Per-job Safety Instruction

• Audit Title

• Document No.

• Project

• Project number

• Prepared by

• Conducted on

  Date

• Questions to be answered
  1. Is the area safe to work in?
  2. Will the activities of other crews interfere with safe operations?
  3. Has a job hazard analysis been completed and do workers understand their assignments?
  4. Have the proper tools and equipment been provided?
  5. Are tools and equipment in safe operating condition?
  6. Has proper P.P.E. been provided?
  7. Are you knowledgable on the use of the P.P.E.?
  8. Can the crew communicate effectively or are there restrictions to prevent clear understanding of what is being conveyed?
  9. If chemicals are being used, is the crew aware of the hazards and safety controls required to safely complete the work assignment?
  10. Is the the crew aware that the P.S.I. is there to assist them in getting the job done safely?
  11. Have workers been encouraged to make suggestions to assist in completing the job assignments safely?
  12. Has the crew been advised to report any unsafe acts or unsafe conditions to their supervisors?
  

Environmental Hazards

• Spill potential

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Weather conditions

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• MSDS reviewed

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Ventilation required

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Heat stress / Cold exposure

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Other workers in area

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Lighting levels to low

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Housekeeping

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

Activity Hazards

• Welding / Grinding

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Burn / Heat source

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Compressed gasses

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Energized equipment

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Electrical cords / tools - condition

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Equipment / Tools inspected

  Yes

  No

• Enter the reason there was no inspection done.

• Was there any defective equipment or tools found?

  No

  Yes
Equipment / tool

• Defective item

• Tap to add picture

  Media

• Was the defective item tagged and removed for service?

  Yes

  No

• Why was the defective item not tagged and removed for servicing?

• Critical lift meeting

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Lockout procedure in place

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Airborne particles in place

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

Ergonomics Hazards

• Working in tight areas

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Parts of the body in line of fire

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Working above your head

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Pinch points identified

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Repetitive motion

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

Work at Height Hazards

• Barricades, flagging and signs

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Hole coverings in place

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Protection from falling items

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Powered platforms

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Others working above / below

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Fall arrest

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Ladders

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

Access / Egress Hazards

• Scaffold (Inspection and tagged)

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Slip / trip potential identified

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Are permits required

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Evacuations

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

Personal Limitations / Hazards

• Have clear instructions been provided

  Yes

  No

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Trained to use tools for specific task

  Yes

  No

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Competent in performing task

  Yes

  No

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Distractions in work area

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Working alone

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Communication

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Heavy lifting or awkward positioning

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• External noise levels

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

• Physical limitations

  No

  Yes

• What is the hazard?

• What controls will be used to reduce or eliminate the hazard?

P.P.E. Requirements

• Mono goggles or face shield

• Gloves (Kevlar or leather)

• Fire retardant clothing

• Hearing protection

• Respirator

• Safety glasses

• Additional P.P.E.
Item

• Required

Task - Hazard - Control

Task

• Task

• Hazard

• Control used to eliminate or reduce hazard

Sign off

• Do not sign until you understand and agree with the P.S.I.

• Worker's name

  Sign
Additional Worker

• Worker's name

  Sign

• Supervisor's name

  Sign