Information

  • WORK ORDER NUMBER

  • MANUFACTURING LINE

  • NAME OF EQUIPMENT & WORK AREA

  • Prepared by:

  • NUMBER OF EMPLOYEES ON SITE

  • INITIAL PERSONNEL - Select your team members

  • NUMBER OF CONTRACTORS ON SITE

  • Initial names of Contractors (if any)

  • EMERGENCY COORDINATOR

  • OTHER EMERGENCY COORDINATOR (if any)

  • Date

  • Additional comments

RISK ANALYSIS & TAKE 5

  • JOB DESCRIPTION

  • PICTURE OF SYSTEM / EQUIPMENT

  • PERSONAL PROTECTIVE EQUIPMENT REQUIRED - PPE

  • OTHER PERSONAL PROTECTIVE EQUIPMENT REQUIRED (if any)

  • WORK AREA PREPARATION

THINK THROUGH THE TASK - Have a clear plan in mind

  • Do I understand what I am supposed to do?

  • Are there standard procedures for this job?

  • Do I have all of the required work permits?

  • Do I have all of the required Personal Protection Equipment?

  • Are my tools and equipment in good working condition?

LOOK FOR THE EXPOSURE - How and where the work is done

  • JOB SPECIFICS HAZARDS (WHICH ARE IDENTIFIED AND COMMUNICATED PRIOR TO WORK BEGINNING)

  • Is there any additional hazard? (if any)

ASSES THE RISK - What could happen if things get out of control?

  • GREEN (LOW) - Continue with task, watch for exposure changes

  • YELLOW (MODERATE) - Continue with task; develop safe action plan

  • ORANGE (HIGH) - Stop, notify Supervisor: develop safe action plan together.

  • RED (CRITICAL) - Stop, notify Supervisor; complete risk assesment

TAKE PRECAUTIONS - Remove impediments to safety

  • Have the hazards been removed or controlled?

  • Have potential problems been discussed?

DO THE JOB SAFELY - Watch for changing conditions and exposure

  • Can we continue the job safely?

PERMITS & REQUIREMENTS

  • LIST OF PERMITS & REQUIREMENTS

  • LIST OTHER PERMIT OR REQUIREMENT (if any)

HOT WORK PERMIT

  • Do you require a Work Permit ?

All temporary operations involving open flames or producing heat and/or sparks require a Hot Work Permit. This includes, but is not limited to brazing, cutting, grinding, soldering, thawing, and welding.

Personel

  • Name of the person doing the "Hot Work"

  • Additional Personnel doing Hot WORK

  • Name of the "Fire Watch"

  • Additional Fire Watches

  • Fire Watch SIGN OFF: <br>Work Area and all adjacent areas to which sparks and heat could spread must be inspected during the fire watch period. <br>Fire Watch personnel must monitor work area for at least 30 minutes following "Hot work"<br>By acknowledging this section, I understand the requirements.

START TIME

  • START TIME

HOT WORK - CHECKLIST

  • Sprinklers and/or fire hoses in service / operable.

  • Hot work equipment in good condition (e.g power source, welding leads, torches, etc)

  • Multi-purpose fire extinguisher and/or water pump can.

REQUIREMENTS WITHIN 35 FT OF WORK

  • Dust, lint, debris, flammable liquids and oily deposits removed.

  • Explosive hazard in area eliminated.

  • Combustible floor (e.g. wood, tile, carpeting) are wet down, covered with damp sand, or fire blankets.

  • Flammable and combustible material were removed where possible. Otherwise, protected with fire blankets, guards, or metal shields.

  • All walls and floor openings covered.

  • Walkways protected beneath hot work.

  • Protect/cover or shutdown ducts and conveyors that might carry sparks to distant combustibles.

WORK ON WALLS OR CEILINGS

  • Combustible moved away.

WORK IN CONFINED SPACES

  • Confined space cleaned of all combustibles ( grease oil, flammable vapors)

  • Containers purged of flammable liquids / vapors.

  • Company confined space guidelines will be followed.

FIRE WATCH / HOT WORK AREA MONITORING

  • Fire Watch will be provided during and for 30 minutes after work, including any coffee or lunch breaks.

  • The Fire watch is supplied with an extinguisher, and/or water pump can. He is aware of other fire extinguishers located throughout the work area.

  • ENDING TIME FOR WORK PERMIT

  • Fire Alarm or extinguisher : The fire watch is trained in use of this equipment and familiar with location of sounding alarm

  • The fire watch is required for opposite side of walls, above, and below floors and ceilings.

ENDING TIME

ADDITIONAL PERSONNEL (if any - at different time)

  • Additional employees at a different time

  • Enter Time

  • Additional employees at a different time

  • Enter Time

  • Additional contractors at a different time

  • Enter Time

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.