

  No

  N/A

• Torso Protection

  Yes

  No

  N/A

• Welding Shield

  Yes

  No

  N/A

• Leather Sleeves / Coat

  Yes

  No

  N/A

• Leather Sleeves / Coat

  Yes

  No

  N/A

• Long Sleeve Shirts

  Yes

  No

  N/A

• Fire Retardant Clothing

  Yes

  No

  N/A

• Cut Resistant Protection

  Yes

  No

  N/A

• Specialized Clothing

  Yes

  No

  N/A

• Personal Gas Detectors Required

  Yes

  No

  N/A

Energized Equipment

• Locks Out Verified

  Yes

  No

  N/A

• All Locks Labeled / Tagged

  Yes

  No

  N/A

• Broken / Exposed Wiring

  Yes

  No

  N/A

• Personal Gas Detectors Required

  Yes

  No

  N/A

Fire Protection

• Proper Fire Extinguisher

  Yes

  No

  N/A

• Flammable Materials Removed

  Yes

  No

  N/A

• Fire Blankets

  Yes

  No

  N/A

• Fire Watch Required

  Yes

  No

  N/A

• Area Needs to be Flagged

  Yes

  No

  N/A

Tools

• Proper Tools for the Job

  Yes

  No

  N/A

• Ladder Inspection

  Yes

  No

  N/A

• Hand Tools in Good Condition

  Yes

  No

  N/A

• Air Hoses Secured

  Yes

  No

  N/A

• Oxygen / Acetylene

  Yes

  No

  N/A

• Flash Back Arrester In Place

  Yes

  No

  N/A

Permits **

• Work Permit

  Yes

  No

  N/A

• Excavation

  Yes

  No

  N/A

• Confined Space

  Yes

  No

  N/A

• Hot Work

  Yes

  No

  N/A

• SDS Available

  Yes

  No

  N/A

• Special Written Procedures

  Yes

  No

  N/A

• SDS Available

  Yes

  No

  N/A

Housekeeping

• Work Surface Level

  Yes

  No

  N/A

• Aisles, Stairs, Floors Cleaned

  Yes

  No

  N/A

• Storage of Materials

  Yes

  No

  N/A

Material Handling / Equipment Inspection

• Cranes or Cherry Pickers

  Yes

  No

  N/A

• Rigging Checked

  Yes

  No

  N/A

• Cables, Ropes, Slings

  Yes

  No

  N/A

• Chain Falls

  Yes

  No

  N/A

• Pre-Lift Required

  Yes

  No

  N/A

• Come-a-long

  Yes

  No

  N/A

• Mobile Equipment

  Yes

  No

  N/A

Fall Protection

• Rope Grabs

  Yes

  No

  N/A

• Retractables

  Yes

  No

  N/A

• Vertical Lifelines

  Yes

  No

  N/A

• Horizontal Lifelines

  Yes

  No

  N/A

• Guardrail System

  Yes

  No

  N/A

• Floor Openings Protected

  Yes

  No

  N/A

Miscellaneous

• Ladders Secured

  Yes

  No

  N/A

• Scaffolds Inspected

  Yes

  No

  N/A

• Rebar Protected

  Yes

  No

  N/A

• Pinch Points

  Yes

  No

  N/A

• Trailer Inspection

  Yes

  No

  N/A

• GFI Protection In Place

  Yes

  No

  N/A

• No Touch Policy Reviewed

  Yes

  No

  N/A

• Asbestos Policy & Procedure

  Yes

  No

  N/A

• Asbestos Policy & Procedure

  Yes

  No

  N/A

• Spill Reporting Procedure

  Yes

  No

  N/A

• Asbestos Policy & Procedure

  Yes

  No

  N/A

• Emergency Signals & Numbers

  Yes

  No

  N/A

• Danger Zone Identification

  Select Moving Equipment Such as Mobile Equipment, Railroad Hazards Chemical Hazards Fire Hazards Fall Hazards Unprotected Floor & Wall Openings Utility and Process Flow Electrical Hazards Working Above / Below Hazards Gas Hazards Crane Operations Radiation / Lazer Hazards

  • Moving Equipment Such as Mobile
  • Equipment, Railroad Hazards
  • Chemical Hazards
  • Fire Hazards
  • Fall Hazards
  • Unprotected Floor & Wall Openings
  • Utility and Process Flow
  • Electrical Hazards
  • Working Above / Below Hazards
  • Gas Hazards
  • Crane Operations
  • Radiation / Lazer Hazards

• Danger Zone Identification Other

• Danger Zone Control Measures

  Select Area Secured / Flagging / Physical Barricades (Safety Personnel Posted) Warning Ribbon & ID Tagging in Place Danger or Warning Signage in Place & Appropriate PPE Hot Work / Permits Complete Special Guarding Requirements Lock Out & Tag Out Devices Applied Procedures (Regulatory & 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 Safety Training Verified and Completed

  • Area Secured / Flagging / Physical
  • Barricades (Safety Personnel Posted)
  • Warning Ribbon & ID Tagging in Place
  • Danger or Warning Signage in Place & Appropriate PPE
  • Hot Work / Permits Complete
  • Special Guarding Requirements
  • Lock Out & Tag Out Devices Applied
  • Procedures (Regulatory & 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
  • Safety Training Verified and Completed

• High Gas Energy Areas: Personal gas detectors are required for all individuals entering or working in these areas.

Post Task & Inspection Checklist

• Job Complete

  Yes

  No

  N/A

• If Job Incomplete - Temporary

  Yes

  No

  N/A

• Provisions, Barricades, Safety

  Yes

  No

  N/A

• Locks, Lighting in Place, Etc...

  Yes

  No

  N/A

• Housekeeping Inspected

  Yes

  No

  N/A

• All Guarding Replaced

  Yes

  No

  N/A

• Permits Closed

  Yes

  No

  N/A

• Equipment Secured

  Yes

  No

  N/A

• Operations Notified

  Yes

  No

  N/A

Job Emergency Numbers

• Ambulance

• Fire

• Medical

• Security

• Environmental

• Materials Management

• Hazmat

• Chemical Emergencies

• DOT

• Safety / Industrial Hygiene Office

• Asbestos Emergencies

• SDS Center

• Guard Shack

• Other Emergency Numbers